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Health & Welfare
Prescription Drug
Benefits
Prescription
drug coverage is available in two convenient ways: either through
the Retail Pharmacy program (up to a 30-day supply) or the Mail
Services Pharmacy program (up to a 90 day supply) Both programs are
administered by CVS/Caremark.
Effective July 1, 2018, the Plan has moved to a formulary based
prescription benefit. The formulary helps highlight cost saving
opportunities for you, helps guide selection for your doctor and
proves overall value to the Plan. Individuals impacted by the
changes will be provided advanced notification. The formulary is
accessible at
www.caremark.com/acdruglist. You are encouraged to register on
Caremark's website and/or download the smart phone app. Use the
Check Drug Cost feature to help find cost saving opportunities.
Always ask your doctor or pharmacist if there is a generic drug to
treat your condition. If your doctor thinks there is a clinical
reason why any of the drugs on the drug list won't work for you,
your doctor can call CVS/Caremark toll-free at (855) 582-2026 to
request approval.
Retail Pharmacy Program
The Plan covers up
to a 30-day supply of medication from a retail pharmacy. This benefit
is designed for short-term or single use medications. A list of
CVS/Caremark pharmacies can be obtained by accessing the
CVS/Caremark website at
www.caremark.com, through CVS/Caremark's smart phone app, by
calling CVS/Caremark customer care at (877) 478-1246, or contacting
the Administrative Office.
Mail Service Pharmacy Program
The Plan covers up to a
90-day supply of medication from a mail-order pharmacy. This benefit
is designed for long-term or maintenance medications. Using
Caremark
via mail or internet,
you may receive a 90-day supply for the price of 60-days! You
should contact the mail service pharmacy at least two weeks before
you need your next fill to allow for processing and mailing of the
prescription.
The Plan allows for
you to refill your prescriptions after 2/3 of the prescribed dosage
has been used.
Cost Share for Medical Plans 500, 551 to 554, COBRA Plans 570, 590
to 593, and all Retiree Plans
Effective July 1, 2018, the Plan moved to the following cost share
structure:
|
Type of Prescription (Tier Category) |
Retail Cost Share
(Up to 30 day supply) |
Mail Service Cost Share
(Up to 90 day supply) |
| Affordable Care
Act Preventive Drugs |
$0.00 |
$0.00 |
| Tier- 1
(Formulary Generics) |
$15.00 |
$30.00 |
| Tier-2
(Formulary Preferred Brands) |
$35.00 |
$70.00 |
| Tier- 3
(Non-Formulary Brands, Non-Preferred Brands) |
$50.00 |
$100.00 |
| Formulary
Exclusions and Brands with a generic equivalent substitute |
You pay 100% of the cost. An exceptions process
may accommodate medical necessity. If approved, the applicable
copay applies. You may be required to try more than one
formulary or generic product. Any prior exception requests may
be subject to review. The Plan may not cover all products. |
Your annual
out-of-pocket limit for prescription drugs is $750.00 per person or
$1500.00 per family. Should you select a brand name medication
when a generic is available, your prescription will not be covered
by the Plan. If you do not use your ID card, or use
a non-member pharmacy, the
difference between the retail charge and the contracted rate will
not apply to your out-of–pocket maximum.
Utilization Management of Diabetic Test Strips
Effective July 1,
2018, the plan will limit the quantity of diabetic test strips
dispensed at one time. The limit will accommodate recommended
testing guidelines by the American Diabetes Association (ADA). Your
doctor may request higher limits from CVS/Caremark
Claims Review of Non-Specialty Drugs Exceeding $1,500.00
Effective July 1,
2018, non-specialty drugs exceeding $1,500.00 will be reviews by a
Consultant Pharmacist to help ensure appropriate use and billing
(dose, quantity, days' supply, charged amounts) or to discuss
possible alternative. You, your doctor or pharmacy may be contacted
by a Consultant Pharmacist.
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