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| Prescription Drug Program |
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The Prescription Drug Plan rules for eligibility and information on maintaining coverage is the same as those for the State Health Benefits Program (SHBP)
- The prescription drug program is separate from your medical plan
- The program is managed by Caremark on behalf of Horizon Blue Cross Blue Shield of New Jersey
- Most pharmacies in New Jersey participate in the program
- If you use a non-participating pharmacy, you must file a claim for reimbursement. You can obtain prescription drug reimbursement forms from the Department of Human Resources or at: www.caremark.com
- Eligibility begins and ends on the same date as your health plan coverage
- Benefits are available through a participating retail pharmacy, the plans designated mail order service, or from a participating specialty pharmaceutical provider
- Normally, retail pharmacy co-payment amounts are for a 30-fay supply. However, you may obtain up to a 90-day supply of your prescription drug. To do so, you must pay two co-payments for a 31-60 day supply or three co-payments for a 61-90 day supply
- Mail order benefits are available where participants can receive up to a 90 day supply of prescription drugs for one co-payment.
- Specialty pharmaceuticals are oral or injected drugs that have unique production, administration, or distribution requirements. They require specialized patient education prior to use and ongoing patient assistance while under treatment
- Mail order forms are available in the Department of Human Resources. You can obtain a mail order refill by mail, using a pre-addressed envelope, by phone at Member Services 866-881-5605 or on the Internet at: www.state.nj.us/treasury/pensions/caremark-mail-order-form.pdf
- $3.00 co-payment for up to a 30-day supply of generic drugs
- $10.00 co-payment for up to a 30-day supply of brand name drugs
- $5.00 co-payment for a 90-day supply of generic drugs through the Mail Order Service
- $15.00 co-payment for a 90-day supply of brand name drugs through the Mail Order Service
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