Statutes, codes, and regulations
Louisiana Administrative Code
Title 32 - EMPLOYEE BENEFITSPart V - Additional Plans and Operations
Chapter 4 - PPO/Consumer-Driven Health Plan Structure-Pelican HSA 775 Plan
Section V-407 - Prescription Drug Benefits

La. Admin. Code tit. 32 § V-407

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Current through Register Vol. 50, No. 9, September 20, 2024
Section V-407 - Prescription Drug Benefits
A. Prescription Drug Benefits

Network Pharmacy

Member pays

Generic

$10 co-pay

Preferred

$25 co-pay

Non-preferred

$50 co-pay

Specialty

$50 co-pay

Prescription drug benefits-31 day refill

Maintenance drugs: not subject to deductible; subject to applicate co-payments above.

Plan pays balance of eligible expenses

Member who chooses a brand-name drug for which an approved generic version is available, pays the cost difference between the brand-name drug & the generic drug, plus the co-pay for the brand-name drug

Medications available over-the-counter in the same prescribed strength are not covered under the pharmacy plan.

Smoking Cessation Medications:

Benefits are available for Prescription and over-the-counter (OTC) smoking cessation medications when prescribed by a physician. (Prescription is required for over-the-counter medications). Smoking cessation medications are covered at 100%.

This plan allows benefits for drugs and medicines approved by the Food and Drug Administration or its successor that require a prescription. Utilization management criteria may apply to specific drugs or drug categories to be determined by PBM.

B. OGB shall have discretion to adopt a pharmacy benefits formulary to help enrollees select the most appropriate, lowest-cost options. The formulary will be reviewed on a quarterly basis to reassess drug tiers based on the current prescription drug market. The formulary may be changed from time to time subject to any applicable advance notice requirements. The amount enrollees pay toward prescription medications will depend on whether they purchase a generic, preferred brand, non-preferred brand, or specialty drug.

La. Admin. Code tit. 32, § V-407

Promulgated by the Office of the Office of the Governor, Division of Administration, Office of Group Benefits, LR 41:362 (February 2015), effective March 1, 2015.
AUTHORITY NOTE: Promulgated in accordance with R.S. 42:801(C) and 802(B)(1).