Pharmacy Summary of Benefits: Classified

Drug Type

Retail

31-day supply

Mail Order

90-day supply

Specialty

31-day supply

$1,100

Value

$4 copay

$8 copay

N/A

Generic

$8 copay

$16 copay

$16 copay

Preferred

$25 copay

$50 copay

$50 copay

Non-Preferred

50% coinsurance

50% coinsurance

50% coinsurance

Value medications include select commonly prescribed products used to treat chronic medical conditions and preserve health.  A list of value medications can be accessed online through myODS.

Generic medications have been determined by physicians and pharmacists to be therapeutically equivalent to their brand name version.  Generic drugs must contain the same active ingredients as their brand name counterpart and be identical in strength, dosage form and route of administration.  Therapeutic equivalency of genenric medications is determined by the FDA approval process, the physicians at the point of prescribing, and the pharmacist at the point of dispensing according to State Pharmacy Laws.  This benefit level may also include select brand medications that have been identified as favorable from a clinical and cost effective perspective.

Preferred drugs have been reviewed by ODS and found to be clinically effective at a favorable cost when compared to other medications in the same therapeutic class and/or category.  Generic medications that have been identified as having no more favoable outcomes, from a clinical perspective, than other more cost effective generics may be included in this tier.  The preferred drug list shows which drugs are considered preferred, and can be accessed online at www.odscompanies.com/oebb, through your myODS account.  This list is subject to change and will periodically be updated.  if you should have any questions regarding the list, please do not hesitate to contact pharmacy customer service.

Non Preferred means brand drugs that have been reviewed by ODS and in comparison do not have any significant therapeutic advantage over their preferred alternative(s).  Drugs that are usually not recommended as first line therapy and have alternative treatment modalities are also considered non-preferred drugs.

Generic Substitution both generic and brand name medications are covered benefits.  If a member requests a brand name drug or the treating physician prescribes a brand name drug when a generic equivalent is available, the member will be responsible for that brand copay plus the difference in cost between the generic and brand name drug.