81-54-HQA

Control Number: 81-54

Subject: Copayment for Prescription Drugs for Which the Charge is Less than $5.00

References: Amended 1950 & 1974 Benefit Plans & Trusts,
Article III, Sections A (4) and A (8) (b)

Question:

How is the copayment applied and credited for a prescription drug for which the charge is $5.00 or less?

Answer:

If the Beneficiary has not yet reached the prescription drug copayment maximum, the Beneficiary is responsible for the payment of the total charge for the prescription. In order to credit the Beneficiary’s copayment account, a receipt should be sent to the Funds.

If the Beneficiary has reached his/her copayment maximum, the pharmacy should bill the Funds for the actual charge.