Prescription Medicines
If you or a member of your family relies on prescription drugs for your health needs, please take a few minutes to read the following information.
City of Scottsdale Basic PPO through Aetna Open Choice |
City of Scottsdale EPO through Aetna Elect Choice |
City of Scottsdale High Level PPO CPOS II | |||
In-Network Benefits |
Out-of-Network Benefits |
In-Network Benefits |
Out-of-Network Benefits | ||
Prescriptions | |||||
Generic |
$10 |
50% co-insurance |
$10 |
$10 |
50% co-insurance |
Brand Name |
20% co-insurance |
50% co-insurance |
20% co-insurance |
20% co-insurance |
50% co-insurance |
Non-Formulary |
40% co-insurance |
50% co-insurance |
40% co-insurance |
40% co-insurance |
50% co-insurance |
Mail Order Generic |
$20 (90-day supply) |
No benefit |
$20 (90-day supply) |
$20 (90-day supply) |
No benefit |
Mail Order Brand Name |
$60 (90-day supply) |
No benefit |
$60 (90-day supply) |
$60 (90-day supply) |
No benefit |
Mail Order Non-Formulary |
$110 (90-day supply) |
No benefit |
$110 (90-day supply) |
$110 (90-day supply) |
No benefit |
If you choose a brand name drug over an available generic drug, you will pay the generic co-pay PLUS the difference in cost between the generic drug and the brand name drug. If your doctor indicates that you must take the brand name drug over the generic, then you will only pay the applicable brand drug co-pay.
Retail Pharmacies
Prescriptions for the Aetna health plans are accepted at most major pharmacy and supermarket chains (i.e. Walgreens, Osco, Fry's, Safeway, etc.) If in doubt, ask your pharmacy if they participate in your health plan's network.
You can obtain a list of participating pharmacies by checking out your plan's on-line provider directory
Aetna EPO or PPO: www.aetna.com
Mail Order Prescriptions
If you take maintenance drugs, you should consider participating in the mail order drug program of your health plan for added convenience and dollar savings. To participate in the mail order program:
- Obtain a prescription for mail order drugs from your physician. A mail order prescription can be written for up to a 90-day supply with three refills.
- Obtain a mail order drug form and submit it with your prescription to your health plan's mail order drug program. Forms are available from Human Resources, your health plan's customer service or your health plan's website.
Special Rules for "Controlled Substance" Mail Order Drugs
- Aetna: Missouri state law mandates that a diagnostic code be included on a prescription for more than a 30-day supply for this type of drug. If a mail order prescription for a controlled substance does not include the diagnostic code, the mail order program will only mail a 30-day supply. In addition, no refills are allowed for controlled substances. You will need to get a new prescription written every 90 days in order to use the mail order program for certain controlled substances.
Formularies
A formulary is a listing of the health plan's preferred drugs. If a drug is not on the preferred listing, it is a non-formulary drug. All Aetna plans have open formularies. This means you can get a drug that is not on the formulary, but you will pay more than for a drug on the formulary. You can obtain a copy of your health plan's formulary listing from, your health plan's customer service number or through your health plan's online system.
Aetna: www.aetna.com
Restrictions on Certain Drugs
Aetna:
- Quantity limits: This means that only a certain number of doses will be approved. This requirement is indicated on the formulary.
- Controlled substance mail order prescriptions: Missouri state law mandates that a diagnostic code be included on a prescription for more than a 30-day supply of this type of drug. If a mail order prescription for a controlled substance does not include the diagnostic code, the mail order program will only mail a 30-day supply. In addition, no refills are allowed for controlled substances. You will need to get a new prescription written every 90 days in order to use the mail order program for certain controlled substances.
Important Telephone Numbers and Websites:
Aetna: Customer Service: (877) 204-9064 or website: www.aetna.com
Human Resources: (480) 312-7600 or hrbenefitsemail@scottsdaleaz.gov
This guide represents a summary of benefits provided by the City of Scottsdale to benefited employees. Every effort has been made to report information accurately. All information, including the amount of any benefit and employee eligibility of benefits, is subject to and governed by the terms and conditions of the applicable policy or plan documents. In all cases where any of the information provided in this guide differs from the amount of benefit actually provided by the policy or plan, the terms of the legal documents will control.
