Prescription drugs

Will anything change with our prescription drug coverage?

Prescription drugs for in-service members through the UFT Welfare Fund:

In-service UFT members receive most of their prescription benefits through the UFT Welfare Fund. The UFT Welfare Fund prescription drug program is not affected by the NYCE PPO city health plan. Members will continue to use Express Scripts pharmacy for these prescription drugs.

In-service members who receive other prescription drugs through their city health plan, including Affordable Care Act and New York State-mandated drugs such as diabetes medication and birth control, will still receive those drugs under the NYCE PPO plan through the city’s new pharmacy benefit manager, Prime Therapeutics (which is replacing Express Scripts for Pre-Medicare retirees and ACA/NYS mandated drugs in this plan).

Prescription drugs for pre-Medicare retirees:

Pre-Medicare retirees who receive their prescription benefit by purchasing an optional rider will be covered under the new NYCE PPO through the new plan’s pharmacy benefit manager, Prime Therapeutics. There will continue to be a mail order service available.

What would the cost be for the NYCE PPO pre-Medicare prescription optional rider?

The cost for the optional rider will be $123.86 for a single person and $227.09 for a family.

Expansion of drugs covered by NYCE PPO

• +20,000 (40%) more medications in the formulary, as Prime Therapeutics will replace Express Scripts as the Pharmacy Benefit Manager (PBM).
• 98% of prescriptions currently filled by pre-Medicare retirees in the GHI CBP plan will still be covered, with only 2% having to change to an alternative medication.
• 99% of prescriptions currently mandated by the Affordable Care Act and NYS law (e.g., diabetic drugs) will still be covered, with only 1% having to change to an alternative medication.
• Prime Therapeutics will allow for a customized formulary and a way to tweak it as needed, which can’t be done under the current plan without impacting the cost.
• Prime Therapeutics does not own retail or mail order pharmacies, meaning it can shop around for the best prices, rather than directing business to its own inventory.

Do I need to get new prescriptions for my existing medications once I am enrolled in the NYCE PPO plan?

No, your prescriptions currently covered under the GHI CBP plan will all be transferred to the new NYCE PPO plan for you.

I currently use PICA for certain specialty drugs. Will anything change?

The NYC PICA prescription drug benefit program, administered by Express Scripts, is not changing at this time.