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Specialty Pharmacy Program at a retail pharmacy, subject to plan

requirements. After the initial fill at a retail pharmacy, all subsequent fills

must be dispensed through the Specialty Pharmacy Program.
• Drugs included in the Specialty Pharmacy Program will be assigned

to copayment levels subject to the following copayments:
a) for up to a 30-day supply:

a. $5 Generic/Level One
b. $25 Preferred-Brand/Level Two ($30 Effective 1/1/19)

c. $45 Non-Preferred Brand/Level Three ($60 Effective 1/1/19)
b) for a 31 to 90 day supply:

a. $5 Generic/Level One
b. $50 Preferred Brand/Level Two ($55 Effective 1/1/19)

c. $90 Non-Preferred Brand/Level Three ($110 Effective 1/1/19)
(d) When deemed appropriate the Empire Plan Prescription Drug

Program Insurer/Pharmacy Benefit Manager shall be permitted additional
flexibility in the management of the formulary, including the following;

• Place a brand name drug on Level One and exclude or place a generic
drug on Level Three subject to the appropriate copayment. This placement

may be revised mid-year when such revision is advantageous to the Plan.
Enrollees will be notified in advance of such changes.

• Certain therapeutic categories with two or more clinically sound and

therapeutically equivalent Level One options may not have a brand name
drug in Level Two.
• Access to one or more drugs in select therapeutic categories may be

excluded if the drug(s) has no clinical advantage over other generic and

brand name medications in the same therapeutic class.
§9.18 Part-time Employees

The State Health Insurance Plans' regulations shall continue to stipulate
that the term employee means any person in the service of the State as

employer whose regular work schedule is at least half-time per bi-weekly
payroll period.

§9.19 Waiting Period
There shall be a waiting period of forty-two (42) days after employment

before an employee shall be eligible for enrollment under the State's Health
Insurance Program.

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