Pharmacy Summary of Benefits: Licensed

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.  This benefit level may also include select brand medications that have been identified as favourable from a clinical and cost effective perspective.

Preferred designated those medications which have limited alternatives available, but have been found to be clinically effective at a favourable cost over the non-preferred alternative(s) within the same therapeutic class and/or category.  In addition, select generic medications that have been identified as having no more favourable outcomes from a clinical perspective than other more cost effective generics are included.

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.