At the request of SAMBA, Medco manages your
prescription drug benefit under the SAMBA Health
Benefit Plan (High Option and Standard Option) and
the SAMBA Dependent Children Health Benefit Plan
(Standard Option only). The benefit includes a list
of drugs preferred by your plan. This list,
sometimes called a formulary, has a wide
selection of generic and brand name medications.
Bring the Preferred
Prescriptions® Formulary Member Guide
with you to each doctor visit to discuss whether a
drug on the list is right for you. You may purchase
the drugs at a retail network pharmacy or through Medco
By Mail, Medco's mail-order pharmacy.
To keep your costs low, your copayment will be
less when you purchase a generic or formulary
brand-name drug. And, if you purchase your drugs
through the Medco By Mail, mail-order pharmacy your
costs are usually much lower.
Your Prescription Drug Benefit Handbook
Copayments
|
2011 HIGH OPTION |
Prescription
Drugs |
Plan
Pays:
Network Pharmacy |
Retail
pharmacy - Rx drugs and medicines - 30-day
supply |
No
deductible
100% after copayment of:
$10 per generic
15% ($40 minimum/$55 maximum) preferred name brand copayment
30% ($60 minimum/$90 maximum) non-preferred name brand copayment |
Network Mail order Rx drugs and medicines - 90-day supply |
No deductible
$15 per generic
15% ($80 minimum/$110 maximum) preferred name brand copayment
30% ($120 minimum/$180 maximum) non-preferred name brand copayment |
|
2011 STANDARD OPTION |
Prescription Drugs |
Plan Pays:
Network Pharmacy |
Retail
pharmacy Rx drugs and medicines - limited to initial fill, 30-day supply,
and one refill |
No deductible
100% after copayment of:
$10 per generic
25% ($40 minimum/$70 maximum) preferred name brand copayment
35% ($60 minimum/$100 maximum) non-preferred name brand copayment; limited to initial
fill and one refill per prescription |
Network Mail order Rx drugs and medicines - 90-day supply |
100% after copayment of:
$20 per generic
25% ($80 minimum/$150 maximum) preferred name brand copayment
35% ($120 minimum/$225 maximum) non-preferred name brand copayment |
Back to top
If you have questions, you can call Medco's
Member Services toll-free at (800) 283-3478, 24-
hours a day, 7 days a week, except Thanksgiving and
Christmas, or you can log on to Medco's website at www.medco.com.
You can also contact SAMBA's Customer Service
toll-free at (800) 638-6589.
