Maintenance Medication Program

Drugs prescribed to patients with chronic health conditions or prescriptions that can be managed on a long-term basis are considered maintenance medications. As these drugs are usually taken continuously over a long period of time, there is a low likelihood that the dosage will change.

ASEBP’s Maintenance Medication Program considers drugs in the following nine classes of maintenance medications. Drugs within these classes have a maximum of five dispensing fees (the amount your pharmacy charges to fill your prescription) allowed within a calendar year (January 1 – December 31). This encourages you to fill a three-month’s supply of your medication at one time—lessening the risk of missing doses between fills—and gives you a safe, simple and affordable way to help keep the plan comprehensive and sustainable over the long term.

1. High blood pressure medications
2. Mood elevating medications (anti-depressants)
3. High cholesterol medications
4. High blood sugar medications
5. Birth control medications
6. Abnormal thyroid medications
7. Asthma or Chronic Obstructive Pulmonary Disease (COPD) medications
8. Hormone replacement medications
9. Overactive bladder medications

If you choose to have your prescription for a maintenance drug filled more than five times during the year, you will be responsible to pay the entire dispensing fee portion of the total prescription cost out-of-pocket after the fifth fill (the drug portion will continue to be covered by your plan). In some circumstances, your prescription won’t allow for a three months supply (e.g. blister packaging and/or other medical reasons). In these cases, your pharmacist will be able to help you to obtain any required approvals. Your pharmacy is notified that you have a limited number of dispensing fees for that drug per calendar year and will be able to tell you how many refills you have before you’re responsible to pay the entire dispensing fee.

Visit the Drug Inquiry Tool on My ASEBP to see if a drug you’ve been prescribed falls within the Maintenance Medication Program.