By Gregory N. Heires

Beginning July 1, coverage for psychotropic, injectable, chemotherapy and asthma (PICA) medications will be switched from union welfare plans to a new program funded through the citywide benefits agreement reached at the beginning of 2001.

For tens of thousands of DC 37 members and retirees who are not yet eligible for Medicare, the new PICA Drug Program will reduce copayments.

The new plan will also provide major savings for the union’s Prescription Drug Benefit, which will no longer cover the four categories of drugs.

The PICA program was created under the multi-million-dollar agreement on benefits reached in January between the city and the Municipal Labor Committee, which includes DC 37 and most major city employee unions.

Cost relief for members and plan
“Coupled with the co-payment structure we adopted last year, the new program will help us preserve, protect and hopefully enhance our drug benefit,” said DC 37 Deputy Administrator Eliot Seide, who chairs the Health and Security Plan’s Board of Trustees.

“PICA will give us considerable relief from the spiraling cost of prescription drugs,” said Roslyn Yasser, administrator of the Health and Security Plan.

The following drugs are included:

• Psychotropic drugs: antidepressants and anti-psychotics
  
  
• Injectable drugs: most medications ordinarily administered by injection outside of a doctor’s office. This does not include diabetes drugs, which state law requires basic health plans to provide.
  
  
• Chemotherapy drugs: medications used to treat cancer, including drugs for side effects like nausea.
  
  
• Asthma drugs: inhalers and most medications.
  
  
• Where health plans already cover these drugs, members will not be covered by PICA and will continue to receive their medication through their insurance carrier. However, GHI subscribers who now get their asthma and chemotherapy medications by using their GHI card should start to use their District Council 37 drug card for these purchases beginning on July 1.

What you will pay
PICA is run by National Prescription Administrators, which also administers DC 37’s drug benefit. Therefore, the new program will be particularly convenient for DC 37 members, who will be able to continue using their current DC 37 Health and Security Plan-NPA card, whereas some city employees will be issued a new special NPA PICA card.

Under the PICA program, patients will be able to obtain their medication in pharmacies or through NPA’s mail-order program, which is run by Central Fill Inc. (CFI). Here’s how it works:

• Both at pharmacies and by mail, generic drugs in all four categories are free, and brand-name chemotherapy and asthma medications are free.
  
  
• At pharmacies, PICA covers up to a 30-day supply of drugs, and there is a $6 co-pay for brand-name psychotropic and injectable drugs.
  
  
• Mail-order purchases provide a 90-day supply, and the co-payment for brand-name psychotropic and injectable drugs is $12. CFI will automatically apply the new co-payment schedule to prescriptions already on file.
  
  
• GHI subscribers who use the GHI/Merck-Medco mail-order service for asthma medications must switch to CFI, which requires a new prescription.

For more information on covered drugs
To find out about covered medications, call NPA’s customer service at 1-800-467-2006 or visit its Web site at www.e-npa.com.

During the first 90 days of the new program, users will be able to submit a “direct reimbursement” form to NPA if they make out-of-pocket purchases without a co-pay or at the wrong co-pay.

To be eligible for PICA, workers and non-Medicare eligible retirees must be enrolled in the city’s health plan. People who are in the New York State Health Insurance Program (NYSHIP), such as state employees represented by some DC 37 locals, and workers who have waived coverage by the New York City program, are not eligible for PICA.

The DC 37 Prescription Drug Plan will continue to provide coverage of the four drug categories for members and non-Medicare-eligible retirees who don’t qualify for PICA, as long as they meet the eligibility requirements of the union plan.

For now, this group will receive the drugs at the plan’s current co-payment rates. In the future, the plan’s trustees will consider providing coverage at the PICA rate.

The DC 37 Prescription Drug Plan will provide coverage of the four PICA drug categories for part-time employees who are ineligible for health insurance because they don’t work a required number of hours, provided that they meet the plan’s other eligibility requirements.