Mandatory Generic Drugs
The OLDC-OCA Insurance Fund only covers the cost of the generic version of a drug, if a generic is available. If you or your physician request a name-brand drug instead of a generic drug, you will be responsible for paying the cost difference between the generic and the name-brand in addition to the name-brand drug copayment. (See the chart to the below for copayment amounts)*
If you or your physician request a brand name drug instead of a generic, you will be responsible for paying the cost difference between the generic and brand name drug in addition to the higher copayment. There is an available cost difference cap of $50 per 30 day supply and $100 per 90 day supply. To be eligible for the cap, a “Brand-Name Drug Override” form will be required from your prescribing doctor. Please contact Elixir to request the form be sent to your doctor.
| Medication Type | Retail (30-Day Supply) | Mail Order (90-Day Supply) |
|---|---|---|
|
Generic |
$10 |
$25 |
|
Brand Name Preferred |
$30 |
$75 |
|
Brand Name Non-Preferred |
$50 |
$125 |
*Copayments are the cap for or limit to which members will pay for a particular drug. For example, if you get a 30-day supply of a generic medication, you will never pay more than $10 for that fill. If the medication is less than $10, you will just pay the smaller amount.
Step Therapy: Certain medications may qualify for a step therapy program. Step therapy requires you to first attempt lower cost drugs to treat an ongoing condition. Step therapy helps you and the Fund control the rising costs of drugs. Drugs will be added or removed from the step therapy program when deemed appropriate by the Fund. Certain exceptions may apply in cases of allergy or certain medical conditions. Your doctor would need to call the Elixir Prior Authorization Department to request an exception be made.