RSA Logo

The Retirement Systems of Alabama

Strength. Stability. Security.

PEEHIP

Prescription Drug Changes

Effective February 1, 2016, PEEHIP made the following benefit changes for members enrolled in PEEHIP’s non-Medicare (commercial) plan.

DAW (Dispense as Written) Cost Differential:

For brand drugs with a generic chemical equivalent, multi-source (MSB) drugs, the total amount covered by PEEHIP will not exceed the amount that would have been covered if the generic equivalent were dispensed. Therefore, members will be subject to the difference between the cost of the brand drug and its generic equivalent, regardless of whether the physician indicates the brand must be taken. This does not apply to the Narrow Therapeutic Index (NTI) drugs such as seizure medications.

PEEHIP Maintenance Drug List – Copay Change for Preferred and Non-Preferred Brands Only:

Effective 2/1/2016, 3 copayments are charged for a 3-month supply of all brand drugs on the PEEHIP Maintenance Drug List. Two copayments are charged for a 3-month supply of all generic drugs on the list.  The DAW cost differential applies for multi-source brand drugs with a generic chemical equivalent.

Copay Structure for PEEHIP’s Maintenance Drug List Effective 2/1/2016:

Tier Number/Drug Type Copay: 1-30 Day Supply Copay: 31-60 Day Supply Copay: 61-90 Day Supply
Tier 1: Generic Drugs $6 $12 $12
Tier 2: Preferred Brand Drugs $40 $80 $120
Tier 3: Non-Preferred Brand Drugs $60 $120 $180

 

Specialty Drugs – New 4th Tier:

A 4th tier copay was implemented for specialty drugs: 20% coinsurance with a minimum copay of $100 and a maximum copay of $150. The DAW cost differential applies for multi-source brand drugs with a generic chemical equivalent.

Specialty Drugs – Copay Assistance Programs:

Copays for certain specialty medications may vary and be set to the maximum of any available manufacturer-funded copay assistance programs. PEEHIP and MedImpact will offer copay assistance programs for certain specialty drugs so that the member copayment will normally be less than the otherwise applicable copayment.

Calculators
A | a Font Size