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. 


Prescription Costs:

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 doctor’s permission.


Patient Pays the Difference

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, 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 (as appropriate).

*      Submit your prescription in one of the following ways:

o        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.

o        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: 

o        Online – visit  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 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  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 at 803-734-2516.


Rebecca Duncan,

Benefits Coordinator