Retiree Health Summary Plan Description
As of February 1, 2018
En Español (PDF)

5.6 Covered Benefits

The Mandatory Generic Prescription Drug Plan covers the following services and materials:

  1. Federal legend drugs: Any medicinal substance which bears the legend, "Caution: Federal law prohibits dispensing without a prescription;"
  2. State-restricted drugs: Any medicinal substance, which may be dispensed by prescription only according to state law;
  3. Federal legend oral contraceptives and birth control pills;
  4. Contraceptive products, including, but not limited to diaphragms, cervical caps, Depo-Provera™ injections and Ortho-Evra™ patches;
  5. Inhaler extender devices and bags (e.g. Aerochamber™, Aerochamber™ with mask, Easivent™, Inspirsease™, EZ-Spacer™, Optichamber™, Optihaler™, Ellipse™);
  6. Anaphylaxis prevention kits, including, but not limited to, Epi-Pen™, Epi-Pen Jr.™, Ana-Kits™, Ana-Kit Jr.™, Glucagon™, Glucagon Emergency Kit™, and Ana-Guard™;
  7. Compounds with at least one federal legend or state-restricted ingredient;
  8. Normal saline for inhalation and irrigation;
  9. Prescription prenatal vitamins; and
  10. Injectables (see also Exclusions for exceptions).

The following non-prescription items are also covered when prescribed in writing by a physician and dispensed by a licensed pharmacist:

  1. Insulin, insulin syringes and needles;
  2. Blood glucose test strips;
  3. Urine glucose test strips;
  4. Sterile lancets; and
  5. Novolin™ pen, Humulin™ pen, pre-filled pens, pen needles and cartridges.