T2679 Exhibit A - Stand Alone Prescription Drug Plan 10.23.25.pdf
PDF 420 KB Posted
- Solicitation number
- 25DPP01133
- Issued by
- Mercer County, New Jersey
About this file
This document is an Exhibit A from the New Jersey Division of Pensions & Benefits (NJDPB) detailing Stand Alone Prescription Drug Plan options for Local Government and Local Education Active Group Prescription Plan Designs for Plan Year 2024. The document provides comprehensive side-by-side comparisons of prescription drug plans from providers Aetna and Horizon, offering multiple plan variations including Freedom, NJ DIRECT, HMO, Liberty Plus, OMNIA, and High Deductible Health Plan (HD) options. These plans cover prescription drug benefits for both local government and education employers, with variations in copayments for generic, preferred brand, and non-preferred brand medications at both retail and mail order pharmacies.
The prescription drug plans feature consistent annual out-of-pocket maximums ranging from $1,600 to $1,890 for individuals and $3,200 to $3,780 for families, with copayments varying by plan type. Retail copayments for generic drugs range from $3 to $7, while preferred brand copayments range from $10 to $18. Mail order plans generally offer 90-day supplies with slightly different copayment structures. Local government and education employers have flexibility to select from the State Health Benefits Program's (SHBP) Prescription Drug Plans, purchase their own coverage, or receive prescription drug coverage through the SHBP medical plan. The document notes that for members hired before July 1, 2019, different enrollment rules apply compared to those hired after that date.
View the file
Other files
Show all 17
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
T2679 25DPP01133 Employee Benefits: Pharmacy Benefits Management
EXHIBIT A - STAND ALONE PRESCIPTION DRUG PLAN LOCAL
GOVERNMENT ACTIVE GROUP PRESCRIPTION PLAN DESIGN - PLAN
YEAR 2024
Pensions & Benefits
HA-1154-0424
Side-by-Side Rx Comparison Aetna Freedom/ Freedom 2019*
Horizon NJ DIRECT/
NJ DIRECT 2019*
Aetna Freedom10
Horizon
NJ DIRECT10
Aetna Freedom15
Horizon
NJ DIRECT15
Retail: Generic Copayments $7 $7 $3 $3 $3 $3
Retail: Preferred Brand Copayments $16 $16 $10 $10 $10 $10
Retail: Non-Preferred Brand Copayments
Member pays difference1
Member pays difference1 $10 $10 $10 $10
Retail: Brand w/ Generic Equivalent
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1
Mail: Generic Copayments $0 $0 $0 $0 $0 $0
Mail: Preferred Brand Copayments $40 $40 $15 $15 $15 $15
Mail: Non-Preferred Brand Copayments
Member pays difference1
Member pays difference1 $15 $15 $15 $15
Mail: Brand w/ Generic Equivalent
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1
Prescription Drug annual Out-of-Pocket Maximum (Individual/Family)
$1,890/$3,780 $1,890/$3,780 $1,890/$3,780 $1,890/$3,780 $1,890/$3,780 $1,890/$3,780
GOVERNMENT ACTIVE GROUP PRESCRIPTION PLAN DESIGN - PLAN
YEAR 2024
Pensions & Benefits
HA-1154-0424
Side-by-Side Rx Comparison Aetna
Freedom1525 Horizon
NJ DIRECT1525
Aetna
Freedom2030 Horizon
NJ DIRECT2030
Aetna
Freedom2035 Horizon
NJ DIRECT2035
Retail: Generic Copayments $7 $7 $3 $3 $72 $72
Retail: Preferred Brand Copayments $16 $16 $18 $18 $212 $212
Retail: Non-Preferred Brand Copayments $35 $35 $46 $46 Member pays difference1,2 Member pays difference1,2
Retail: Brand w/ Generic Equivalent
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1,2
Member pays difference1,2
Mail: Generic Copayments $0 $0 $0 $0 $0 $0
Mail: Preferred Brand Copayments $40 $40 $36 $36 $52 $52
Mail: Non-Preferred Brand Copayments $88 $88 $92 $92 Member pays difference1,2 Member pays difference1,2
Mail: Brand w/ Generic Equivalent
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1,2
Member pays difference1,2
Prescription Drug annual Out-of-Pocket Maximum
$1,890/$3,780 $1,890/$3,780 $1,890/$3,780 $1,890/$3,780 $1,890/$3,780 $1,890/$3,780
GOVERNMENT ACTIVE GROUP PRESCRIPTION PLAN DESIGN - PLAN
YEAR 2024
Pensions & Benefits
HA-1154-0424
Side-by-Side Rx Comparison Aetna HMO Horizon HMO3 Aetna Liberty Plus Horizon OMNIA Aetna
Freedom HDHigh** Horizon
NJ DIRECT HDHigh** Retail: Generic Copayments $3 $3 $7 $7
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Retail: Preferred Brand Copayments $10 $10 $16 $16
Retail: Non-Preferred Brand Copayments $10 $10 $35 $35
Retail: Brand w/ Generic Equivalent
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1
Mail: Generic Copayments $0 $0 $0 $0
Mail: Preferred Brand Copayments $15 $15 $40 $40
Mail: Non-Preferred Brand Copayments $15 $15 $88 $88
Mail: Brand w/ Generic Equivalent
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1
Prescription Drug annual Out-of- Pocket Maximum
$1,890/$3,780 $1,890/$3,780 $1,890/$3,780 $1,890/$3,780
GOVERNMENT ACTIVE GROUP PRESCRIPTION PLAN DESIGN - PLAN
YEAR 2024
Pensions & Benefits
HA-1154-0424
Side-by-Side Rx Comparison Aetna
Freedom HDLow** Horizon
NJ DIRECT HDLow** Retail: Generic Copayments
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Retail: Preferred Brand Copayments Retail: Non-Preferred Brand Copayments Retail: Brand w/ Generic Equivalent Mail: Generic Copayments Mail: Preferred Brand Copayments Mail: Non-Preferred Brand Copayments Mail: Brand w/ Generic Equivalent Prescription Drug annual Out-of- Pocket Maximum (Individual/Family)
* Members hired before July 1, 2019, will be enrolled in Aetna Freedom or Horizon NJ DIRECT. Members hired after July 1, 2019, will be enrolled in Aetna Freedom 2019 or Horizon NJ DIRECT 2019.
