Effective January 1, 2025, there will be a change to prescription drug coverage for weight loss drugs. Click HERE to read the announcement.
The Capital Rx Member Portal is https://app.cap-rx.com/login.
You may continue to use Wegmans and (if in the Rockland County area)
Stony Point Pharmacy for 90-day maintenance mail order.
Remember that you can call Capital Rx Customer Care anytime at 1-833-772-2779.
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Coverage
Your NY44 Medical Plan coverage includes coverage for prescription drugs. The Pharmacy Plan is administered by CapitalRx.
*Non-Maintenance Medications are 30 days, 90-day maintenance costs could differ slightly.
| Traditional Plan | Core Plan | Progressive Plan | |
| Tier One | $0 | $5 | $5 |
| Tier Two | $15 | $25 | $40 |
| Tier Three | $30 | $60 | $75 |
*The Progressive Plan Rx Copays are first to subject to this plan’s deductible.
The Board of Trustees have approved a change to a new pharmacy benefits manager, also known as a (PBM) vendor. Effective July 1, 2021, we changed the prescription drug coverage administration to our new administrator, Capital Rx.
A few key points:
- If there are any formulary changes, impacted enrollees will be notified directly by Capital Rx.
- Click HERE to learn more about the Capital Rx formulary and check the list of drugs that are included on the formulary list.
- Members will be able to fill mail order prescriptions through Optum, Wegmans, and Stoney Point Pharmacy (North Rockland).
- Much of the remaining mail order will be transferred directly to Optum. (Note: There are some limitations on what cannot be transferred such as: expired prescriptions, prescriptions without refills, compounds, controlled substance drugs).
- Capital Rx has a broad network of over 60,000 retail pharmacies. Their network includes most major retail chains, grocery in-store pharmacies as well as some locally owned pharmacies. This means the retail pharmacy you currently utilize is most likely included in their current network.
- Don’t Forget! The enrollee is responsible to end Mail Order automatic refills when their Rx prescription changes, their coverage ends, or they transfer their prescriptions to a new Pharmacy.
