 The co-pay for insulin and diabetic supplies
— lancets, syringes, test strips (urine and blood) — is only $10 for a 34-day supply. A 90-day supply is available by mail for $20.
Each participant in Duke Basic must satisfy a $100 prescription drug deductible before the plan begins to pay benefits
under the co-pay structure described above. For Duke Basic, home delivery is mandatory for maintenance medications.
Maintenance medications are those medications that a provider has prescribed for regular (i.e., daily) use, and include
(but are not limited to) heart/ulcer/blood pressure medication, hormone therapy, and birth control pills. After three
purchases of maintenance medications at a retail pharmacy, home delivery must be used. Some medications prescribed for
certain uses must receive authorization before they can be covered.
Most major pharmacy chains are included on the Medco Health list. To locate a participating pharmacy, log on to
www.medcohealth.com, or call 1-800-717-6575.
 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
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.
Home Delivery Co-Pay Structure
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. Here's how home delivery works:
- Ask your doctor to prescribe medication in a three-month supply, plus refills. If you're getting a new prescription, ask your doctor to write two prescriptions — one for a one-month supply from a retail pharmacy for immediate use, and one that you'll mail to Medco Health for a three-month supply.
- Consult the Medco Health drug formulary to determine whether your medication is covered by your plan, and what your co-pay will be. You may consult the formulary by logging on to
Medco
Health's web site or by calling 1-800-717-6575.
- Complete the home delivery form and include your credit card information or your check; mail the form and prescription in the postage-paid envelope you'll receive with your pharmacy ID card (be sure to make a copy of the prescription before you mail it).
- You'll receive your order and a receipt within 10 days.
- When you need a refill, just call the toll-free number two weeks before you need it. You can order refills by web or touch-tone phone 24 hours a day, 7 days a week. Medco Health will ship your order and bill you for the co-pay.
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