Benefits will be provided for presc
Benefits will be provided for prescription drugs only if such drugs are medically necessary. The outpatient prescription drug program is available to all employees and dependents who have coverage through District 59's HMO Illinois Plan.
Covered Services
The drugs for which benefits are available under the outpatient prescription drug program are:
- Drugs that require by federal law:
- a written prescription
- injectible insulin
- insulin syringes
Benefits are provided when:
You have been given a written prescription for them by your physician, dentist or podiatrist, and you purchase the drugs from a Pharmacy or from a physician, dentist or podiatrist who regularly dispenses drugs.
Benefit Payment for Prescription Drugs
The benefits you receive and the copayment amount you pay for drugs will differ depending on whether or not they are obtained from a participating prescription drug provider and whether or not you obtain generic, brand formulary or brand non-formulary drugs. Check with your PCP or pharmacist for specifics on formulary prescriptions.
When you obtain generic, formulary, and brand, you must pay a copayment amount as follows:
- Generic
- $10
- Brand Formulary
- $20
- Brand Non-Formulary
- $35
Oral contraceptives and nicotine patches are available through mail order only for a copayment of $20 (Brand Formulary) or $35 (Brand Non-Formulary) for a 90-day supply.
Mail Order
The mail order program provided by PrimeMail & Walgreens is available to all employees and dependents who have coverage through District 59's HMO Illinois Plan. The mail order program provides members with maintenance drugs that are used on a continual basis for treatment of chronic health conditions such as high blood pressure, arthritis, or diabetes. With each order you place, you must enclose the appropriate payment.
When you obtain your 3-month supply through mail order of generic, brand formulary, and brand non-formulary, you must pay a copayment amount as follows:
- Generic
- $20
- Brand Formulary
- $40
- Brand Non-Formulary
- $75
Please refer to your employee benefits handbook for a more detailed description of benefits or check the
Blue Cross/Blue Shield web site.
