Prescription Benefit for Greater New York Members
Useful Resources
- Preferred Drug List (PDL)
- List of Participating Pharmacies
- Express Scripts Mail Order Form
- Medications Requiring Prior Authorization
- Specialty Medications
- Step Therapy Drug List
- Quantity Duration Drug List
- Prescription Reimbursement Form (Direct Claim Form)
There is no out-of-pocket cost for your prescriptions when you follow the Benefit Fund’s prescription programs:
- Use preferred drugs on the Preferred Drug List (PDL)
- Use participating pharmacies for short-term medications
- Order maintenance medications using The 90-Day Rx Solution. Then fill it through Express Scripts by Mail, or order and pick up your prescription at any Rite Aid, Walgreens or Duane Reade pharmacies nationwide.
- Some medications require prior authorization. If your doctor thinks you need a medication that is not on the Preferred Drug List, call the Fund at (646) 473-9200
- Effective September 1, 2009: In order to continue to safeguard your health while providing you access to the medications you need, Express Scripts has expanded some of our prescription programs, such as our prior authorization list, step therapy drug list and quantity duration drug classes.
Think Generics First!
Always ask your doctor to prescribe generic drugs from the Fund’s PDL where possible. The generic drugs listed on the Fund’s PDL have the same effectiveness as the name brands, but they cost much less. Remember, if your doctor prescribes a brand-name even though a generic is available, or a non-covered medication, you will have out-of-pocket costs.
For more information, call (646) 473-9200.
Who Is Eligible?
Eligibility Class I — Family Coverage
Eligibility Class II and III — Not covered for this benefit
Not sure what wage class you are?
Check the front of your Health Benefits ID Card, or click here for an explanation.
Greater New York members employed by New Jersey employers receive healthcare benefits through Aetna. Call (646) 473-9200 for questions about your benefits.
Additional Resources
- Summary Plan Description (SPD)
- Overview of Your Benefits:
- Eligibility Class I & II (As of January 2019)
- Eligibility Class I & II in Spanish (As of January 2019)
- Summary of Benefits and Coverage (SBC)
- Pharmacist Authority to Administer Vaccines by State New
Access Care from the Comfort of Your Home
If you are a National Benefit Fund, Greater New York Benefit Fund or Home Care Benefit Fund member, you can schedule a virtual visit with any hospital or provider in our 1199SEIU Benefit Fund network, wherever you may be. This is in addition to your Teladoc benefit.
