Prescription Drug Benefits . . .

The MMEHT has a three-tier prescription drug program. This type of three-tier program is often referred to as a “formulary” program.  The “preferred” brand name drugs are sometimes called “formulary” brand name drugs, and the “non-preferred” brand name drugs are sometimes called “non-formulary”.  The Health Trust’s prescription drug program is administered by Anthem Prescription Management/Wellpoint Next Rx. 

 MMEHT Prescription Benefit Design

Benefit	Copay Most Active Medical Plans and Retiree Plan	Copay PPO 2500 Only
Retail (at the Pharmacy) – up to 30 day supply
Tier 1 (Formerly Generic)	$10	$10
Tier 2 (Formerly Formulary (Preferred))	$25	$30
Tier 3 (Formerly Non-Formulary (Non-Preferred))	$40	$50
Maintenance (at the Pharmacy or via Mail Order) – 31-90 day supply
Tier 1 (Formerly Generic)	$20	$20
Tier 2 (Formerly Formulary (Preferred))	$50	$60
Tier 3 (Formerly Non-Formulary (Non-Preferred))	$80	$100

Links For More Information:

• How does a formulary work?
  
  
• What is a generic drug?
  
  
• How will you know if your medication is on Anthem’s formulary list?
  
  
  (Search Anthem's formulary lists)
  
  
• What are the Copays Under the Health Trust’s Prescription Drug Program? 

 

How does a formulary work? 
When you use the prescription medications on the “preferred” list, you will pay a lower copay than if you were using medications that are considered as “non-preferred” by Anthem Prescription Management/Wellpoint Next Rx.  Most generic medications are included in Anthem’s formulary, and are subject to the lowest copay in the program.  The formulary also includes many brand name medications, for which you will pay the “preferred” copay, shown on the chart below.  If you choose to purchase a medication that is not on the formulary list, then you will be charged the non-preferred copay, which is the highest copay on the chart shown below.   Certain prescription drugs may be excluded when better value, clinicaaly-equivalent medications int he same therapeutic class are available.  Please contact the MMEHT at 1-800-852-8300 for more information. 

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What is a generic drug? 
A generic drug has the same active ingredients as its brand-name counterpart.  Normally, a generic drug is available only after the patent protection expires on a brand-name drug.  Even though it may look different, the generic drug works the same as its brand-name counterpart.  By purchasing generic drugs whenever possible, you will save money on the amount of copay you pay at the pharmacy. 

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How will you know if your medication is on Anthem’s formulary list? 
You can check on line at Anthem's Prescription Formulary. This Website will allow you to check your prescription to see if it is included in the Anthem formulary.  If not, you can find suggested alternatives to your medication which are part of Anthem’s formulary. 

You can also contact the Health Trust at 1-800-852-8300 (in Maine) or 207-621-2645 (out of state) or by email at htservice@memun.org.  The Health Trust Service Representatives can look up your particular medication to see if it is on Anthem’s formulary list.  Or, if you prefer, you can ask for a copy of the Anthem Prescription Management formulary list to be sent to you. 

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What are the Copays Under the Health Trust’s Prescription Drug Program? 
Most of the Trust’s health insurance programs, including the retiree Major Medical program, offer the same prescription drug benefits.  There are different levels for the PPO 2500 plan.  The copays are shown in the chart at the top of this page and on each health insurance summary.

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