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Directors Guild of America – Producer Pension and Health Plans
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Prescription Drug Benefits Overview


For full details about the prescription drug benefits available from the DGA–Producer Health Plan, refer to the March 2020 Health Plan Summary Plan Description, beginning on page 67.

Prescription Drug Network

Express Scripts is the Health Plan’s prescription benefit manager.

To locate an Express Scripts network pharmacy, go to express-scripts.com or call (800) 987-7828.

Below is a summarized schedule of prescription drug benefits under the Health Plan.

Retail Pharmacy Mail Order/Walgreens Smart90 Program
Deductible There is no deductible associated with the prescription drug benefit.
Allowable Quantity Up to 30-day supply Up to 90-day supply
Generic Drug Co-Payment $10 $25
Brand Name Drug Co-Payment $24 $60
Lifestyle Drug Co-Payment
(i.e. erectile dysfunction drugs, proton pump inhibitors and sleep aides.
Greater of $40 or 50% of the
cost of the medication
Greater of $60 or 50% of the
cost of the medication

There are special rules for coverage of proton pump inhibitors and sleep aides. See the “Lifestyle Drugs” section beginning on page 70 of the March 2020 Health Plan Summary Plan Description for more information.

Generic contraceptives are covered at 100% under the Health Plan’s Preventive Care Services benefit.

Drugs that are not listed in the Express Scripts formulary are not covered under the Health Plan. This affects a small number of brand name medications. To find out whether your current prescription is listed in the formulary, log on to your Express Scripts account at express-scripts.com/covered.

If you choose to take a brand name drug when a generic equivalent is available, you will pay the cost difference between the two drugs plus the generic co-pay.

MAINTENANCE MEDICATIONS

If you are taking a maintenance medication (three months or more), you are allowed two 30-day fills at a retail pharmacy. After the first two fills, to avoid paying the entire cost of the medication, you will be required to obtain your medication in 90-day supplies, using one of the following two options:

  1. Express Scripts Home Delivery
    1. Obtain a 90-day prescription for your maintenance medication from your doctor.
    2. Complete the Express Scripts Home Delivery Order Form available here or by visiting www.express-scripts.com.
    3. Attach your 90-day prescription(s) to your completed form (which will include your payment information) and return both documents to Express Scripts at the address provided on your Order Form.
    4. Your medication(s) will be delivered to your home.
  2. Walgreens (may operate as Duane Reade or as Happy Harry’s in certain regions of the country)
    1. Obtain a 90-day prescription for your maintenance medication from your doctor.
    2. Fill your 90-day prescription in person at any participating Walgreens, Duane Reade or Happy Harry’s pharmacy.

    For questions about the program, please call (866) 890-1419 or visit www.express-scripts.com/90day.

For more information on maintenance medications, please refer to pages 67-69 of the March 2020 Health Plan Summary Plan Description.

NON-NETWORK PHARMACIES

You may purchase your medication at a non-network pharmacy, but you will have higher costs and will have to file a claim with Express Scripts for reimbursement.

More on the Health Plan

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Benefits Overview

About the Health Plan

Medical

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Self-Pay Plans

Pay Your Premium

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Affordable Care Act Information for Participants

Resources for Non-Covered DGA Members

 

About Us

Created as a result of the Directors Guild of America's collective bargaining agreements with producer associations representing the motion picture, television and commercial production industries, the DGA-Producer Pension and Health Plans provide excellent benefits to participants.

The DGA-Producer Pension and Health Plans are separate entities from the DGA and are administered by a Board of Trustees made up of DGA representatives and Producers' representatives.

RECENT NEWS

Important Notice Regarding the American Rescue Plan Act – 100% COBRA Subsidy

Important Notice Regarding the American Rescue Plan Act – 100% COBRA Subsidy

By DGA-PPHP Communications  /  April 1, 2021
Spring 2021 Spotlight on Benefits Newsletter Available Now

Spring 2021 Spotlight on Benefits Newsletter Available Now

By DeLon Howell  /  March 30, 2021
Board of Trustees Approves 13th Check for Basic Plan Retirees and Beneficiaries in Pay Status as of December 2020

Board of Trustees Approves 13th Check for Basic Plan Retirees and Beneficiaries in Pay Status as of December 2020

By DeLon Howell  /  March 26, 2021
New Federal Law Provides 100% COBRA Premium Subsidy to Eligible Individuals, Beginning April 1, 2021

New Federal Law Provides 100% COBRA Premium Subsidy to Eligible Individuals, Beginning April 1, 2021

By DGA-PPHP Communications  /  March 18, 2021

Contact Us

Main Phone: (877) 866-2200

Faxes:

Address Change: (323) 866-2389
Contributions: (323) 866-2311
Health Plan Claims: (323) 782-9287
Health Plan Eligibility: (323) 866-2399
Pension: (323) 866-2372

5055 Wilshire Boulevard
Suite 600
Los Angeles, CA 90036

Office Hours:
Monday through Friday
8:30 a.m. to 5:00 p.m. Pacific Time

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