Prescription Benefit for Home Care Members
Select Your Plan
Plan A: Member Choice Home Care Select Plan
If you select Plan A, our Member Choice Home Care Select plan, you have no co-payments for covered medications or medical services when you use your pre-selected Health Center for primary care.
Plan B: Panel Provider Plan
If you select Plan B, our Panel Provider plan, you receive the same quality care – with minimal co-pays for certain services (see below) – by choosing participating providers within the Home Care Benefit Fund network.
Using Your Plan
The Preferred Drug List (PDL)
Have your doctor prescribe preferred drugs on the 1199SEIU Preferred Drug List (PDL). Share this list with your doctor and work together to find the best covered option for you. If your doctor prescribes a drug in a category covered by the Benefit Fund but you don’t see it on the Preferred Drug List, just ask your doctor to prescribe any generic medication or a brand-name if there are no generics available.
Maintenance medications – those you take on an ongoing basis for conditions such as high blood pressure, diabetes or high cholesterol – may be filled as 30-day or 90-day supplies. The Fund’s pharmacy network offers easy and convenient pharmacy choices for filling maintenance medication prescriptions. Your provider can e-prescribe (mandated by NYS law) prescription orders for maintenance medications to CVS, Walgreens, Duane Reade or other participating pharmacies.
Participating Pharmacies
Fill short-term prescriptions at participating pharmacies.
CVS retail pharmacies are offering the updated COVID-19 vaccines to patients nationwide.
Appointments can be scheduled online via CVS.com, through the CVS Health app, or patients can walk into CVS retail pharmacies. Prescriptions from outside prescribers is not required in any state to receive a COVID-19 vaccine. CVS pharmacists will answer any questions patients may have about the vaccine.
Prior Authorization
Some medications and services require prior authorization. If your doctor thinks you need a medication that is not on the Preferred Drug List, call CVS Caremark at (833) 250-3237 or CVS Specialty at (855) 299-3262.
Specialty, Step Therapy and Quantity Duration Drugs
In order to continue to safeguard your health while providing you access to the medications you need, we use prescription programs such as our specialty medications list and drug quantity management drug list.
Prescription Co-Pays
| Generic Drugs | $0 |
$3 co-pay/retail prescription; $6 co-pay/mail-order prescription
|
You may be charged the amount the provider bills above the Fund’s payment. |
| Preferred Brand Drugs | $0 |
$6 co-pay/retail prescription; $12 co-pay/mail-order prescription |
You may be charged the amount the provider bills above the Fund’s payment. |
| Non-Preferred Brand Drugs | You will be charged a differential. |
$6 co-pay/retail prescription; $12 co-pay/mail-order prescription; You will be charged a differential. |
You may be charged the amount the provider bills above the Fund’s preferred drug price. |
| Specialty Drugs | No charge for generic and preferred brands. You will be charged a differential for nonpreferred brand drugs. |
$6 co-pay/retail prescription; Generic and brand co-pays apply (see above). You will also be charged a differential for non-preferred brand drugs. |
You may be charged the amount the provider bills above the Fund’s preferred drug price. |
Your Benefit Overviews
- Plan A: Member Choice Home Care Select
- Plan A: Member Choice Home Care Select in Spanish
- Plan B: Panel Provider Plan
- Plan B: Panel Provider Plan in Spanish
Additional Resources
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.
