STATE HEALTH BENEFITS
PROGRAM and
SCHOOL EMPLOYEES' HEALTH BENEFITS
PROGRAM
EMPLOYEE PRESCRIPTION DRUG PLAN COPAYMENTS
STATE EMPLOYEES ENROLLED IN THE SHBP
Employee Prescription Drug Plan copayments
for Plan Year 2012
Copayments are based on the medical plan in which the employee is enrolled
NJ DIRECT15, Aetna HMO, Cigna HMO | 1525 Plans | 2030 Plans | High Deductible Plans
NJ DIRECT15, Aetna HMO, or Cigna HealthCare HMO
RETAIL PHARMACY COPAYMENT AMOUNTS
Up to a 90-day Supply |
| Supply |
Generic |
Brand
Name Drug
without generic equivalents |
Brand
Name Drug
with generic equivalents |
| 01-30 days |
$3 |
$10 |
$25 |
| 31-60 days |
$6 |
$20 |
$50 |
| 61-90 days |
$9 |
$30 |
$75 |
MAIL ORDER COPAYMENT AMOUNTS
Up to a 90-day Supply |
| Supply |
Generic |
Brand
Name Drug
without generic equivalents |
Brand
Name Drug
with generic equivalents |
| 01-90
days |
$5 |
$15 |
$40 |
NJ DIRECT1525, Aetna1525, or Cigna1525
RETAIL PHARMACY COPAYMENT AMOUNTS
Up to a 90-day Supply |
| Supply |
Generic |
Brand
Name Drug
without generic equivalents |
Brand
Name Drug
with generic equivalents |
| 01-30 days |
$7 |
$16 |
$35 |
| 31-60 days |
$14 |
$32 |
$70 |
| 61-90 days |
$21 |
$48 |
$105 |
MAIL ORDER COPAYMENT AMOUNTS
Up to a 90-day Supply |
| Supply |
Generic |
Brand
Name Drug
without generic equivalents |
Brand
Name Drug
with generic equivalents |
| 01-90
days |
$18 |
$40 |
$88 |
NJ DIRECT2030, Aetna2030, or Cigna2030
RETAIL PHARMACY COPAYMENT AMOUNTS
Up to a 90-day Supply |
| Supply |
Generic |
Brand
Name Drug
without generic equivalents |
Brand
Name Drug
with generic equivalents |
| 01-30 days |
$3 |
$18 |
$46 |
| 31-60 days |
$6 |
$36 |
$92 |
| 61-90 days |
$9 |
$54 |
$138 |
MAIL ORDER COPAYMENT AMOUNTS
Up to a 90-day Supply |
| Supply |
Generic |
Brand
Name Drug
without generic equivalents |
Brand
Name Drug
with generic equivalents |
| 01-90
days |
$5 |
$36 |
$92 |
NJ DIRECT HD4000 or HD1500, Aetna HD4000 or HD1500, or Cigna HD4000 or HD1500
Under the High Deductible (HD) Health Plans prescription drug benefits are subject to the HD plan deductible and coinsurance. See your plan handbook or contact you HD Plan directly for details.
Note:
In certain circumstances of intolerance or the therapeutic
failure of a drug's generic equivalent, a member may be
able to receive a third tier brand name drug where a
generic equivalent is available for the lower second
tier copayment for a brand name drug without generic
equivalent.
If you have any questions
regarding this information,
contact the Office of Client Services
at
(609) 292-7524
or send an e-mail using the "contact us" link
below.
