Board of Regents of The University System of Georgia

Welcome to Your Prescription Drug Benefit Program for 2008!
The Prescription Drug Benefit program provides quality care for you and your family while managing costs. With the Board of Regents of the University System of Georgia/Express Scripts prescription program, you can get your prescription filled at any participating pharmacy. Please remember to present your prescription ID card with your prescription. Look below for information regarding the 2008 Board of Regents Prescription Drug Program.

Standard Retail Copayment Amounts (up to a 30-day supply)
Generic Drugs	$10
Preferred Brand Drugs	$25
Non-Preferred Brand Drugs	20%, with $40 minimum and $100 maximum

Maintenance Retail Copayment Amounts (up to a 90-day supply)
Generic Drugs	1-30 Days supply = $10 31-60 Days supply = $20 61-90 Days supply = $30
Preferred Brand Drugs	1-30 Days supply = $25 31-60 Days supply = $50 61-90 Days supply = $75
Non-Preferred Brand Drugs	1-30 Days supply = 20%, with $40 minimum and $100 maximum 31-60 Days supply = 20%, with $80 minimum and $200 maximum 61-90 Days supply = 20%, with $120 minimum and $300 maximum

Restricted Generic Policy/Pay the Difference
Restricted Generic Policy applies to the pharmacy benefit. With this program, members are required to pay the ancillary charges (the difference in cost between the brand and generic medication), in addition to their generic copayment when they request brand-name drugs that have a generic available. If your physician mandates or requests the brand name over the generic, you will only be responsible for the brand or non-preferred brand copayment.

Maintenance Medication
Maintenance Medications are those prescription drugs that a member may obtain for a Period of up to 90 days. The member will be charged one co-payment per 30-day supply, subject to plan design and plan coverage rules. Maintenance Medications for the plan include but are not limited to:

Cardiovascular medications for hypertension and heart disease
Anti-Parkinson medications
Medications for the treatment of epilepsy
Asthma medications that are taken orally, excluding inhalers
Diabetic medications
Thyroid medications
Estrogen and Progestin medications (when not made into a compound medication)

Quarterly Out-of-Pocket Maximum
The Board of Regents (BOR) Prescription Drug Program includes a quarterly out-of-pocket maximum for members who obtain generic and preferred brand prescription medications. The following quarterly out-of-pocket maximum amounts (stop loss) will apply:

Employee: $450 per quarter
Employee plus Child or Employee plus Spouse (2 covered members): $900 per quarter
Family (3 or more covered members): $1,350 per quarter

Once a member has reached his or her quarterly out-of-pocket maximum, his or her prescription drug copayments will be waived for any additional generic and preferred brand medications for the remainder of that quarter. Member copayments will resume at the beginning of the next calendar quarter and will be charged until the plan thresholds are reached for that quarter.

Quarters consist of three consecutive months and are referenced as follows:

1^st quarter = January through March
2^nd quarter = April through June
3^rd quarter = July through September
4^th quarter = October through December

Important Notes:

Copayments for non-preferred brand medications will not apply to the quarterly out-of-pocket maximum benefit.
Prescription drug copayments do not apply to University System of Georgia medical annual deductibles or to medical maximum annual out-of-pocket limits (stop loss).
If a member purchases a preferred brand prescription drug that is not indicated as “Brand Necessary,” and there is a generic alternative available; only the $10 generic member copayment will be applied to the quarterly maximum out-of-pocket member benefit. The difference in cost between the generic alternative and the preferred brand medication will not apply to the quarterly maximum out-of-pocket member benefit.
Prescription drug copayments covered by the healthcare plan will not be changed or overridden on an individual basis.

Pharmacy Network
The pharmacy network for the Board of Regents includes the major chains as well as independent pharmacies. View or print our convenient pharmacy listing (PDF file) . For up-to-date pharmacy location information, including participating pharmacies outside of Georgia, please call the Express Scripts Customer Service Center toll-free at 877.650.9341 (TDD 800.842.5754).

