Retiree Prescription Drug Benefits

Prescription Drug Coverage Options

Retirees and dependents under age 65 who select medical coverage through Penn are automatically covered under Penn’s prescription drug plan through CVS/caremark. The amount you pay for prescriptions depends on the type of medication and how you buy it:

  • When you go to a retail pharmacy, you pay less if you use a participating CVS/caremark in-network pharmacy.
  • You can use the mail order program for long-term maintenance medications. Its advantages include: three-month supplies; home delivery (you can also pick prescriptions up at a CVS.
  • If you can use a generic drug, you save money: not only do you pay a lower coinsurance, but that lower coinsurance is a percentage of a lower base price.

The table below shows how you can save significantly in two areas by making wise purchasing decisions:

  • Get 90-day supplies of maintenance drugs: If you use a retail pharmacy for more than three 30-day fills of a maintenance medication, you’ll pay double the normal coinsurance amount as well as double the minimum and maximum copays. If, however, you get 90-day supplies, your coinsurance and copays remain the same no matter how many refills you get.
  • Use generic drugs if possible: If you choose to get a brand-name drug instead of an available generic equivalent, you pay a percentage of the cost of the brand-name version PLUS the cost difference between the brand name and the generic—and this difference doesn’t count toward the minimums and maximums.

PennCare/PersonalChoice PPO • Aetna Choice POS II • Keystone/AmeriHealth HMO

 

Generics

Brand Name
without Generic Equivalent

Brand Name
with Generic Equivalent*

Non-maintenance drugs

30-day supply (any network
retail pharmacy)

Coinsurance 10%

$5 min/$20 max

Coinsurance 30%

$15 min/$75 max

Coinsurance 10%+

$15 min/$100 max

Maintenance drugs

30-day supply (any network
retail pharmacy, up to 3 fills)**

Coinsurance 10%

$5 min/$20 max

Coinsurance 30%

$15 min/$75 max

Coinsurance 10%+

$15 min/$100 max

30-day supply (any network
retail pharmacy, after 3 fills)**

Coinsurance 20%

$10 min/$40 max

Coinsurance 60%

$30 min/$150 max

Coinsurance 20%+

$30 min/$200 max

90-day supply
(CVS pharmacy or CVS Mail Service)

Coinsurance 10%

$10 min/$40 max

Coinsurance 20%

$20 min/$100 max

Coinsurance 10%+

$30 min/$200 max

Annual Out-of-Pocket Maximum

 

$2000 individual/$6000 family

*For brand names with a generic equivalent, you pay a percentage of the brand name cost PLUS the cost difference between brand name and generic. The cost difference between brand name and generic does not count toward the minimums and maximums.

**After three 30-day fills, you will pay double the normal coinsurance amount as well as double the minimum and maximum coinsurance payments. You can save money by ordering 90-day suppliesthrough the CVS/caremark Mail Service or at a CVS pharmacy.

Retirees and dependents age 65 and over who elect medical coverage through Penn will be automatically covered under the SilverScript Medicare Part D Plan. Members will have the same coverage and services for prescription drugs as in the CVS/caremark plan for those under age 65. All members must be Medicare-eligible with a permanent and valid street address in the U.S. or a U.S. territory.

Some important points to note:

  • You cannot enroll in Penn’s prescription plan if you enroll in a non-Penn sponsored Medicare Part D plan.
  • Opting out of Penn’s prescription drug coverage is considered permanent unless you meet certain conditions as explained below.
  • You will need to provide your Health Information Claim Number (HICN) from your Medicare card.

Based on the medical plan elected, Medicare-eligible retirees and dependents have the following prescription drug coverage options:

 

Medical Plan

Penn's Rx Coverage

Opt Out of Penn's Rx Coverage

A Non-Penn Sponsored Medicare Part D Plan

Aetna Medicare Plan PPO

Yes

Yes

No

Keystone/AmeriHealth 65 Medicare-Advantage Plan (HMO)

Yes

Yes

No

Medigap Security 65 Plans

Yes

Yes

Yes

Opting Out of Penn’s Prescription Drug Coverage

If you’re eligible for and have decided to enroll in a non-Penn sponsored Medicare Part D plan, you must opt out of Penn’s prescription drug coverage. You cannot enroll in Penn’s prescription plan if you enroll in an individual Medicare Part D plan. If this occurs, the Centers for Medicare & Medicaid Services (CMS) will disenroll you from Penn’s prescription coverage.

You also cannot enroll in one of Penn’s Medicare-Advantage plans (HMO and PPO plans) if you elect a non-Penn sponsored Medicare Part D plan. If you do this, CMS will cancel both your medical and prescription coverage as of the date you enrolled in both plans.

Opting out of Penn’s prescription drug coverage is considered permanent. This means you will not be able to obtain this coverage in the future unless Medicare’s change in policy adversely affects your coverage. Under this circumstance, you must notify the Penn Benefits Center immediately.

Medicare Part D

Through Medicare Part D, Medicare beneficiaries have access to prescription drug benefits administered by private companies such as health insurers. Beneficiaries can get the prescription drug benefit in one of two ways: (1) as a separate policy for prescription drugs, or (2) as part of private health plans that also provide overall medical coverage. Similar to Medicare Part B, there is a monthly premium for Medicare Part D. Changes may be made annually to Medicare Part D deductibles and thresholds. For more information about 2011 Medicare Part D changes, you are encouraged to contact Medicare at 1‑800‑633‑4227 or visit Medicare’s website. If you are hearing-impaired, please call 1‑877‑486‑2048.

Split Family Coverage

Split family coverage occurs when one person is under age 65 (not eligible for Medicare) and enrolled in an under age 65 medical plan, and one person is age 65 and older and enrolled in a Medicare-eligible plan for retirees. Certain rules apply:

  • Retiree under age 65 / dependent age 65 and older—If the retiree enrolls in Penn’s medical coverage, prescription drug coverage is automatically provided through Penn. The dependent must also enroll in Penn’s prescription drug plan even though he/she is eligible for Medicare Part D.
  • Retiree age 65 and older / dependent under 65—If the retiree elects not to enroll in Penn’s prescription drug coverage, the dependent can remain covered under Penn’s prescription drug plan only until he/she reaches Medicare-eligible age.