|Members Retirees Employers|
Prescription Drug Coverage
Prescription drug coverage is included with all medical plans offered by SERS.
All prescription plans have a formulary of covered medications. The amount you are responsible for paying, known as the co-pay, is based on the medication’s formulary status.
You pay the least for generic medications. You pay the most for brand-name medications that are not on the formulary.
You can get your prescriptions at retail pharmacies or through the mail.
You save money by having prescriptions for maintenance medications mailed to your home. Maintenance medication is taken on an ongoing, long-term basis, such as medicine for high blood pressure.
Prescriptions Not Covered
The following is a partial list of situations or types of medications that are not covered. If you
are unsure if a medication is covered, you can call your prescription plan’s customer service.
All prescription plans include these common coverage rules:
If you or your doctor believes that one of these coverage rules should not be applied to your
situation, you can ask for an exception. Contact your prescription plan for more information.
Medicare and Prescription Coverage
You have Medicare Part D prescription coverage through your SERS Medicare coverage.
You do not need to buy additional coverage. If you enroll in another Part D plan, SERS is
required to cancel your health care coverage.
Some medications and supplies are covered by Medicare Part B, which is part of your
medical plan rather than your prescription drug plan. These include but are not limited to:
You will use your medical plan ID card, not your prescription card, to obtain these
Medicare Coverage Gap (Donut Hole)
When you reach the Coverage Gap, also known as the “donut hole,” SERS continues to help you with your prescription costs. Your co-pays will NOT change just because you have entered the donut hole. For more information, contact Health Care Services toll-free at 800-878-5853.
To learn more about the Coverage Gap, watch the video "All About Medicare Part D."
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