SOC and OHC
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Share-of-Cost Requirements and Other Health Coverage

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Pharmacy Benefits

For prescriptions provided under the CMSP Standard Benefit, there are no cost-sharing requirements beyond the CMSP memberís monthly Share of Cost (SOC). For members that have a SOC, the pharmacy will handle these payments at the time the prescription is provided to the member, in the same way SOC payments have been handled in the past. If members do not have a SOC for their CMSP Standard Benefit, they will not be charged a SOC for their prescriptions.

For prescriptions provided under the CMSP Primary Care Benefit, there is a $5.00 copay for each prescription provided to the member. There is no additional Share of Cost (SOC) beyond the copay. Members with a SOC under the CMSP Standard Benefit may seek prescriptions under the CMSP Primary Care Benefit first.

Other Health Coverage

If a CMSP member has Other Health Coverage that provides coverage for prescription drugs, this coverage will be billed first, before coverage under the CMSP Primary Care Benefit or the CMSP Standard Benefit is billed. CMSP prescription drug coverage is intended to serve as secondary coverage to a CMSP member's Other Health Coverage.

 

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