Progressive Drug Management Program
The Progressive Drug Management Program (PDMP) is designed to assist your physician in identifying the most appropriate and cost-efficient therapeutic treatment strategy for you and your family. The Progressive Drug Management Programs currently supported by the Board of Regents are:

COX-2 (for example, Celebrex); effective Jan. 1, 2005
Xopenex; effective July 1, 2005
Leukotriene Pathway Inhibitors (for example, Accolate, Singulair, and Zyflo); effective July 1, 2005
Topical Immunomodulators (for example, Elidel and Protopic); effective July 1, 2005
ACE Inhibitors and ACE Inhibitor combinations (for example, Accupril, Capoten, Monopril, Prinivil, and Zestril and Capozide, Monopril HCT, Prinzide, and Zestoretic); effective Jan. 1, 2006
ARBs (angiotensin receptor antagonists) and ARB Combinations (for example, Cozaar, Diovan, and Teveten and Hyzaar, Diovan HCT, and Teveten HCT); effective Jan. 1, 2006
Branded NSAIDs (nonsteroidal anti-inflammatory agents) (for example, Arthotec, Ponstel, and Mobic); effective Jan. 1, 2006
CCBs (calcium channel blockers) (for example, Covera-HS, Veralan-HS, Norvasc, Cardene SR, Sular, and DynaCirc CR); effective Jan. 1, 2006
HMG (cholesterol-lowering agents) (for example, Lipitor, Lescol, Mevacor, Altoprev, Pravachol, Crestor, Zocor, Caduet, Pravigard, and Advicor); effective Jan. 1, 2006
SSRIs (selective serotonin reuptake inhibitors) (for example, Celexa, Lexapro, Luvox, Paxil, Pexeva, Prozac, Zoloft, and Sarafem); effective Jan. 1, 2006
Other Antidepressants (for example, Cymbalta, Effexor, and Wellbutrin XL); effective Jan. 1, 2006
Nasal Steroids (for example, Rhinocort Aqua, Beconase AQ, Nasacort AQ, Nasarel, and Nasonex); effective Jan. 1, 2007
NSAs (Non Sedating Antihistamines) (for example, Allegra, Allegra-D, Clarinex, Clarinex-D, Zertec, and Zertec-D); effective Jan. 1, 2007
Topical Corticosteroids (for example, Locoid, Diprolene, Elocon, Aclovate, and Lidex); effective Jan. 1, 2007
OAB (Overactive Bladder) (for example, Detrol, Detrol LA, Vesicare, Enablex, Oxytrol, Ditropan, and Ditropan XL) – effective January 1, 2008
Standard Hypnotics (for example, Ambien, Ambien CR, Sonata, Rozerem, and Lunesta) – effective January 1, 2008

Note: Additional drug categories may be added to the PDMP during the plan year. Members currently taking one of the above mentioned medications on a regular basis will be grandfathered into the program.

2008 Express Scripts/Board of Regents Preferred Drug List
The 2008 Express Scripts/Board of Regents Preferred Drug List is a list of recommended prescription medications that is created, reviewed and continually updated by a team of physicians and pharmacists. The 2008 Express Scripts/Board of Regents Preferred Drug List contains a wide range of generic and brand-name preferred products that have been approved by the Food and Drug Administration (FDA). A medication becomes a preferred drug based first on safety and efficacy, then on cost effectiveness.

View the List by Therapy Class (PDF file)
View the List Alphabetically (PDF file)

Paper Claims
If you use a non-participating pharmacy or are unable to use your prescription card at a pharmacy, you will be required to pay in full for your prescription. You will have to submit a Member Reimbursement Claim Form (DOC file) by mail for reimbursement.

For additional forms, please feel free to copy the form. The following information will be required in order to process your claim: pharmacy receipt or patient profile (cash register receipts will not be accepted), date of service, prescription number, amount paid, quantity and days supply of the medication, National Drug Code (NDC) of the medication and member signature.

2008 Board of Regents Member Handbook
View the 2008 Board of Regents Member Handbook. (PDF file)

Coordination of Benefits
There will be no Coordination of Benefits (COB) for allowed pharmacy charges between the Board of Regents pharmacy plan and another pharmacy/medical plan in which the member may be enrolled.

For questions regarding the Board of Regents' pharmacy program please contact Express Scripts toll-free at 877.650.9341 (TDD 800.899.2114).

PDF files require Adobe Acrobat Reader.

DOC files require Microsoft Word®.