As a result of the citywide health benefit agreement negotiated earlier this year, there are changes in the way you get certain prescription drugs. Four classifications of drugs are now covered by the PICA Drug Program rather than by the DC 37 Health and Security Plan. These changes became effective July 1, 2001.

1. Am I covered?
In order to be eligible for the PICA program you must be an active employee, or non-Medicare eligible retiree, enrolled in a New York City health insurance plan.

2. What drugs are covered?
PICA covers medications in four specific drug categories: Psychotropic, Injectable, Chemotherapy, and Asthma. Examples include:

Psychotropic

• antidepressants
• antipsychotics

Injectable

• most medications normally administered by injection (not in the doctor’s office)

Chemotherapy

• medications used to treat cancer
• medications to treat the side effects of chemotherapy

Asthma

• inhalers
• most medications used to treat asthma

3. What company administers PICA?
National Prescription Administrators (NPA) was chosen to administer these benefits under the PICA program. NPA has also been selected as the Prescription Benefit Manager for the Plan’s prescription drug program.

Pharmacy benefits

4. What drug card do I use at the pharmacy for PICA drugs?
Use your DC 37 Health and Security Plan NPA card at participating pharmacies. You should continue to use that card for all prescription drugs, including PICA drugs.

5. What pharmacy benefits are available?
Under the PICA program, you can obtain up to a 30-day supply of drugs at the pharmacy. Refills for PICA drugs are available as prescribed for up to one year from the date of the original prescription.

6. What are the pharmacy copays for PICA drugs?
The copays for a 30-day supply of PICA drugs bought at the pharmacy are:

	Generic	Brand-name
Psychotropic	$0	$6
Injectables	$0	$6
Chemotherapy	$0	$0
Asthma	$0	$0

7. How do I find a participating pharmacy?
Ask your pharmacist if he/she accepts NPA cards, visit NPA’s website at www.e-npa.com or contact NPA’s customer service at 1-800-467-2006.

Mail order program

8. What mail order benefits are available?
NPA offers a mail order program through Central Fill, Inc. (CFI). Through CFI, you can receive a 90-day supply of PICA drugs. Refills are available as prescribed for up to one year from the date of the original prescription.

9. What are the mail order copays for PICA drugs?
The copays for a 90-day supply of PICA drugs bought through the mail order program are:

	Generic	Brand-name
Psychotropic	$0	$12
Injectables	$0	$12
Chemotherapy	$0	$0
Asthma	$0	$0

10. How do I use the mail order pharmacy?
On July 1, drugs covered under the PICA program became available from your current mail order program pharmacy, CFI. Continue to use CFI for all maintenance drugs, including PICA drugs. Send your new prescriptions and any applicable co-pays to CFI and a 90-day supply will be sent to you.

11. What if my medication requires special handling?
CFI has the ability to ship your medication appropriately. For example, medications needing refrigeration will be shipped cold-packed.

Using your card

12. Do I need another prescription drug card to obtain PICA drugs?
No. You should continue to use your prescription drug card for all medications, including PICA drugs. If your prescription is not covered by PICA, the Plan’s co-payment schedule will be automatically applied: $3 co-pay for generic medication, $8 for preferred brand name drugs and $15 for non-preferred brand name drugs (30-day supply) at the pharmacy; $6 for generic, $16 for preferred brand name and $30 for non-preferred brand name medication (90-day supply) through CFI mail order.

13. I am a GHI subscriber and I was getting my asthma or chemotherapy medications by using my GHI card. How do I get these now?
Show your DC 37 Health and Security Plan NPA card instead. Please remind your pharmacist that he/she must submit the claim to NPA and not GHI (Telepaid®).

14. Are all drugs in the four classifications covered under this program?
No. Anti-anxiety medications such as Valium®, Xanax®, and their generics are still covered by the Plan’s drug program. Please continue to access these prescriptions as you have in the past.

15. Why are there different co-pays for Valium® and Prozac®?
While PICA covers anti-depressants, it does not cover anti-anxiety medications. Including Valium® which is a tranquilizer and is covered by the Plan’s prescription drug benefit. Prozac® is an anti-depressant and is part of the PICA program at a co-pay of $6 and no co-pay for the generic.

16. How do I get my diabetic medications?
Under a New York State mandate, diabetic medications are covered by your health plan. Continue to get your supplies as you have in the past.

17. What if I accidentally try to use another prescription card for a drug covered by PICA?
If you have more than one drug card and accidentally use the wrong card at the pharmacy, your pharmacistís computer should remind him/her to ask you for the correct card.

18. Can I use my NPA card for a prescription already on file at the pharmacy?
Yes. If your pharmacy already has a valid prescription for a drug covered by PICA, simply present your NPA card when you refill the prescription.


Getting help with problems

19. What do I do if my pharmacist tells me that Iím not eligible?
If there is a problem with your eligibility at the pharmacy, call NPA’s customer service at 1-800-467-2006.

20. What do I do if my pharmacist tells me that my drug is not covered?
If your pharmacist ever tells you that a drug is not covered, ask him/her the following questions:

• Is my prescription still good (have I used up all my refills)?
  
  
• For PICA drugs, did you use “Sponsor Number 2020”?
  

If there is still a problem, ask your pharmacist to call NPA, or you can call NPAís customer service at 1-800-467-2006.

The eligibility for this program is determined by New York City Health Plan enrollment and not by District Council DC 37 Health and Security Plan eligibility. Therefore, NPA customer service representatives will assist you through the New York City Health Benefits Program in resolving your problem.

21. What if I send a prescription to the wrong mail order pharmacy?
The mail order pharmacy that receives your prescription may forward it to the correct mail order pharmacy, or they may return it to you.

22. Can I get my money back if I paid for a PICA drug out of my own pocket?
It’s important that you use your NPA card for any drugs covered by the PICA program. After July 1, 2001, if you have paid for PICA drugs out of pocket, you can file for direct reimbursement. Call the Plan office and a direct reimbursement form will be sent to your home. Or, you can call NPA 1-800-467-2006 for forms.


For more information

23. Where should I call with questions about eligibility or covered drugs under the PICA plan?
If you have questions about your eligibility under the PICA plan, you can contact NPA customer service at1-800-467-2006.

24. What if I’m not sure whether my mail-order prescription is for a PICA drug?
Call CFI’s customer service at 1-800-628-0717 for information about drugs covered under the PICA plan.

25. Where should I call for a replacement NPA card?
If you were using GHI (Merck-Medco) or another mail order service for asthma, chemotherapy injectable or psychotropic drugs, you must get a new prescription and mail it to CFI.