Frequently Asked Questions
About the New
Preferred Drug List
The Benefit Fund has updated the Preferred Drug List as of October 1.
What is the Fund's Preferred Drug List?
The Preferred Drug List is the list of 'preferred' drugs covered by the Fund in certain categories. When a doctor prescribes preferred drugs on the PDL—generic or brand-name—you will not have out-of-pocket costs (except for GNY members, who have a $3 co-pay on brands, and Rochester members, who have a $4 co-pay for all covered drugs).
There are still many drugs covered by the Fund that are not on the Preferred Drug List. For those drugs, your doctor can prescribe any generic medication, or a brand if a generic is not available.
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Where can I get a copy of the new Preferred Drug List (PDL)?
- You can download it here.
- You can have a copy of the Preferred Drug List mailed to you by calling Member Services at (646) 473-9200.
- You can ask your Outreach Coordinator for a copy.
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How do I use the updated Preferred Drug List?
Check the updated Preferred Drug List to make sure your medications are still 'preferred' and listed on it. If they are, you’re all set and don't have to do anything. You may also want to bring a copy of the Preferred Drug List to your doctor, to be sure that he or she has it on file when prescribing medications for you.
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What if my medication category/class is not on the Preferred Drug List?
The Preferred Drug List only contains 32 categories of medications — those that are most commonly prescribed — even though the Fund covers more than 100 categories in total. If you need a medication in a Fund-covered category that is not on the Preferred Drug List, ask your doctor to prescribe any generic medication in that category. If there's no generic available, your doctor may prescribe a brand.
Remember, there are certain classes of drugs that the Fund doesn't cover, like cosmetic medications.
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What if my medication used to be listed, but it's not on the updated Preferred Drug List?
If your medications are no longer preferred and are not included on the updated Preferred Drug List, talk to your doctor right away about switching to a preferred medication on the list. If you don't, you'll end up paying the full difference for your prescriptions.
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My doctor still says that I need a certain drug, but it's not a preferred medication on the Preferred Drug List. What should I do?
In the rare cases when a doctor feels that a certain brand-name drug is medically necessary, but it's not preferred on the Preferred Drug List, she or he can call the Fund at (646) 473-7446 to request authorization. If the doctor demonstrates that the preferred medication is not right for you, and the Fund covers that type of drug, we'll authorize payment for it.
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My doctor wrote me a prescription for a brand-name drug. Can the pharmacy or Medco just give me the generic instead?
Yes. The pharmacy (or Medco, if you are using The 90-Day Rx Solution) will automatically fill your prescription generically, even if your doctor has written a prescription for a brand. The exception is if your doctor writes "DAW" (Dispense as Written) on your prescription. In that case, to avoid out-of-pocket costs, you will need to ask your doctor for a new prescription for a generic medication, or a prescription that does not have "DAW" on it.
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What if I have questions about my medication(s) and I can't reach my doctor?
- For any clinical questions about specific medications, call Medco at (800) 818-6720 24 hours a day to speak with a pharmacist.
- After October 1, you can call our 24-Hour Nurse Helpline at (866) 935-1199, and ask to speak to a pharmacist.
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What happens if I don't change my medications to preferred medications by the October 1 deadline?
If you try to fill a prescription for a non-preferred drug after October 1, you will pay the full difference in cost, just like in our mandatory generic program, which can be very expensive.
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What if I order a non-preferred drug through The 90-Day Rx Solution after October 1? Will I be charged automatically?
If you order a non-preferred drug, and there is a differential to be paid, Medco will call you to let you know.
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How do I change my prescription for my maintenance medication?
Ask your doctor to write a 30-day prescription with one refill for a preferred medication to fill at your local participating pharmacy, and a 90-day prescription with three refills (a one-year supply) that you can fill through The 90-Day Rx Solution.
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Is there a difference between generic and brand-name drugs?
The U.S. Food and Drug Administration (FDA) ensures that generic drugs are equally clinically effective and safe as their brand-name equivalents. Federal law requires generic drugs to contain the same active ingredients in the same quantities and strength as the corresponding brand-name drugs, and the Fund's clinicians and Medco review the clinical effectiveness and safety of all our covered medications.
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