Preferred Pharmacies Cost for Brand Name Drugs Maintenance Drug Policy Injectable Drugs Summary of your prescription benefits Limitations Exclusions     Home

UFCW LOCAL 1776 and PARTICIPATING EMPLOYERS                                   HEALTH and WELFARE FUND

 

Prescription Drug Benefit

You should contact the Fund office at 1-800-458-8618 immediately if the pharmacy is unable to process your claim on-line You and your dependents are eligible for prescription drug benefits under the Plan. We will send you a Drug Identification Card, which you must show to your pharmacist. This card is only accepted by pharmacies called “point of sale” or ‘on-line” which have computer systems connected with National Prescription Administrators, Inc. (“NPA”) that can check your eligibility while you are still in the store. If you have your prescription filled at a pharmacy that is not “on-line” with NPA, your prescription will not be covered and you must pay the full cost of the prescription. Generally, you do not need to file a claim for your prescriptions - you simply present your drug card to the pharmacist. However, if for some reason you pay for a covered prescription in full, contact the Fund office immediately to see if you can be reimbursed. If you or your dependents are covered for prescription drug benefits under any other plan, please refer to the section titled “Coordination of Benefits” to see how to submit your claims. You may also be eligible to participate in the Fund’s Prescription Incentive Program. Please refer to that section for more information. Preferred Pharmacies If you use a preferred pharmacy when you have prescriptions filled, you pay only $5 per prescription. The preferred pharmacies are:

Acme	Rite Aid
Esquire	Shelly's
Laneco	Shop Rite
Pathmark	Super Fresh

If you use a pharmacy other than these preferred pharmacies, you will pay a $7 co-payment for each prescription you receive. Cost for Brand Name Drugs If you receive a brand name drug and an FDA-approved generic equivalent is available, you must also pay the difference between the cost of the generic drug and the cost of the brand name drug plus the applicable co-payment. This applies at both preferred pharmacies and non-preferred pharmacies. To avoid unnecessary expenses, ask your doctor to prescribe generic drugs whenever, in your doctor's medical judgment, the generic drug will work as safely and effectively as the brand name drug. Maintenance Drug Policy You must use a preferred pharmacy or the mail order program to have coverage for maintenance medication (any drug prescribed regularly for long periods of time for control or treatment of a chronic illness). You are limited to a 34-day supply at the preferred pharmacy and are required to pay a $5 co-payment. You pay only one $5 co-payment per prescription for a 100-day supply when using the mail order program. If you have the prescription filled anywhere else, you must pay the full cost of the prescription. The mail order program is handled through: Remote Xpress Distribution Network (RxDN) 2809 Southampton Road Philadelphia, PA 19154 For more information about the mail order program and how it works, you can contact RxDN directly at 1-800-800-8769. Injectable Drugs Self-injected medications must be pre-authorized by NPA and must be filled through a preferred pharmacy or the mail order program (RxDN) to be covered. If you have the prescription filled anywhere else, you must pay the full cost of the prescription. You must allow forty-eight (48) hours for NPA and the Fund to process the request for self-injected medication. To obtain pre-authorization, contact the Fund office with the following information:   Participant’s name and social security   Patient’s name and date of birth (if prescription is for eligible dependent).   Name of drug.   Reason for drug.   Dosage and length of time needed.   Pharmacy name and phone number.   Does the pharmacy have the drug in stock? Here is a summary of your prescription benefits:

Type of Drug	Preferred Pharmacy	Non-Preferred Pharmacy	RxDN (Mail Order Program)
Generic	$5 co-payment	$7 co-payment	$5 co-payment for 100-day supply
Brand Name	$5 co-payment; plus you pay the difference between cost of generic and brand name drugs, if generic equivalent is available	$7 co-payment; plus you pay the difference between cost of generic and brand name drugs, if generic equivalent is available	$5 co-payment for 100-day supply; plus you pay the difference between cost of generic and brand name drugs, if generic equivalent is available
Maintenance	$5 co-payment for a 34-day supply	Prescription not covered	$5 co-payment for 100-day supply
Injectable	Must be pre-authorized; $5 co-payment for 34-day supply.	Prescription not covered	Must be pre-authorized; $5 co-payment for 100-day supply.

Limitations There are certain limitations on prescriptions. The Plan does not pay for more than a 34-day supply at a retail pharmacy, or a 100-day supply through the mail order program. The Fund retains the right to limit or deny payment for any drug based on cost, efficacy or suspected abuse, among other things. The pharmacist can only provide refills if authorized by your doctor, and if filled within one year of the original prescription’s date. Injectables are not covered if an alternative is available. Exclusions Some prescription drugs and supplies are excluded. The Plan does not cover:   Oral contraceptives for anyone except the participant or spouse.   Non-oral contraceptives, regardless of use.   Dietary aids, cosmetics or other health or beauty aids.   Hypodermic needles or syringes.   Non-legend vitamins.   Vaccines (oral or injectable), immunological or serological agents.   Maintenance drugs, unless they are filled at a preferred pharmacy or through the mail order program.   Injectable drugs, unless they are pre-authorized and filled at a preferred pharmacy or through the mail order program.   Medical appliances, such as back braces, cervical collars, bandages, etc.   Prescriptions for conditions covered under Workers’ Compensation or to the extent paid under a plan or policy of motor vehicle insurance or payable under the Pennsylvania Motor Vehicle Financial Responsibility Law.   Charges for the administration of any drug.   Drugs that are not medically necessary or appropriate for the condition diagnosed.   Drugs that are experimental or investigational.   Any prescription that is filled at a pharmacy that is not on-line with NPA.   Items lawfully obtainable without a prescription. Please note: The Plan conducts random audits of pharmacies to check for duplication of prescriptions at different pharmacies or for medications that are filled too often. If the Plan finds violations, the participant must reimburse the Fund, and the Fund may take other appropriate action. Fraudulent or unauthorized use of prescription cards is illegal, and the person whose name is on the card is held responsible. If you terminate your employment, you must return your card to the Fund office immediately. Any charges made to the card after you are no longer eligible for prescription drug benefits are your personal responsibility - you must reimburse the Fund for any charges.