Employee Prescription Drug Plan
The Employee Prescription Drug Plan is offered to active State
employees and their eligible dependents as a separate prescription drug plan.
Local employers may also elect* to provide the SHBP/SEHBP Employee Prescription
Drug Plan to their employees as a separate prescription drug benefit.
Employee Prescription Drug Plan benefits are available through
a participating retail pharmacy or through the CVS Caremark mail order
service.
- Retail pharmacy services require a copayment for each
30-day supply. You may obtain a 90-day supply of prescription
drugs at a participating retail pharmacy.
- Mail order participants can receive up to a 90-day supply
of prescription drugs for one copayment through CVS Caremark.
*Employees whose local employer does not offer a separate prescription drug plan
have prescription drug coverage through the
Employee Prescription Drug Reimbursement Plan.
See NJ DIRECT section for more information.
Pharmacy Locator
Click here to locate a Participating Pharmacy.
Drug Center
Click here to access the Horizon BCBSNJ Drug Center.
Pharmacy Dispensing Limits
Click here to access Pharmacy Dispensing Limit information.
Retiree Prescription Drug Coverage
Retirees enrolled in NJ DIRECT have access
to a separate prescription drug plan that includes retail pharmacies
and a mail order service through CVS Caremark. The plan features a three-tier
copayment design - Tier I for generic drugs, Tier II for preferred
brand name drugs, and Tier III for all other brand name drugs.
Click here to view the Preferred Prescription Drug Guide.
You may purchase up to a 90-day supply of medication at a retail pharmacy
when prescribed, by paying the applicable copayment for each 30-day
supply. Mail order service provides up to a 90-day supply for a
single copayment. An annual, per person, prescription drug copayment
maximum applies which limits your out-of-pocket expenses.
Important Note regarding Medicare Part D
Most Medicare eligible retirees and/or their Medicare eligible
dependents should not enroll in Medicare Part D. Some members
who qualify for low income subsidy programs may find it beneficial
to enroll in Medicare Part D. However, once you and/or your dependents
enroll in Medicare Part D, your SHBP/SEHBP Retiree Prescription Drug
Coverage benefits will be terminated for you and your dependents.
CVS Caremark Specialty Pharmacy Program
SHBP/SEHBP Prescription Drug Plans will include an exclusive arrangement with
CVS Caremark Specialty Pharmacy for the purchase of specialty pharmaceuticals. Specialty
pharmaceuticals are a class of medications that are typically produced through
biotechnology, administered by injection and/or require special patient
monitoring and handling.
Click here
to access the Specialty Pharmacy Drug List. To be eligible, specialty pharmaceuticals
must be purchased from the CVS Caremark Specialty Pharmacy. For more information,
click here.
Click here
to be redirected to the NJ Division of Pensions and Benefits
website which includes a detailed description of Prescription
Drug Benefits for retirees in the NJ State Health Benefits Program and the School
Employees' Health Benefits Program.
This section includes only a general description of the benefits available to members
of the NJ State Health Benefits Program and School Employees' Health Benefits Program.
The benefits described are subject to all of the terms, conditions, limitations and
definitions included in the Plan documents. If there is a contradiction between the
benefits described in this section and those provided in the Plan documents, the Plan
documents will prevail.
NJ Division of Pensions and Benefits - State Health Benefits Program and School Employees' Health Benefits Program
Here you will find information such as the Summary Plan Description, Member Handbooks, Plan Comparisons, Enrollment Forms, and more.
