Prescription Drug Benefits Copayments do not apply to out-of-pocket maximums
Retail Pharmacy (up to 34-day supply)
Generic Drug Preferred Brands (formulary) Non-preferred and All Other Brands (non-formulary) Specialty Drug	$10 Copayment $25 Copayment $40 Copayment $100 Copayment
Mail Order Program (up to 90-day supply)
Generic Drug Preferred Brands (formulary) Non-preferred and All Other Brands (non-formulary) Specialty Drug	$30 Copayment $75 Copayment $120 Copayment $300 Copayment

Step Therapy Program: When many different drugs are available for treating a medical condition, it is sometimes useful to follow a Step Therapy process for finding the best treatment for individual people. The first step in Step Therapy is usually a simple, inexpensive drug that is known to be safe and effective for most people. This treatment is known as "first line" therapy. If this doesn’t work or causes problems for a person, the next step is to try second-line therapy. Here is how it works:

• When a prescription for a second-line drug is being processed at your pharmacy, the online computer system will scan your recent prescription records.
• If the system finds a record for a first-line alternative, the Step Therapy program will not interrupt the dispensing process.
• If the system does not find a prescription for a first-line alternative to your prescription, it will alert the pharmacist that your prescription is not a covered benefit. The system will indicate why the prescription is not covered and list covered first-line alternatives. The doctor will then be contacted to prescribe the first-line medication.
• The types medications included in the Step Therapy program are:
  • Pain/arthritis (non-steroidal anti-inflammatory drugs)
  • High blood pressure (angiotensin II receptor antagonists and ACE inhibitors)
  • GI acid-peptic disorders (proton pump inhibitors)

Prescription coverage is only available when AGC is the primary carrier. Effective January 1, 2006, the AGC Health Plan does not provide prescription benefits for Medicare participants who are not actively at work. The Trustees strongly encourage you to contact Medicare regarding new prescription benefits available under the Medicare Part D prescription plan.

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2008 Express-Scripts (ESI) Formulary List