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CAPITAL RX

Effective January 1, 2025, there will be a change to prescription drug coverage for weight loss drugs. Click HERE to read the announcement.

CLICK HERE to learn more about the Capital Rx formulary and check the list of drugs that are included on the formulary list.

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.
  • 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.
CapRx_ImportantReminders

As previously communicated, with the transition to Capital Rx, we indicated there would be differences in the formulary drug lists and drugs requiring prior authorization.

To minimize the impact to members, the Trust instructed Capital Rx to “waive” these requirements through a period known as “Continuation of Therapy,” originally set to expire October 1st. The Trust has decided to extend this period through January 31, 2022 to allow members additional time to work with their providers and Capital Rx.

At the NY44 Health Benefits Plan Trust (“Trust”) Board of Trustees meeting on November 18, 2021, a decision was made to cancel certain changes and postpone other changes to the new prescription drug plan formulary with Capital Rx. Please click HERE here for important details regarding how your current prescription drug coverage is impacted.