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
informedRx
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
informedRx at 1-800-645-3332.
Specialty Pharmacy Program
The Plan offers the
informedRx
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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