LOCAL GOVERNMENT EMPLOYEES
ENROLLED IN THE SHBP
Employee Prescription Drug Plan copayments
for Plan Year 2012
Copayments are based on the medical plan in which the employee is enrolled
NJ DIRECT10, NJ DIRECT15, Aetna HMO, or Cigna HMO | 1525 Plans | 2030 Plans | High Deductible Plans
NJ DIRECT10, NJ DIRECT15, Aetna HMO, or Cigna HealthCare HMO
RETAIL PHARMACY COPAYMENT AMOUNTS
Up to a 90-day Supply |
| Supply |
Generic |
Preferred
Brand Name Drug |
Non-Preferred
Brand Name Drug |
| 01-30 days |
$3 |
$10 |
$10 |
| 31-60 days |
$6 |
$20 |
$20 |
| 61-90 days |
$9 |
$30 |
$30 |
MAIL ORDER COPAYMENT AMOUNTS
Up to a 90-day Supply |
| Supply |
Generic |
Preferred
Brand Name Drug |
Non-Preferred
Brand Name Drug |
| 01-90
days |
$5 |
$15 |
$15 |
NJ DIRECT1525, Aetna1525, or Cigna1525
RETAIL PHARMACY COPAYMENT AMOUNTS
Up to a 90-day Supply |
| Supply |
Generic |
Preferred
Brand Name Drug |
Non-Preferred
Brand Name Drug |
| 01-30 days |
$7 |
$16 |
$35 |
| 31-60 days |
$14 |
$32 |
$70 |
| 61-90 days |
$21 |
$48 |
$105 |
MAIL ORDER COPAYMENT AMOUNTS
Up to a 90-day Supply |
| Supply |
Generic |
Preferred
Brand Name Drug |
Non-Preferred
Brand Name Drug |
| 01-90
days |
$18 |
$40 |
$88 |
NJ DIRECT2030, Aetna2030, or Cigna2030
RETAIL PHARMACY COPAYMENT AMOUNTS
Up to a 90-day Supply |
| Supply |
Generic |
Preferred
Brand Name Drug |
Non-Preferred
Brand Name Drug |
| 01-30 days |
$3 |
$18 |
$46 |
| 31-60 days |
$6 |
$36 |
$92 |
| 61-90 days |
$9 |
$54 |
$138 |
MAIL ORDER COPAYMENT AMOUNTS
Up to a 90-day Supply |
| Supply |
Generic |
Preferred
Brand Name Drug |
Non-Preferred
Brand Name Drug |
| 01-90
days |
$5 |
$36 |
$92 |
NJ DIRECT HD4000 or HD1500, Aetna HD4000 or HD1500, or Cigna HD4000 or HD1500
Under the High Deductible (HD) Health Plans prescription drug benefits are subject to the HD plan deductible and coinsurance. See your plan handbook or contact you HD Plan directly for details.
If you have any questions
regarding this information,
contact the Office of Client Services
at
(609) 292-7524
or send an e-mail using the "contact us" link
below.
LOCAL EDUCATION EMPLOYEES
ENROLLED IN THE SEHBP
Employee Prescription Drug Plan copayments
for Plan Year 2012
Copayments are based on the medical plan in which the employee is enrolled
NJ DIRECT10, NJ DIRECT15, Aetna HMO, or Cigna HMO | 1525 Plans | 2030 Plans | High Deductible Plans
NJ DIRECT10, NJ DIRECT15, Aetna HMO, or Cigna HealthCare HMO
RETAIL PHARMACY COPAYMENT AMOUNTS
Up to a 90-day Supply |
| Supply |
Generic |
Preferred
Brand Name Drug |
Non-Preferred
Brand Name Drug |
| 01-30 days |
$3 |
$10 |
$10 |
| 31-60 days |
$6 |
$20 |
$20 |
| 61-90 days |
$9 |
$30 |
$30 |
MAIL ORDER COPAYMENT AMOUNTS
Up to a 90-day Supply |
| Supply |
Generic |
Preferred
Brand Name Drug |
Non-Preferred
Brand Name Drug |
| 01-90
days |
$5 |
$15 |
$15 |
NJ DIRECT1525, Aetna1525, or Cigna1525
RETAIL PHARMACY COPAYMENT AMOUNTS
Up to a 90-day Supply |
| Supply |
Generic |
Preferred
Brand Name Drug |
Non-Preferred
Brand Name Drug |
| 01-30 days |
$7 |
$16 |
$35 |
| 31-60 days |
$14 |
$32 |
$70 |
| 61-90 days |
$21 |
$48 |
$105 |
MAIL ORDER COPAYMENT AMOUNTS
Up to a 90-day Supply |
| Supply |
Generic |
Preferred
Brand Name Drug |
Non-Preferred
Brand Name Drug |
| 01-90
days |
$18 |
$40 |
$88 |
NJ DIRECT2030, Aetna2030, or Cigna2030
RETAIL PHARMACY COPAYMENT AMOUNTS
Up to a 90-day Supply |
| Supply |
Generic |
Preferred
Brand Name Drug |
Non-Preferred
Brand Name Drug |
| 01-30 days |
$3 |
$18 |
$46 |
| 31-60 days |
$6 |
$36 |
$92 |
| 61-90 days |
$9 |
$54 |
$138 |
MAIL ORDER COPAYMENT AMOUNTS
Up to a 90-day Supply |
| Supply |
Generic |
Preferred
Brand Name Drug |
Non-Preferred
Brand Name Drug |
| 01-90
days |
$5 |
$36 |
$92 |
NJ DIRECT HD1500, Aetna HD1500, or Cigna HD1500
Under the High Deductible (HD) Health Plans prescription drug benefits are subject to the HD plan deductible and coinsurance. See your plan handbook or contact you HD Plan directly for details.
If you have any questions
regarding this information,
contact the Office of Client Services
at
(609) 292-7524
or send an e-mail using the "contact us" link
below. |
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