Pharmacy Benefits
The co-pay for insulin and diabetic supplies* is only $10.
 You will save time and money by filling your recurring, long-term
maintenance prescriptions through the mail. Home delivery medication is
ordered in a three-month supply at a discounted co-pay. For Duke Basic, home
delivery is mandatory for maintenance medication.
 You can save $300 a year in co-payments if you switch from a brand name
prescription drug to a generic prescription drug.
Pharmacy benefits for all four Duke health care plans are provided through Medco Health, a national
pharmacy benefit manager. You may fill your prescriptions at retail locations or through home delivery.
Co-Pay Structure
Your co-pay structure is based on three levels of co-pays, depending on
whether you purchase generic, formulary, or non-formulary drugs. Please see the
Pharmacy Benefits Chart below for more details.
The co-pay structure for a 34-day supply is as follows:
- $10 co-pay for a generic drug
- $35 co-pay for a formulary drug
- $50 co-pay for a non-formulary drug
If you choose a formulary drug when the generic equivalent is available, you'll pay
a $10 co-pay plus the cost difference between the formulary
and the generic drug. For example, if the formulary drug is $60 and the generic
equivalent is $18, you'll pay a $10 co-pay plus $42 ($60 - $18 = $42). That brings
the total to $52.
If you are prescribed a formulary drug and there is no generic equivalent, you'll
only pay the $35 co-pay. If your doctor prescribes a covered drug that isn't on
the formulary, your co-pay will be $50. A copy of the formulary is available
here.
Note: When drugs such as Claritin® become "over the counter," they are no
longer covered under the plan. Some prescribed medications (for example,
growth hormones and migraine medications) must receive authorization
before they can be covered.
2009 Pharmacy Benefits Plan Chart
|
Medco Health
|
| |
34-day supply |
90-day supply |
Retail |
Generic |
$10 co-pay |
$30 co-pay |
Formulary |
$35 co-pay |
$105 co-pay |
Non-Formulary |
$50 co-pay |
$150 co-pay |
Home Delivery (90-day
supply)1,2
|
Generic |
N/A |
$20 co-pay |
Formulary |
N/A |
$87 co-pay |
Non-Formulary |
N/A |
$125 co-pay |
Deductible for Duke Basic |
$100 per person |
- With Duke Basic, home delivery is required after the first three months on
a maintenance prescription medication.
- With home delivery, your prescription should be written for a 90-day
supply. A prescription for less than 90 days will still be charged a 90-day
co-payment.
Please note: Injectable fertility drugs are not reimbursed according to the standard pharmacy co-payment. These drugs are only
covered by Duke Select and Duke Options at 50 percent for those employees or their spouse with at least two years of service with
Duke and only if treatment is received at Duke University Medical Center.
*Lancets, syringes, test strips (urine and blood)
|
