T2679 Exhibit B - Built In Prescription Drug Plan 10.23.25.pdf
PDF 295 KB Posted
- Solicitation number
- 25DPP01133
- Issued by
- Mercer County, New Jersey
About this file
This document is an Exhibit B for Pharmacy Benefits Management for the New Jersey Division of Pensions & Benefits, specifically detailing prescription drug plan designs for the State Active Group and Union Negotiated Plans for Plan Year 2024. The document provides comprehensive side-by-side comparisons of prescription drug benefit options from Aetna and Horizon for various health plan categories, including CWA members, state active group, and union negotiated plans. The plans include multiple options such as CWA Unity Freedom, Horizon NJ DIRECT, Aetna HMO, Horizon HMO, Aetna Liberty Plus, Horizon OMNIA, and High Deductible Health Plans (HD).
The prescription plans feature consistent annual out-of-pocket maximums of $1,890 for individuals and $3,780 for families across all options. Retail copayments vary by plan, with generic medications ranging from $3 to $7 and brand-name medications from $10 to $16. Mail-order generic medications are consistently $0, while brand-name mail-order copayments range from $15 to $40. A notable feature is that for brand medications with generic alternatives, members pay the cost difference between the brand and generic drug. The document also notes that members hired before July 1, 2019, will be enrolled in different plan variations compared to those hired after that date, and oral contraceptive coverage is available under both medical and prescription plans.
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T2679 25DPP01133 Employee Benefits: Pharmacy Benefits Management
EXHIBIT B - BUILT IN PRESCRIPTION DRUG PLAN CWA MEMBERS
STATE ACTIVE GROUP
PRESCRIPTION PLAN DESIGN - PLAN YEAR 2024
Pensions & Benefits
HA-1156-0424
Side-by-Side Rx Comparison
Aetna CWA Unity Freedom/ Unity Freedom 2019*
Horizon CWA Unity DIRECT/
DIRECT 2019* Aetna HMO Horizon HMO1 Aetna Liberty Plus Horizon OMNIA Retail: Generic Copayments $7 $7 $3 $3 $7 $7
Retail: Brand Copayments $16 $16 $10 $10 $16 $16
Retail: Brand w/Generic available Copayments2
Member pays difference
Member pays difference
Member pays difference
Member pays difference
Member pays difference
Member pays difference
Mail: Generic Copayments $0 $0 $0 $0 $0 $0
Mail: Brand Copayments $40 $40 $15 $15 $40 $40 Mail: Brand w/Generic available Copayments2
Member pays difference
Member pays difference
Member pays difference
Member pays difference
Member pays difference
Member pays difference
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
EXHIBIT B - BUILT IN PRESCRIPTION DRUG PLAN CWA MEMBERS
STATE ACTIVE GROUP
PRESCRIPTION PLAN DESIGN - PLAN YEAR 2024
Pensions & Benefits
Side-by-Side Rx Comparison Aetna
Freedom HDHigh** Horizon
NJ DIRECT HDHigh** Aetna
Freedom HDLow** NJ DIRECT HDLow** Retail: Generic Copayments
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Retail: Brand Copayments Retail: Brand w/Generic available Copayments Mail: Generic Copayments
Mail: Brand Copayments Mail: Brand w/Generic available Copayments Prescription Drug annual Out-of-Pocket Maximum (Individual/Family)
HA-1156-0424
* Members hired before July 1, 2019, will be enrolled in Aetna CWA Unity Freedom or Horizon CWA Unity DIRECT. Members hired after July 1, 2019, will be enrolled in Aetna CWA Unity Freedom 2019 or Horizon CWA Unity DIRECT 2019.
** HD = High Deductible Health Plan.
| 1 | 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. |
| 2 | You pay the cost difference between the brand drug and the generic drug. |
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.
Note: Retail – 30 day supply. Mail – 90 day supply. Oral contraceptive coverage is available under the medical and prescription plans.
http://www.nj.gov/treasury/pensions
EXHIBIT B - BUILT IN PRESCRIPTION DRUG PLAN UNION NEGOTIATED PLANS
PRESCRIPTION PLAN DESIGN - PLAN YEAR 2024 STATE ACTIVE GROUP
Pensions & Benefits
HA-1157-0424
Side-by-Side Rx Comparison Aetna Freedom/ Freedom 2019*
Horizon NJ DIRECT/ NJ DIRECT 2019* Aetna HMO Horizon HMO1
Aetna Liberty Plus Horizon OMNIA
Retail: Generic Copayments $7 $7 $3 $3 $7 $7
Retail: Brand Copayments $16 $16 $10 $10 $16 $16
Retail: Brand w/Generic available Copayments2
Member pays difference
Member pays difference
Member pays difference
Member pays difference
Member pays difference
Member pays difference
Mail: Generic Copayments $0 $0 $0 $0 $0 $0
Mail: Brand Copayments $40 $40 $15 $15 $40 $40
Mail: Brand w/Generic available Copayments2
Member pays difference
Member pays difference
Member pays difference
Member pays difference
Member pays difference
Member pays difference
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
EXHIBIT B - BUILT IN PRESCRIPTION DRUG PLAN UNION NEGOTIATED PLANS
PRESCRIPTION PLAN DESIGN - PLAN YEAR 2024 STATE ACTIVE GROUP
Pensions & Benefits
Side-by-Side Rx Comparison Aetna
Freedom HDHigh** Horizon
NJ DIRECT HDHigh** Aetna
Freedom HDLow** Horizon
NJ DIRECT HDLow** Retail: Generic Copayments
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Retail: Brand Copayments Retail: Brand w/Generic available Copayments Mail: Generic Copayments
Mail: Brand Copayments
Mail: Brand w/Generic available Copayments Prescription Drug annual Out-of-Pocket Maximum (Individual/Family)
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.
HA-1157-0424
* 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 | 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. |
| 2 | You pay the cost difference between the brand drug and the generic drug. |
Note: Retail – 30 day supply. Mail – 90 day supply. Oral contraceptive coverage is available under the medical and prescription plans.
http://www.nj.gov/treasury/pensions
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