Prescription drug plan
What you need to know about: Prescription drug coverage
When will the prescription drug plan take effect?
If you currently have the Prescription Drug Rider through GHI Senior Care, you will continue with your prescription drug plan through ExpressScripts until Dec. 31, 2023. You will transition to the Aetna Medicare Rx offered by SilverScript on Jan. 1, 2024.
If you are enrolled in any other plan through the City of New York and purchase the prescription drug rider through that plan, or you currently purchase and are enrolled in an individual prescription drug plan (Part D) in the open market, you will make the transition to the SilverScript prescription plan on Sept. 1, 2023, at the same time you are enrolled in the new Aetna Medicare Advantage PPO plan.
What is the cost for the optional prescription drug rider?
Beginning on Sept. 1, 2023, the cost of the Aetna optional prescription drug rider will be $103.50 monthly. The cost of the rider increases to $135.50 in 2024.
Who is the prescription drug plan administered by?
Your prescription drug plan is through Aetna Medicare Rx offered by SilverScript. It is not part of your Aetna Medicare Advantage PPO plan. You will receive a separate Aetna Medicare Rx/SilverScript member ID card for prescription drug services.
What are the copays for prescription drugs?
There is no copay for tier 1/preferred generic drugs at an Aetna preferred pharmacy.
The prescription drug rider cost share is 25% in all other tiers until you get to the catastrophic phase which starts once $7,400 in true out-of-pocket costs is incurred. Then you’ll pay the greater of 5% of the cost of the drug, which comes to $4.15 for a generic drug (or a drug that is treated like a generic) and $10.35 for all other drugs.
How does this coverage compare to the GHI Senior Care drug plan?
View a chart that shows a side-by-side comparison between the GHI Senior Care and Aetna Medicare Rx plan.
How does this coverage compare to HIP VIP?
View a chart that compares prescription drug coverage between HIP VIP, GHI Senior Care and Aetna Medicare Rx.
Does this prescription plan have a deductible?
No, there is no annual deductible for this plan.
Do out-of-pocket prescription drug costs apply to my medical out-of-pocket maximum?
No, the out-of-pocket maximum only applies to medical services under the Aetna Medicare Advantage PPO plan.
I currently have GHI Senior Care, and I’m also enrolled in a private non-NYC Medicare Part D plan. Will I have drug coverage under the Aetna Medicare Advantage PPO plan?
Action is needed before June 30. You cannot use a private, small-group Medicare Part D plan if you are enrolled in a Medicare Advantage plan. If you switch to the Aetna Medicare Advantage PPO plan, you will need to add the Aetna Medicare Rx drug rider as well to ensure drug coverage starting on Sept. 1, 2023. You need to fill out the city Office of Labor Relations’ Retiree Special Enrollment/Waiver Form and check off box #2. If you need more guidance, please call the UFT Welfare Fund at 212-539-0500.
I currently have GHI Senior Care, and I’m also enrolled in a private non-NYC Medicare Part D plan. I am planning to switch to the HIP VIP Premier Medicare HMO plan. Will I have drug coverage under HIP VIP plan? What do I need to do?
Action is needed before June 30. You cannot use a private, small-group Medicare Part D plan if you are enrolled in HIP VIP Premier Medicare HMO plan. If you opt out of the Aetna plan and switch to the HIP VIP plan, you will need to add the HIP VIP Rx rider as well to ensure drug coverage starting on Sept. 1, 2023. You need to fill out the city Office of Labor Relations’ Retiree Special Enrollment/Waiver Form and check off box #3. If you need more guidance, please call the UFT Welfare Fund at 212-539-0500.