Pharmacy Center for VIP Premier (HMO) Medicare
For City of New York Employees and Retirees
The VIP Premier (HMO) Medicare plan includes an in-network prescription drug benefit which covers drugs that are prescribed by network doctors and filled by our nationwide network of pharmacies or the network home delivery service.
The standard prescription plan offers a basic Medicare Part D plan. City of New York retirees who do not receive prescription drug coverage through their Union Welfare Fund must purchase a prescription drug rider, which provides additional prescription drug benefits with no annual limit.
You may have to pay a portion of the cost for these medicines. This may include a:
- Copay – the amount you pay for drugs.
- Deductible – the amount you pay for drugs before EmblemHealth starts to pay each year.
- Coinsurance – The percentage you pay for drugs after your deductible when EmblemHealth begins to pay.
||Drug Benefit: With Rider|
Tier 1 (Preferred generic drugs)
$10 copay per 30-day supply|
Tier 2 (Preferred brand drugs)
$15 copay per 30-day supply|
Tier 3 (Non preferred generic and brand drugs)
||$100 copay per 30-day supply|
|Tier 4 (Specialty drugs)
||25% coinsurance per 30-day supply
|Home delivery (preferred drugs)
||Tier 1 (Preferred generic drugs): $5 copay per 30-day supply|
Tier 2 (Preferred brand drugs): $7.50 copay per 30-day supply
Tier 3 (Non preferred generic and brand drugs): $50 copay per 30-day supply
Tier 4 (Specialty drugs): 25% coinsurance per 30-day supply
|Benefit limits||The member pays copays and coinsurance as listed above for drug costs between $0 and $2,960. After reaching $2,960, the member is covered for generic and brand drugs, until the member qualifies for catastrophic coverage.|
Catastrophic coverage is when a member reaches $3,700 of true out-of-pocket (TrOOP) costs for the calendar year. The member will then pay either a $3.30 copay for generic ($8.25 copay for brand drugs), or a 5% coinsurance, whichever is the greater amount.|
Search for Medications
Please go to the EmblemHealth Medicare website for the following listings:
- The EmblemHealth HMO/PPO Drug Formulary (the listing of preferred, non-preferred and specialty covered drugs)
- The drugs that require your doctor get prior approval so that they may be covered by your plan
- The drugs that are covered for only a limited quantity
- The drugs that require step therapy pre-approval
To use the retail pharmacy service, present your ID card at any participating pharmacy nationwide. Most major drug store chains (e.g., Walgreens, Duane Reade, CVS, Rite Aid, Target and Walmart) are part of your plan. The retail pharmacy should be used when filling a prescription for short-term (a 30-day supply or less) medications.
Find a pharmacy.
Set Up Home Delivery and Refills
Using Express Scripts, Inc. (ESI), our home-delivery pharmacy, you can have your approved long-term medications (maintenance drugs) mailed right to your home.
Examples of maintenance drugs are medications used for high cholesterol, high blood pressure, allergies and heartburn. There is no difference between drugs delivered by ESI and those you pick up at your walk-in pharmacy.
Go to the EmblemHealth Medicare website to find out more about the benefits of home delivery and how to enroll in the service.
Additional Pharmacy Information
Go to the EmblemHealth Medicare website for additional pharmacy information, such as details on:
- Medication therapy management (MTM)
- Low-income subsidy (extra help)
- Additional forms and resources