State Health Plan – Pharmacy Copay Assistance Cards and Your Deductible

(Members Enrolled in the 70/30 & 80/20 Plans)

Prescription copay cards are offered by drug manufacturers to reduce members’ out-of-pocket costs for prescription medications. The State Health Plan (Plan) does not offer nor manage copay cards, but the Plan does support the usage of these cards or coupons to assist members with the high cost of medication

Important Reminder for Members: Only the amount you actually pay for your prescriptions will be applied toward your deductible or out-of-pocket maximum, when using a third party or manufacturer copay card or coupon. For example, if your copay is $2,000 and the copay card covers $1,995, you pay $5 and the $5 paid would be applied to your deductible or out-of-pocket maximum. In many circumstances the copay card pays for all of the costs, resulting in no cost to you. In this situation nothing would apply to your deductible or out-of-pocket maximum because you did not pay anything out-of-pocket.

Overall, your deductible and out-of-pocket maximum include the amounts you actually pay out of pocket. Using a copay card lowers your out-of-pocket expenses, assisting with the expense of the medication, but does not impact your deductible or out-of-pocket maximum.

This information can be viewed on the State Health Plan’s website under Employee Benefits or Retiree Benefits, whichever is applicable. Once there, select your plan then Pharmacy Benefits for that plan. From Pharmacy Benefits:

  • Select Pharmacy Cost-Saving Programs
  • THEN scroll down the page to find Copay Assistance Cards and How They Affect Your Deductible.

House Bill 469 UPDATE! Click to read an update from NCRGEA Executive Director, Richard Rogers

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