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Know Your Benefits

Prescription drug coverage

New York Teacher

All eligible in-service UFT members and their dependents have prescription drug coverage through the UFT Welfare Fund.

There are no waiting periods for this coverage. After enrolling in the Welfare Fund, members who are waiting for their Express Scripts prescription ID drug cards can purchase the prescription drugs they need and, once their cards arrive, submit the original receipts to the Welfare Fund for reimbursement.

Prescription drug copays

The Welfare Fund has a three-tier copay structure for generic, preferred-brand and nonpreferred-brand medications. You can save money by using generics (Tier 1) or preferred-brand medications (Tier 2) whenever possible, but this is a decision between you and your doctor. Nonpreferred-brand drugs (Tier 3 — those not listed on the Fund's formulary) have the highest copays.

At the pharmacy, if your doctor has not indicated that the pharmacist must dispense a brand-name drug, you will get a 30-day supply of a generic drug for $5 provided there is one available.

Your doctor will prescribe one of two types of drugs:

1. Acute illness drugs

Acute illness drugs are those you need immediately, such as an antibiotic. Your local pharmacy dispenses this type of drug to you. You can fill your prescription at the pharmacy the first time and then get up to two refills if your doctor has indicated the refills.

2. Maintenance drugs

Maintenance drugs are those that are taken over extended periods of time, such as antihistamines for allergies or drugs for high blood pressure.

The Welfare Fund provides for a 90-day supply of maintenance drugs for the price of a two months' supply (two copays) through the Express Scripts Home Delivery Service or the new Smart 90 Walgreens or Duane Reade retail network. You can get up to three refills — or a year's supply — on one prescription.

Certain maintenance drugs, such as narcotics or controlled medications, can only be dispensed in a 30-day supply at the local pharmacy.

New York City PICA Program

As a result of a citywide health benefit agreement negotiated by the municipal unions, the city-administered PICA Drug Program, rather than the UFT Welfare Fund, covers injectables (including EpiPen) and chemotherapy drugs. The New York City PICA drug plan card should be used to obtain these types of drugs. The PICA program is administered by Express Scripts, which can be reached at 800-467-2006.

By state law, diabetes drugs are covered by your health insurance plan, not by the Welfare Fund drug plan. Show your health insurance card at the pharmacy when ordering these drugs.

Express Scripts mobile app

Members who use a smartphone should download the Express Scripts Mobile app at the app store for their cell phone. The app provides a host of services, including getting refills and renewals, and a section called Medicine Cabinet to check drug interactions, claims and history, which is great for reviewing a drug you have taken in the past.

Best of all, if you have forgotten your drug card, the app has a copy available by tapping the Prescription ID Card.

Category Tier # Category Tier # SI Home Delivery Service copayment (90-day supply)
Generic 1 $5 $10
Preferred Brand (On Formulary) 2 $15 $30
Nonpreferred Brand (Not on Formulary 3 $35 $70
Related Topics: Health Benefits