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High Option Benefits
Under the High Option plan, we divide prescription drugs into three categories
or tiers: generic, single-source brand-name and multi-source brand-name.
When an approved generic equivalent is available, that is the drug you will
receive unless you or your physician specifies that the prescription must be
filled as written. When an approved generic is not available, you will pay the
single-source brand-name copayment. If an approved generic equivalent is
available, but you or your physician specifies that the prescription must be
filled as written, you will pay the multi-source brand-name copayment.
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Generic drugs are chemically and therapeutically equivalent to the
corresponding brand-name drug, but are available at a lower price.
Information About Generics
can help you learn more about the safety and effectiveness of generic drugs.
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Single-source
brand-name drugs are available from only one manufacturer and are patent
protected. No generic equivalent is available.
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Multi-source brand-name drugs are available from more than one
manufacturer and have at least one generic equivalent alternative available.
The chart below shows a summary of your cost for prescription drugs with GEHA
High Option. Health plan members with Medicare Part A & B primary pay a
reduced copayment for prescription drugs. For complete benefit information,
refer to the GEHA Plan Brochure.
| 2012 PLAN YEAR |
High
Option |
| Prescriptions |
You Pay - In-Network |
You Pay - Out-of-Network |
Mail order Generic
(90-day supply)
|
Nothing (most new prescriptions), then $15 copay |
N/A |
| Brand
(single-source) |
25% (up to $350 max) |
|
| Brand
(multi-source) |
$15, plus additional
cost of brand-name drug over generic equivalent |
|
Retail pharmacy Generic
(30-day supply) |
$5** |
$5**, plus difference between plan allowance and cost of drug |
| Brand
(single-source) |
25%, up to $150 max** |
25% (up to $150 max)**, plus difference between plan allowance and cost of drug |
| Brand
(multi-source) |
$5, plus difference in
cost of brand-name drug over generic equivalent** |
$5, plus difference in cost of brand-name
drug over generic equivalent**, plus difference between plan allowance and cost of drug |
**Costs for initial prescription and first refill. You pay 50% for additional
refills at retail. For long-term prescriptions, please use Mail Order.
With Medicare A&B, you pay lower copays. For specialty drugs
which are injected or infused, see the GEHA Plan Brochure.
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