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Prescription Plan
Please click here for 2009-2010 Prescription Rates
General Description
Prescription plan coverage is available to all individuals and their dependents who are eligible for health benefits with the State. The State's prescription plan is administered by Catalyst Rx (1-866-643-3004). The prescription plan covers the cost of approved prescription drugs, subject to nominal copayments. These copayments are determined by whether the drug is on the Catalyst Rx formulary and whether the drug is a brand-name or generic.
Formulary:
A formulary is a preferred list of drugs. Catalyst Rx has a panel of physicians and pharmacists that meets regularly to identify and review prescription drugs that provide the highest therapeutic and economic value. By choosing drugs on this list, your physician helps keep the cost of prescription drugs affordable. Formulary drugs are subject to change at any time. Your physician may contact Catalyst Rx to obtain information on formulary drugs
Brand-name drug:
A brand-name drug is any approved drug a particular pharmaceutical company has the exclusive right to produce and sell. Over time, companies can lose the patents on particular drugs, opening up the market to generic equivalents. Generic drug equivalents may become available at any time.
Generic drug:
A generic drug is made with the same active ingredient as found in the brand-name product. All generics must meet the same manufacturing testing standards as the brand-name drug. If a generic drug is available, the State plan only covers up to the cost of the generic.
NOTE: The State prescription plan only covers up to the cost of a generic drug, when the generic is available. If you purchase a brand-name drug when a generic drug is available, even if it is prescribed by your physician, you must pay the difference in price between the brand-name and the generic, as well as the standard copayment amount. The plan does not pass judgment on a physician's determination as to the appropriate medication for treatment, but the plan does have limitations as to the types and amounts of reimbursement available.
How to Receive Prescription Plan Benefits
Please take your Catalyst Rx card with you when you get prescriptions filled. If you are enrolling in the prescription plan for the first time, Catalyst Rx will issue you a maximum of two cards per family. An additional card may be ordered for students residing out of state, by calling Catalyst Rx. Any stolen cards must be reported to Catalyst Rx immediately. All cards are issued with the name of the employee or retiree embossed on the card. Dependent names are not listed on the card.
If you choose a formulary drug, you will pay a $15.00 copayment when you purchase the drug. If your physician has prescribed a drug that is not on Catalyst Rx formulary, the copayment will be $25.00. If you purchase a brand-name drug when a generic drug is available, you must pay the difference between the brand-name and generic drug, in addition to the standard copayment amount of $15.00 or $25.00. Preferred generic drugs have $5.00 copayments.
Participating Pharmacies:
If you use a pharmacy that participates in the Catalyst Rx network, you only need to pay the necessary copayment at the time of service. More than 900 pharmacies in the state of Maryland participate in the Catalyst Rx network. Catalyst Rx also has a nationwide network of participating pharmacies. If you are traveling out-of-state or just want to know if a particular pharmacy participates in the Catalyst Rx network call 1-800-345-9384.
If you visit a pharmacy that is not a member of the Catalyst Rx network, you must pay the pharmacist the entire cost of your prescription drug and submit a paper claim form to Catalyst Rx for reimbursement. You will be reimbursed the amount that the State would have paid a Catalyst Rx pharmacy minus a $12.50 copayment. This amount may be less than your out-of-pocket cost. You have one year from the date you have a prescription filled to submit a paper claim to Catalyst Rx.
If you must obtain a prescription without a Catalyst Rx Enrollment Card, you will need to submit a Catalyst Rx claim form for reimbursement. Please send your completed claim form and receipt to: Employee Benefits Division, 301 W. Preston St., Room 510, Baltimore, MD 21201 Attn: Catalyst Rx Coordinator. All claims must be submitted within one year of the date of service.
Preferred Performance Drugs:
Certain drugs, which are called "Preferred Performance Drugs," are available for a $15.00 copayment. Preferred Performance Drugs are subject to change at anytime. Contact Catalyst Rx at 1-866-643-3004 for the current information on "Preferred Performance Drugs."
Maintenance Drugs:
Some prescription drugs may be available in 90- or 100-day supplies, depending on State law or Catalyst Rx policy. Please contact Catalyst Rx for more information on drugs that may be prescribed 100-day supplies. Please see your physician for more information on drugs that may be prescribed in 90-day supplies under State law.
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