Your State Health
Plan Prescription Drug Program
Effective January 1, 2004, the Employee
Insurance Program (EIP) made several changes to the prescription drug program
in order to reduce the amount of increase in employee premiums for 2004. The options chosen were consistent with
program changes made by other health plans around the country which were
necessary due to increasing costs and utilization of prescription drugs.
The following table compares the Retail
Pharmacy Service and the Medco Health Home Delivery Pharmacy Service costs:
Retail Pharmacy (31-day supply)1
Medco Home Delivery (90-day supply)2
1. You can get up to a 90-day
supply of covered medication at one time if prescribed by your doctor; however,
the co-payment will apply for each 31-day supply.
2. The applicable
co-payment for a 90-day supply will be charged even if a prescription for a
31-day supply is sent in to be filled.
NOTE: Your doctor must write your prescription for
a 90-day supply; the pharmacist cannot give you a 90-day supply without the
Patient Pays the
If your doctor prescribes or you request a
brand-name medication (preferred or non-preferred) whether at retail or through
home delivery, and there is an equivalent generic medication available, you
will be charged the generic co-payment PLUS the cost difference between the
brand-name medication and the generic medication. If this amount is less than the preferred or
non-preferred brand co-payment, you will pay the applicable brand co-payment.
How do I find out if
my prescription is Preferred or Non-Preferred?
Your prescription drug program includes a
formulary, which is a list of generic and brand-name drugs that are preferred
by your plan. This list includes a wide
selection of medications and is preferred because it offers you a choice while
helping to keep the cost of your prescription drug program affordable. To determine if your prescription is on the
preferred or non-preferred list, you may check the packet you received in the
mail in December, which included a listing of most commonly prescribed
preferred drugs, you may visit www.medcohealth.com,
or you may check with your pharmacist.
What can I do to save
money if my prescription is non-preferred?
You need to speak to your doctor. You will need to ask if there is a generic or
other alternative to the medication you are currently taking. If there is not an alternative or you simply
cannot take an alternative, you will have to pay the higher rate and should
consider ordering your prescriptions through the mail to save money.
How do I order my
prescriptions through the mail?
If you need medication on an ongoing basis
for things such as high blood-pressure, cholesterol, allergies, birth control,
or other such medications, the prescription mail program is right for you. To order medication through the mail, you
will need to take the following steps:
Ask your doctor to
prescribe a 90-day supply for home delivery, plus refills for up to one year
prescription in one of the following ways:
By mail – send the
prescription along with the Medco Health Home Delivery Pharmacy Service Order
Form (available from your Benefits Coordinator) and the appropriate co-payment
to Medco Health.
By fax – ask your doctor to
call 1-888-327-9791 for instructions on how to fax a prescription. Only your doctor may fax a prescription. You will need to give your member ID number
which is located on your State Health Plan ID card. Please use the numbers only, do not include
the letters. You will be billed later. If you need a new insurance card, you may
visit this link to print out a request form from EIP: http://www.eip.state.sc.us/category/active/forms.htm
Online – visit www.medcohealth.com. Once you are registered and logged in, scroll
to the bottom of the “order center” and click on the “request a new
prescription from your doctor” link, and follow the on-screen instructions.
Your medication will
be delivered to you within 7-11 days after you mail your order, but may be
received even faster when using fax or the internet.
You can request
additional order forms and envelopes at www.medcohealth.com
or by calling the member center at 1-800-711-3450.
Who can I contact for
more information on my benefits?
You may call Rebecca Duncan, Benefits
Coordinator, at 941-5418 or contact her by
e-mail at firstname.lastname@example.org You may also contact EIP at 1-888-260-9430.
Be nice to your pharmacist:
The EIP staff has recently learned of
situations in which State Health Plan subscribers have confronted their
community pharmacists regarding the program changes. Your
pharmacist did not make these changes. EIP made these changes to reduce the increase
of premiums in 2004. All employees were
sent a letter in December 2003 announcing the Prescription Drug Program
changes. For more information on your
benefits, please refer to your Insurance
Benefits Guide, contact your Benefits Coordinator, or you may contact EIP