Prescription Benefits
Prescription drug benefits help you pay for the cost of covered drugs and medicines for you and your eligible dependents. The Plan provides coverage through a retail pharmacy
program and a mail order service. To receive prescription drug benefits under the Plan you must have prescriptions filled through a participating retail pharmacy or the mail order services.
Retail Pharmacy Program
The Plan has contracted with a network of retail pharmacies (called
participating pharmacies) that fill your prescriptions at negotiated rates.
When you become eligible for benefits, you and your spouse will receive
a prescription drug card. When you fill your short-term prescription at a
participating pharmacy and present your prescription drug card, for up to
a 30-day supply, you pay:
$6 copayment for each generic prescription; $25 copayment for each brand name single source prescription; and $40 copayment for each brand name multi source prescription
The Plan covers the rest of the prescription cost. You do not need to
complete or submit a claim form. Prescriptions filled at non-participating
pharmacies are not covered under the Plan.
For information about participating retail pharmacies, contact NMHC at
1-800-645-3332.
Mail Order Service
If you take an ongoing medication (i.e., for conditions such as high blood
pressure or asthma), consider using the mail order service. Filling prescriptions
through the mail order service is fast and convenient. Plus, you do
not pay postage and shipping costs.
You can receive up to a 90-day supply of your long-term medication after
paying a:
$15 copayment for a generic prescription; $65 copayment for a brand-name single source prescription; and $100 copayment for a brand-name multi source prescription.
Refills through the mail order service can only be dispensed 30 days
before the depletion of your present supply.
The first time you have a prescription filled through the mail order service
program, you will need to submit a copy of your prescription and complete
the applicable forms. For information about having a prescription
filled or refilled through the mail order service program or for the applicable
forms, contact NMHC at 1-800-645-3332.
Specialty Pharmacy Program
The Plan offers the NMHC Ascend Specialty Pharmacy Program. This
Program is designed to help manage expenses for specialty medications,
which can be some of the most costly forms of medication. Specialty
medications are used to treat genetic or rare chronic conditions. When
you have your prescription filled through the Ascend Specialty Pharmacy,
you receive your prescription at a discounted rate, which is generally lower
than what other retail pharmacies charge. The Program provides you with
unlimited access to specialty pharmaceutical consultation and monitors
your progress and your medications.
Step Therapy Pharmacy Program
Often when there are many different medications available to treat a
medical condition, it is useful to follow a stepwise approach (called “Step
Therapy”) to find the best treatment for you. The Step Therapy Program
can help you and the Fund save money by ensuring that you get the most
cost-effective medication that is appropriate for your condition. Under
this Program, the pharmacist with work with you and/or your physician
to find an equally effective, yet less expensive, medication known to be
safe and effective for most people. These are the steps:
Step 1: Try a generic or over-the-counter (OTC) medication first. If an
OTC medication is appropriate, it will be covered by the Plan at the
generic medication copayment. In this instance, you will just need to purchase
the medication at the pharmacy window and show your ID card. Step 2: If after trying a preferred alternative, generic, or OTC medication
and it does not work or causes problems, an alternative medication will be
tried. Step 3: If the alternative medication does not work, then the original
prescription medication will be dispensed.
Generally, medications covered under this Step Therapy Program are
those that are used on an ongoing basis to treat chronic conditions, such
as asthma or allergies.
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This is a plan description. Not a guarantee of benefits.
Benefits depend on eligibility, date of service and Fund Plan limitations.
In the event of a conflict between the Summary Plan Description,
this web site and the Plan's legal documents, the legal documents will govern.
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