Prescription Benefits

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Overview

Serve You Rx Pharmacy is the City’s retail pharmacy network. You are able to obtain up to a 34-day supply of medication at most chain retail pharmacies. Mail order is required after two fills at a retail pharmacy for maintenance medication.

Serve You DirectRx is the City’s mail order pharmacy network. Members must fill maintenance medication prescriptions through Serve You DirectRx mail order. Using Serve You DirectRx is a cost savings to members - you will only pay the equivalent of two copays for a 90-day supply of medication. 

Member Portal

Visit serve-you-rx.com to access your Member Portal, where you can view the Prescription Drug List, confirm copay amounts, locate a pharmacy, obtain your medication history, and find other useful prescription drug benefit information. 

Copays

Your prescription drug plan has different cost levels, known as tiers. Periodically drugs may change tiers resulting in different copays than what you may have previously paid. The change in tiers may be triggered by a loss of patent or a drug moving from prescription to over-the-counter.


PPO PlanHigh Deductible Health Plan
In-NetworkOut-of-NetworkIn-NetworkOut-of-Network
Annual Deductible
IndividualN/A$1,500
Family$3,000
Retail Prescription Drug Copays (34-day Supply)
Tier 1 (Generic)$15N/A$5Not Covered
Tier 2 (Brand-name)$40$20
Tier 3 (High-cost Brand)$75$40
Tier 4 (Specialty)5% to $100 Maximum$40
Mail-order Prescription Drug Copays (90-day Supply)
Tier 1 (Generic)$30N/A$10Not Covered
Tier 2 (Brand-name)$80$40
Tier 3 (High-cost Brand)$150$80
Tier 4 (Specialty)5% to $100 Maximum$80


Brand Name Drugs

Members may choose a brand name drug over its generic equivalent, however the member will be required to pay the difference in cost between the brand name and its equivalent generic, in addition to the applicable copay; the same holds true if a health care provider prescribes a specific brand name drug (e.g., writes on the prescription “dispense as written”) when an equivalent generic is available.

Prescription Drug List

The Prescription Drug List (PDL), or formulary, is a listing of the most commonly prescribed medications sorted by therapeutic category. The PDL, which you can access via your Member Portal at serve-you-rx.com, identifies the drugs available for certain conditions and organizes them into tiers. It is intended to be used as a guide to help you and your doctor choose the best course of treatment for you. Some exclusions apply.

To use the PDL, simply bring it with you when you see your doctor. You and your doctor should consult it when choosing a medication. It is organized by common medical conditions. Medications are then listed alphabetically and identified as generic or brand, and if special rules apply.

What are Tiers?

The PDL groups medications by the conditions they treat. Each medication is placed in a tier that indicates the amount you pay to fill a prescription, as determined by your health plan. Tier 1 medications are your lowest-cost options. If your medication is placed in Tier 2 or 3, check the PDL to see if a Tier 1 option is available. Discuss your options with your doctor. Medications may occasionally move from one tier to another. 

Additional information can be found on Serve You's step therapy brochure and medication list.

Generic Drug Incentive Program

Copays for certain preferred, generic medications are waived. You may wish to discuss the use of a preferred generic medication with your doctor. A list of these medications can be found through your Member Portal at serve-you-rx.com.

Specialty Medication

Specialty medications treat rare or complex conditions and are typically higher cost medications. Specialty drugs have the following characteristics:

  • Treat complex and often costly medical conditions such as: cancer, rheumatoid arthritis, multiple sclerosis, hepatitis C, and pulmonary hypertension
  • Are often injected or infused (IV) medicines, but may also be taken orally
  • Require close monitoring of response to drug therapy
  • May require individualized dosing, medical devices to administer the medicine, and/or special handling and delivery
  • Require additional education for safe and cost-effective use

Not all specialty medications are listed in the PDL. The Serve You DirectRx Specialty Pharmacy stocks most specialty medications and can help you navigate the complexity of specialty drug therapy with helpful programs, services, and enhanced patient care. 

Medicare Participants

The prescription drug coverage offered by the PPO Plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage and is therefore considered Creditable Coverage. 

The prescription drug coverage offered by the City’s High Deductible Health Plan (HDHP) is, on average for all plan participants, NOT expected to pay out as much as standard Medicare prescription drug coverage pays. Therefore, your coverage under the HDHP is considered Non-Creditable Coverage.  

Full Medicare notices are provided for you on AskAllis. To access these and other required notifications, navigate to the “Resources” menu and select “Employee Benefits.” 


Additional Resources

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