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  Prescription Drug Program

If you elect medical coverage, your are automatically enrolled in the prescription coverage (with the exception of the Basic Plan which excludes prescription coverage).

State of Delaware Prescription Coverage

  Generic1 Preferred Brand2 Non-Preferred Brand3
30-Day Supply $8.50 $20.00 $45.00
90-day supply
(mail order/participating retail pharmacy in Delaware)
(mail order/participating retail pharmacy outside of Delaware)
$17.00 $40.00
1 Tier on covers generic products
2 Tier two covers preferred brand name (formulary) drugs
Tier three covers non-preferred brand (non-formulary) drugs.

Effective 7-1-09 members must obtain maintenance medications as 90 day fills at a 90-day participating pharmacy or Medco-by-Mail to avoid paying a penalty after a third 30 day fill. Additional information on this program, a list of 90-day participating pharmacies, and information on Medco-by-Mail may be obtained at http://ben.omb.delaware.gov/script/index.shtml. (If the strength of a current prescription is changed, it is considered a NEW prescription. You must obtain the mandatory 30-day supply)

Generic Plus Choice Program
Effective July 1, 2002

Traditionally, physician and hospital costs have comprised the majority of the health care dollar. Today, drug costs account for approximately 23% of the health care spending for the State of Delaware program. New cost sharing strategies are being implemented in order to control the rate of increase in prescription drug expenses while still providing patients and physicians with a choice for prescription drugs and maintaining the same co-payment levels for generic and preferred brand drugs. Effective July 1, 2002, if you purchase a brand name medication when a generic is available, you will pay the difference in price between the generic and brand drug, in addition to the generic co-pay (see example below). This provision applies regardless of whether your prescription is written for a brand name drug and designated "dispense as written".

  Drug Cost Employee Share University Share
Generic Equivalent $30.00 $8.50 $21.50
Brand Drug $50.00 $28.50 ($8.50 + $20.00) $21.50

You are also strongly encouraged to use the mail order programs for your 90-day supply of maintenance medications. More information will be available from the State of Delaware Pharmacy Benefit Manager during Open Enrollment.

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