Effective January 1, 2018, the previous State Prescription Plan; Express Scripts will be replaced by OptumRx. During this implementation period, members will receive information directly from OptumRx. This information will include: a welcome letter and new prescription drug cards. All new information will be mailed directly to the participating members home address. The Division of Pensions and Benefits and OptumRx will be working hand and hand to ensure a smooth transition for all members involved. For any further questions or concerns feel free to visit the OptumRx website or call the customer service telephone number, 1-844-368-8740. Please continue to use your current identification card and refill order forms. Members can continue to use the Medco website and the customer service telephone number on your identification card, 1-866-220-6512 until December 31, 2017. 

Eligibility to Enroll in the State Health Benefits Program

Eligibility for Dependents

  • Legal spouse
  • Same-sex domestic partner or civil union partner
  • Eligible children under age 26 (including stepchildren, foster children, adopted children or children an employee is legally required to support)

When Coverage Begins

  • Academic year 10-month employees with September 1 hire date = September 1 effective date
  • All other employees, effective after 2 months of continuous employment; i.e., August 15 hire date = October 15 effective date

Program Overview

  • Administered by OptumRx
  • Access to thousands of retail locations
  • Most pharmacies in New Jersey participate
  • Prescription copayments determined by the health plan selected

NJ Direct 15, Aetna HMO, Horizon HMO

Retail Prescription Copayments

  • $3.00 Generic Copayment
  • $10.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

Mail Order Prescription Copayments

  • $5.00 Generic Copayment
  • $15.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

NJ Direct 1525, Aetna 1525, Horizon 1525, Horizon OMNIA, Aetna Liberty

Retail Prescription Copayments

  • $7.00 Generic Copayment
  • $16.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

Mail Order Prescription Copayments

  • $18.00 Generic Copayment
  • $40.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

NJ Direct 2030, Aetna 2030, Horizon 2030

Retail Prescription Copayments

  • $3.00 Generic Copayment
  • $18.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

Mail Order Prescription Copayments

  • $5.00 Generic Copayment
  • $36.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

NJ Direct 2035, Aetna 2035, Horizon 2035

Retail Prescription Copayments

  • $7.00 Generic Copayment
  • $21.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

Mail Order Prescription Copayments

  • $18.00 Generic Copayment
  • $52.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

NJ Direct HD 4000, Aetna HD 4000

  • Prescription is integrated with the medical plan and subject to deductible and coinsurance

NJ Direct HD 1500, Aetna HD 1500

  • Prescription is integrated with the medical plan and subject to deductible and coinsurance