** HD = High Deductible Health Plan 1 You pay the cost difference between the brand drug and the generic drug.
| 2 | For maintenance prescription drugs, mail order is mandatory under Aetna Freedom 2035 and Horizon NJ DIRECT2035. |
| 4 | Service areas for the Horizon HMO plan are limited to New Jersey, New Castle County in Delaware, and bordering counties of Pennsylvania and New York. |
Note: Retail – 30 day supply. Mail – 90 day supply. Oral contraceptive coverage is available under the medical and prescription plans.
Local government employers can select from the SHBP’s Prescription Drug Plans, purchase their own prescription drug coverage plan, or receive prescription drug coverage through the SHBP medical plan. Copayments shown above to the plans when coverage is through the SHBP’s Prescription Drug Plans. If prescription drug coverage is through the medical plan: Coinsurance is 10% for Aetna Freedom10, Horizon NJ DIRECT10, Aetna Freedom15, and Horizon NJ DIRECT15; Coinsurance is 15% for Aetna Freedom1525, Horizon NJ DIRECT1525 Aetna Freedom2030, and Horizon NJ DIRECT2030; Coinsurance is 20% for Aetna Freedom2035 and NJ DIRECT2035. For High Deductible Health Plans, prescription drug coverage must be through the SHBP medical plan and are subject to the plan’s deductible and coinsurance amounts.
This publication is produced and distributed by the New Jersey Division of Pensions & Benefits — www.nj.gov/treasury/pensions This is a summary and not intended to provide all information. Although every attempt at accuracy is made, it cannot be guaranteed.
T2679 25DPP01133 Employee Benefits: Pharmacy Benefits Management
EXHIBIT A - STAND ALONE PRESCRIPTION DRUG PLAN
LOCAL EDUCATION ACTIVE GROUP PRESCRIPTION
PLAN DESIGN - PLAN YEAR 2024
Pensions & Benefits
HA-1155-0424
Side-by-Side Rx Comparison Aetna
Freedom10 Horizon
NJ DIRECT10
Aetna
Freedom15 Horizon
NJ DIRECT15
Retail: Generic Copayments $3 $3 $3 $3
Retail: Preferred Brand Copayments $10 $10 $10 $10
Retail: Non-Preferred Brand Copayments $10 $10 $10 $10
Mail: Generic Copayments $5 $5 $5 $5
Mail: Preferred Brand Copayments $15 $15 $15 $15 Mail: Non-Preferred Brand Copayments $15 $15 $15 $15
Prescription Drug annual Out-of- Pocket Maximum (Individual/Family) $1,890/$3,780 $1,890/$3,780 $1,890/$3,780 $1,890/$3,780
T2679 25DPP01133 Employee Benefits: Pharmacy Benefits Management
EXHIBIT A - STAND ALONE PRESCRIPTION DRUG PLAN
LOCAL EDUCATION ACTIVE GROUP PRESCRIPTION
PLAN DESIGN - PLAN YEAR 2024
Pensions & Benefits
HA-1155-0424
Side-by-Side Rx Comparison Aetna NJEHP Horizon NJEHP
Aetna Garden State Health
Plan (GSHP) Retail: Generic Copayments $5 $5 $5
Retail: Preferred Brand Copayments $10 $10 $10
Retail: Non-Preferred Brand Copayments1
Member pays difference
Member pays difference
Member pays difference
Mail: Generic Copayments $10 $10 $10
Mail: Preferred Brand Copayments $20 $20 $20 Mail: Non-Preferred Brand Copayments1
Member pays difference
Member pays difference
Member pays difference
Prescription Drug annual Out-of- Pocket Maximum (Individual/Family) $1,600/$3,200 $1,600/$3,200 $1,600/$3,200
This publication is produced and distributed by the New Jersey Division of Pensions & Benefits — www.nj.gov/treasury/pensions This is a summary and not intended to provide all infor mation. Although every attempt at accuracy is made, it cannot be guaranteed.
Note: Retail – 30 day supply. Mail – 90 day supply. Oral contraceptive coverage is available under the medical and prescription plans.
Local education employers can select from the SEHBP’s Prescription Drug Plans, purchase their own prescription druge coverage plan, or receive prescription drug coverage through the SEHBP medical plan. Copayments shown apply to the plans when coverage is through the SEHBP’s Prescription Drug Plans. If prescription drug coverage is through the medical plan: for Aetna Freedom10, Horizon NJ DIRECT10, Aetna Freedom15, and Horizon NJ DIRECT15, coinsurance is 10%; for Aetna and Horizon NJEHP and Aetna GSHP, copays are the same as if coverage through the SEHBP’s Prescription Drug Plan as show in the chart above.
1 You pay the applicable brand copayment listed above, plus the cost difference between the brand drug and the generic drug.
File details come from the government source that posted it. Updated .