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.
Optumrx The Superior Officers Council Retiree Health and Welfare Fund pays up to $7,000 per calendar year for you and your family’s prescription drug expenses or up to $10,000 per calendar year for Medicare eligible individuals and an additional $5,000 for members with families.
The SOC Prescription Plan is a mandatory generic plan. Being a mandatory generic plan means the Plan design 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.
The SOC Prescription Plan is based on a co-payment schedule. The member is responsible for 35% of the total cost of covered brand name medications and 5% of generic medications. There is an annual (January-December) $50 family deductible that must be met prior to the co-payment schedule going into effect.
Medications covered by the PICA Program
- 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 Copayments 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 copayment. See Generics Preferred section for additional information.