Welfare Fund additions
In addition to the proposed MOA, the PSC-CUNY Welfare Fund has announced new benefit enhancements, the funding for which is already in place:
The enhancements will be effective January 1, 2020. The enhancements will double the frequency of the Welfare Fund’s vision benefit, introduce new lower copayments for generic drugs, and offer major relief for members with conditions that entail exceptionally high prescription drug costs.
Fund Trustees carefully considered the financial position of the Fund and the expressed needs of our members before making the decision to enhance benefits. Given the increased funding from contracts negotiated by city municipal unions with New York City and by the PSC with CUNY, and the continued focus of the fund on administrative efficiencies, the trustees determined that the fund was well positioned financially and able to enhance benefits.
Barbara Bowen, chair of the PSC-CUNY Welfare Fund, spoke for the trustees when she said, “Thanks to PSC contracts and smart decisions by the Welfare Fund administrators, the Welfare Fund is in a strong financial position and can project continuing financial strength. As trustees, we were able to enhance benefits last year, and we are now in a position to enhance benefits again to cover needs of members that are currently unmet.”
What follows are brief overviews of the benefit additions and improvements. Complete descriptions will follow this letter and will be available on the Welfare Fund website.
Beginning January 1, 2020, the frequency of the Davis Vision in-network benefit will be doubled. All plan participants and their eligible dependents will be entitled to a pair of glasses (lenses and frames, or contact lenses, and an optometric examination) once per year (12 months). This annual benefit is available through the Davis Vision vendor network contracted by the fund, which includes all licensed optometrists that participate with Davis Vision. Service through the Davis network requires no out-of-pocket costs for a broad selection of Davis-branded frames, lenses and contact lenses, and includes coverage for progressive lenses, transition lenses and other enhancements. Eyeglasses and eye exams purchased outside of the Davis Vision in-network plan are not eligible for this enhancement.
REDUCED GENERIC COPAYS
Beginning January 1, 2020, members in active employment and retirees under 65 enrolled in the PSC-CUNY Welfare Fund Prescription Plan will have no copayment when filling a prescription for a generic drug included in the Welfare Fund-CVS $0 generic copay formulary and when the prescription is filled at a CVS pharmacy or through the CVS mail program. A list of the $0-copay generic medications will be posted on the Welfare Fund website. Generic drugs purchased outside of a CVS pharmacy are not included in the program.
While the new $0 generic copay formulary list includes many of the drugs most often prescribed to our members, some generic drugs are not on the formulary list. For generic drugs covered by the fund but not on the list, costs will also be reduced. Members will be able to take advantage of the new 10% generic copay program, described below.
The copayment for generic drugs not included in the $0 generic copay formulary but covered under the PSC-CUNY Welfare Fund Prescription Plan formulary will be reduced from 20% to 10% when the prescription is filled at a CVS pharmacy or CVS mail-order facility. If the fund’s coverage for a member’s prescription drugs reaches $10,000 in a 12-month period beginning on January 1 of each calendar year, the member’s copay will revert to the plan’s usual tiered copay structure. At that point the member will be eligible to apply for copay reimbursement under the new High-Cost Rx Program, described below.
The fund is aware that not all members have a CVS drugstore as conveniently located as some other retail pharmacies, but members will now have a choice of continuing to use a non-CVS pharmacy or realizing new savings by filling prescriptions at CVS or through the CVS mail-order facility.
HIGH-COST RX PLAN
Beginning January 1, 2020, the fund’s prescription drug benefit will include up to an additional $25,000 in reimbursement for out-of-pocket prescription costs when certain conditions are met.
Some of our members purchase prescription drugs for medical conditions that are very costly and not completely covered by our prescription drug plan. For example, the cost of medications that treat HIV, MS, hepatitis C, and other diseases expose members to possible high out-of-pocket costs.
Because drug companies’ pricing and marketing structure is complicated, our plan to cover members who face high out-of-pocket costs is forced to be complicated as well. Over the last several years, the fund has explored various ways to provide some relief to our members for copayments of high-cost drugs. We believe the new High-Cost Rx Plan is the best way to provide our members with help for coverage of high-cost prescription drug copayments.
DRUG EXPENSE ASSISTANCE
The High-Cost Rx Plan will take effect on January 1, 2020, and is designed to assist members in active employment and retirees under 65 who are enrolled in the PSC-CUNY Welfare Fund Prescription Plan and who are experiencing significant out-of-pocket drug expenses. Retiree members who are 65 and over are currently covered under the Welfare Fund’s Medicare Part D SilverScript prescription program, which has its own catastrophic copay cost protection. Because they do not face the same high out-of-pocket cost threat as active and under-65 retiree members, these members will not be eligible to participate in the new High-Cost Rx program.
Under the new High-Cost Rx Plan, eligible members and their covered dependents may apply for reimbursement of eligible out-of-pocket drug costs that exceed $2,500 on an annual basis. The fund will reimburse up to $25,000 per person per year, after the first $2,500 of eligible out-of-pocket costs are expended. The plan will be administered by Administrative Services Only (ASO), a third-party company hired by the Welfare Fund. Members will submit their claims to be reimbursed directly to ASO, and reimbursement claims may only be submitted on a quarterly basis.
Eligible claims submissions to ASO must include copies of pharmacy cashier’s receipts, prescription package receipts (including complete drug information, date of service and amount paid), and use of any copay-reduction coupons. The claim form and examples of acceptable receipts will be available on the Welfare Fund website. If the member participates in a catastrophic medical insurance plan that covers prescription drug costs, the Welfare Fund will pay only after claims have been submitted to the other catastrophic insurance carrier.
Not all out-of-pocket drug costs will be eligible, such as costs for drugs purchased through any plans other than the PSC-CUNY Welfare Fund Prescription Plan, drugs excluded from the Welfare Fund formulary or plan, and any dispensing penalty costs. Complete plan details will be available on the fund website.
Detailed plan descriptions of these enhanced benefits will follow this notification and will be available on the PSC-CUNY Welfare Fund website, psccunywf.org. The website is always the first, best place to learn about your benefits and how to take advantage of them. You can also call the fund staff at 212-354-5230, or email [email protected].
Steve London is the executive officer of the PSC-CUNY Welfare Fund.