Public Employee Press

Changes in city’s PICA plan

Beginning April 1, maintenance drugs obtained through the city’s PICA program must also be purchased through the mail. PICA covers psychiatric, injectable, chemotherapy and asthma drugs.

Express Scripts Inc. handles mail orders for the city’s PICA Prescription Drug Program. The co-pays for a three-month supply of maintenance drugs through the PICA mail-order program are $10 for generic medications, $30 for preferred (formulary) brand-name medications and $70 for non-preferred brand-name medications. (Participants who choose a brand-name medication that has a generic equivalent will be charged the difference between the cost of the drugs plus the non-preferred drug-pay.)

New prescriptions for maintenance drugs covered by PICA should now be filled through the mail-order program. Old prescriptions won’t be accepted once patients have obtained two refills. You may obtain mail-order envelopes for the PICA program by calling 1-800-467-2006.

Also beginning April 1, PICA will require prior authorization before filling prescriptions for erythropoetins (e.g., Epogen or Procrit), growth hormones, Botox, Myobloc, Wellbutrin XL/SR and Forteo. Your physician must provide a letter of diagnosis and medical necessity.

PICA is also instituting a step therapy program April 1 for certain medications used to treat rheumatoid arthritis, asthma and depression. Step-therapy requires patients to use “tried and true” treatments known to be safe and effective before they are permitted to take new and more expensive medications.

Certain injectable medications not covered by city health plans will be provided by the Express Scripts Specialty Care Pharmacy. These include medications for hepatitis C and multiple sclerosis.

For additional information, contact Express Scripts. PICA is only open to active employees and non-Medicare-eligible retirees who are enrolled in the city’s health insurance program.