[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-337840-105":53,"doc-detail-337840-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","prescription-drug-benefit-adjuncts-coverage-and-copayment-details","Prescription Drug Benefit (Adjuncts) - Coverage and Copayment Details","","Prescription Drug Benefit (Adjuncts) explains eligibility and coverage rules for prescription medications under an adjunct plan, including the requirement to enroll in basic health insurance through the NYC Employee Health Benefits Program (NYC HBP). It details how benefits work with CVS/Caremark, which drug types are covered (FDA-approved prescription drugs) and excluded (over-the-counter items). Copayment levels are presented by generic/preferred/non-preferred categories, retail versus mail-order, and by annual fund cost thresholds ($10K–$15K and over $15K).",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/prescription-drug-benefit-adjuncts-coverage-and-copayment-details/337840/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/prescription-drug-benefit-adjuncts-coverage-and-copayment-details/337840.png","ImageObject",442,249,{"name":88,"@type":89},"Eliana","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-26","2026-09-21",true,{"@type":98,"interactionType":99,"userInteractionCount":76},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"Who is eligible for prescription drug benefits under the Adjuncts plan?","Question",{"text":108,"@type":109},"Eligibility requires enrollment in basic health insurance through the NYC Employee Health Benefits Program (NYC HBP). Coverage is described as individual-only under the adjunct plan unless family coverage is elected.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"Which medications are covered and which are not?",{"text":113,"@type":109},"The program covers most FDA-approved drugs that require a prescription for specified conditions. Over-the-counter medications (OTC) are not covered, and the document lists additional non-covered or restricted categories such as fertility drugs, growth hormones, and experimental/investigational drugs.",{"name":115,"@type":106,"acceptedAnswer":116},"How are copayments determined for covered prescriptions?",{"text":117,"@type":109},"Copayments depend on the drug category (generic, preferred, non-preferred) and where it is purchased (retail pharmacy or mail-order/CVS pharmacy). The document also ties copayment percentages to annual fund cost thresholds such as $10,000–$15,000 and above $15,000.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},337840,1790382100,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":76,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":20,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":47},4398048949847,"https://ap-avatar.wpscdn.com/avatar/400002536579ef2da7f?_k=1778318612642679267","Prescription Drug Benefit (Adjuncts)  \nHome 5 Adjuncts 5 Fund Benefits (Adjuncts) 5 Prescription Drug Benefit (Adjuncts)  \nCoverage under the adjunct plan is individual-only. You may elect to purchase family coverage. Please call the Fund office for more information and for the current rate. Family premiums must be paid on a quarterly basis. Enrollment in NYC-CBP basic health insurance, family coverage, is requisite. The Welfare Fund Family Enrollment Supplement form is on the Forms page.  \nYou must be enrolled in basic health insurance through the NYC Employee Health Benefits Program (NYC HBP) to be eligible for prescription drug benefits under supplemental health insurance. Prescription drug benefits are available through CVS/Caremark for yourself and your eligible dependents. The program covers most FDA-approved drugs that require a prescription. Over-the-counter medications are not covered. The amount you pay for a prescription depends on a number of factors:  \n whether your prescription is filled with a generic drug when one is available  \n whether your prescription is filled with a drug that is included on the CVS/Caremark formulary  \nHow does the Welfare Fund drug coverage work? 􀂲  \nPlan participants must be enrolled in an NYC Health Benefits Program basic health insurance plan to be eligible for the CVS/Caremark Prescription Drug Program.  \nParticipating members will receive a CVS/Caremark prescription drug card unless they elect to purchase an optional drug rider through certain basic  \nhealth programs. Those who elect a rider over the CVS Plan should refer to the stipend section below. Please note that the CVS/Caremark Prescription Drug Program restricts coordination of benefits with another drug coverage.  \nWhat does the CVS Prescription Drug Program cover?  \n􀂲  \nThe plan covers most drugs that legally require a prescription and have FDA approval for treatment of the specified condition(s) . Drugs available without a prescription, classified as “over the counter”(OTC), are not covered regardless of the existence of a physician’s prescription. The Welfare Fund program through CVS/Caremark encourages utilization of (a) generic equivalent medications,(b) selected drugs among clinical equivalents.  \nIf a generic equivalent medication is available and you or your physician chose it, you pay the standard co-payment for a generic drug. If you choose a brand name drug when a generic is available, you will pay the full cost of the brand name drug.  \nCVS/Caremark has determined a list of drugs that treat medical conditions in the most cost-efficient manner. The Welfare Fund Drug List is regularly reviewed and updated by physicians, pharmacists and cost analysts.  \nHome delivery (mail-order) or use of a CVS pharmacy is encouraged as a less costly way to fill prescriptions for long-term (maintenance) drugs. After an initial 30 day fill and 2 subsequent 30 day fills at a local pharmacy, higher levels of co-payment will be assessed for continued use of 30 day fills instead of 90 day (maintenance) fills.  \nCopayment 􀂲  \nA co-payment is the part of the drug cost that is paid by the plan participant.  \nCo-payments are based on the category (generic, preferred and non-preferred) and place of purchase (retail pharmacy or mail-order pharmacy) .  \nHow Much You Pay for a Covered Prescription Drug*  \n\n| Retail Pharmacy (up to a 30-day supply) | First Three\u003Cbr>Fills | Each Subsequent Refill |\n| --- | --- | --- |\n\n| Generic | If filled at CVS: No Copay for Genericson Welfare Fund Drug List\u003Cbr>20% at all Non-CVS pharmacies | 35%($5 minimum) |\n| --- | --- | --- |\n| Preferred | 20%($15 minimum) | 35%($15 minimum) |\n| Non-Preferred | 20%($30 minimum) | 35%($30 minimum) |\n\n\n| CVS/Caremark Mail or CVS Pharmacy (90-day supply) | Cost |\n| --- | --- |\n| Generic | No Copay for Generics on Welfare Fund Drug List |\n| Preferred | 20%($30 minimum) |\n| Non-Preferred | 20%($60 minimum) |\n\n*On July 1, 2014, the maximum benefit limit was lifted in compliance","cbCaiipKJC41SL8E","https://ap.wps.com/l/cbCaiipKJC41SL8E","pdf",1313255,"English","# Eligibility and Coverage Overview\n## Family coverage and enrollment requirements\n## CVS/Caremark prescription drug program\n# What the Program Covers and Pricing Rules\n## Covered vs non-covered drugs\n## Generic vs brand-name cost differences\n## Home delivery and refill co-payment rules\n## Copayment structure by drug category and purchase channel\n# Benefit Limits and Annual Expenditure Thresholds\n## Up to $10,000 cost to the Fund\n## Between $10,000 and $15,000 cost to the Fund\n## Over $15,000 cost to the Fund","[{\"question\":\"Who is eligible for prescription drug benefits under the Adjuncts plan?\",\"answer\":\"Eligibility requires enrollment in basic health insurance through the NYC Employee Health Benefits Program (NYC HBP). Coverage is described as individual-only under the adjunct plan unless family coverage is elected.\"},{\"question\":\"Which medications are covered and which are not?\",\"answer\":\"The program covers most FDA-approved drugs that require a prescription for specified conditions. Over-the-counter medications (OTC) are not covered, and the document lists additional non-covered or restricted categories such as fertility drugs, growth hormones, and experimental/investigational drugs.\"},{\"question\":\"How are copayments determined for covered prescriptions?\",\"answer\":\"Copayments depend on the drug category (generic, preferred, non-preferred) and where it is purchased (retail pharmacy or mail-order/CVS pharmacy). The document also ties copayment percentages to annual fund cost thresholds such as $10,000–$15,000 and above $15,000.\"}]","Prescription Drug Benefit (Adjuncts) - Coverage and Copayment Details | PDF",1790020861]