Prescription drug benefits are available for our members through the Superior Officers Council Health and Welfare Fund Prescription Plan administered by OptumRx. Certain specialty drugs not covered by the Fund’s Prescription Drug Plan may be available through the City Health Benefits Plan, commonly referred to as PICA, which is explained in more detail on page 19. Also in this section you will find information on guidelines pertaining to diabetes medication on page 22.
Note: Medications prescribed as a result of a Line-of-Duty Injury (LODI) are covered in FULL through the New York City Police Department’s Line-of-Duty Prescription Drug Program. Information regarding the NYPD LODI Prescription Drug Program is included in this section.
The Superior Officers Council Active Health and Welfare Fund Prescription Drug Plan does not have an annual maximum. The member is responsible for 35% of brand name medication costs and 5% of the cost of generic medications for the first $10,000 in drug spend. Beyond the $10,000 in drug spend the member is responsible for a 55% co-payment of the cost of all brand name medications. The SOC Prescription Plan is a mandatory generic plan. Mandatory generic means the Plan eliminates coverage for all brand name medications that have a direct generic available. Should you or your doctor insist on receiving a brand name medication where there is a generic equivalent available, you will be responsible for the full Cost of the medication.
PICA Drug Plan Benefit Overview
The PICA Program is a prescription drug benefit that is provided to all NYC employees, non-medicare retirees, and eligible dependents who are enrolled in a health plan offered by the City’s Health Benefits Program. It is made available through the joint efforts of the City of New York Office of Labor Relations and the Municipal Labor Committee.
PICA covers medications in two specific drug categories:
- Injectable — Most injectable medications not requiring administration by a health care professional (self administered).
- Chemotherapy — Medications used to treat cancer and/or to treat the side effects of chemotherapy
Co-payments Retail Pharmacy (up to a 30-day supply)
- $10 for generic medications
- $25 for preferred brand (formulary) medications
- $45 for non-preferred brand (non-formulary) medications
Mail Order Pharmacy (up to a 90-day supply)
- $20 for generic medications
- $50 for preferred brand (formulary) medications
- $90 for non-preferred brand (non-formulary) medications
Note: The Superior Officers Council Prescription Plan does not cover medications covered by the City of New York Office of Labor Relations PICA Program. However, if you choose a non-preferred brand name medication that has a generic equivalent, you will be charged the difference in cost between the non-preferred brand name drug and the generic drug plus the non-preferred brand name drug co-payment. See Generics Preferred section for additional information.