When prescription drugs are purchased from pharmacies that are participating in the plan, the individual will either pay $7 or 25% of the amount charged, whichever is higher. Cost could be higher if the individual uses a non-generic or non-formulary drug. Most pharmacies in Iowa City, Coralville, and North Liberty participate in this plan.
The OPM expense provision for prescription drugs is separate from the medical OPM. The OPM for prescription drugs is $1,000 for single coverage, and $1,700 for all other contracts. Once the OPM has been met, the plan pays 100% of the expenses incurred for drugs during the rest of the calendar year.
The pharmacy is responsible for submitting your prescription claims electronically.
If you purchase a brand name drug when an FDA-approved “A”-rated generic equivalent is available, you are responsible for your co-payment or coinsurance, plus any difference between the billed charge for the brand name drug and the billed charge for the generic. This can result in you paying substantially higher costs than if you had chosen the generic drug.
If your physician feels it is essential for you to have the brand name drug, they can write the prescription for the brand name drug with the direction, “Dispense as Written” on the prescription. In this situation you will not be responsible for the difference between the billed charge for the brand name drug and the billed charge for the generic drug.