DEPENDENT CHILDREN HEALTH BENEFIT PLAN
PRESCRIPTION BENEFIT PLAN
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Managing
the prescription medications that you need to
stay healthy!
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You
can refill or renew your Medco prescriptions online!
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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.
Copayments
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2010 Dependent Children Health Benefit Plan |
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% ($35 minimum/$60 maximum) preferred name
brand copayment
35% ($50 minimum/$90 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% ($55 minimum/$100 maximum) preferred name
brand copayment
35% ($70 minimum/$120 maximum) non-preferred name
brand copayment |
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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.
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