Cost Care Program
What is the Cost Care Program?
The Cost Care Program allows members and their dependents to obtain medication in a cost-effective manner, while maximizing the resources available to the Fund.
Who is enrolled in the Cost Care Program?
Families whose combined prescription drug claims totaled in excess of $1,200.00 for the twelve (12) months from December through November will be enrolled in this program. For members and their in-service spouse/domestic partner who are also members (SCOB), this total is $2,400.00. These members must notify the Fund of this relationship in order for the $2,400.00 total to be applied.
How do I verify the costs of my prescription drugs?
Your utilization is reflected on the PBR explained previously. The dates used to determine your eligibility in the Cost Care Program are the dates listed in the column headed “Prescription Date.”
How long will I be in the Cost Care program?
That all depends on your drug expenditures. The Welfare Fund will review your claim experience every twelve (12) months. If your costs fall below $1,200.00 (or $2,400.00 if your spouse/domestic partner is also an in-service member,) you will be re-enrolled in the non-Cost Care prescription drug plan.
How is the Cost Care Program different?
The program differs in two (2) ways:
- You will receive a Prescription Drug ID card that will have the words "Cost Care Program" printed on the front.
- Mandatory Generic Price Provision - When a brand name prescription drug has an approved generic equivalent, you can still get the brand name drug. However, you will be responsible for the difference between the cost of that brand name drug and the cost of the generic equivalent. This is known as an “ancillary” charge. This charge is in addition to the applicable copayment. Therefore, in order to avoid this ancillary charge, ask your prescriber to write prescriptions generically whenever possible.
What is a generic drug?
A generic drug is one that is defined by its official chemical name, rather than its advertised brand name. Generic equivalent drugs must meet the same U.S. Food and Drug Administration (FDA) regulations for purity, strength, and safety as brand name drugs; they just cost less.
What if my prescriber insists on a brand name drug?
The Fund has established a procedure whereby members may seek a waiver to its Mandatory Generic Price Provision. Any member seeking such an exception may do so by having a “Mandatory Generic Price Waiver Form” completed in full by the member and his or her physician. The form is also available by calling the UFT Welfare Fund Forms Hotline at 212-539-0539. (In lieu of the form, a physician’s letter will suffice.)
The Fund’s Pharmacist and Medical Advisor, whose decision will be based upon specific medical criteria, other available medications, and other pertinent information, will review each request. Members will be notified by mail as to whether an exception can be made to have the Fund pay for a brand name drug where a generic equivalent exists.
If there is a generic drug available, how will I be charged if I obtain a brand name at a pharmacy?
The Welfare Fund pays only for the cost of the generic drug. You are responsible for the difference (known as an “ancillary” charge) between the generic’s price and the brand name’s price, plus the co-payment. Medco/ESI determines this difference, known as an “ancillary” charge, according to their contractual arrangement with the pharmacies.