PHARMACY BENEFIT PROGRAMS

The Funds’ pharmacy benefit programs are a comprehensive group of programs that cover medications and diabetic supplies for beneficiaries of the Combined Benefit Fund, the UMWA 1992 Benefit Plan, the UMWA 1993 Benefit Plan and the UMWA Prefunded Benefit Plan.  Each Plan has specific co-payment requirements.

Broad in scope, the Funds’ pharmacy benefit programs provide services to both beneficiaries and medical providers. Services for beneficiaries include FastStart, a prescription mail order service, and the Generic Drug Substitution Program. Both programs offer quality service and save money for beneficiaries and the Funds. Services for medical providers include the Funds’ Prescribing Guide, a prescribing reference tool which promotes the use of generics and contains a Preferred Products Program, and the Iscribe program, which allows medical providers to review beneficiaries’ prescription histories.

The Funds’ Pharmacy Benefit Manager (PBM) is CVS Caremark which offers FastStart mail service and a retail network of over 60,000 pharmacies nationwide. Among the participating pharmacies are all locations of the major chains (e.g. CVS, Rite-Aid, Walgreens, Wal Mart, Eckerd). In addition, hundreds of independent pharmacies are part of the Funds’ network through Caremark. They also offer Drug Safety Alerts (recalls and warnings) and other health resource information.

The Pharmacy Services Inquiry Line will answer questions from beneficiaries, medical providers and pharmacists. Beneficiaries may also contact the Funds’ Call Center.

Plan Co-payments and Out-of-Pocket Maximum

Caremark FastStart Mail Service

Save time and Money with Mail Service Use!

Thousands of the Funds’ beneficiaries love the value and convenience of the mail service for obtaining refills of maintenance prescriptions. Maintenance prescriptions are those prescriptions used every day for treatment of chronic, ongoing conditions. Examples include blood pressure and diabetes medications. Also, use of mail service saves money for the Funds. Call toll-free 1-866-443-9160 to transfer your maintenance prescriptions to mail order. Doctors may fax a prescription to Caremark Mail Service Pharmacy at 1-877-278-0328. Maintenance medications should be prescribed for a 90-day quantity with 3 refills.

For more information: email health@umwafunds.org or call the Funds’ Call Center at 1-800-291-1425.  

UMWA President Cecil Roberts supports mail service.

Funds’ beneficiaries comment on the pharmacy mail service:

“I always get them on time, when they say so.”

“We were surprised at how fast our medications were delivered after we sent in our prescription for the first time.”

“The bottles are easy to open. The letters on the prescription labels are easy to see and read.”

“Caremark pharmacists are very nice. They treat me like family.”

Generic Drug Substitution Program

A generic drug is identical to a brand name drug in safety, strength, quality and performance. The generic drug substitution program requires that generic drugs be dispensed. Therefore, if a beneficiary chooses a brand name drug when a generic drug is available, the beneficiary will pay the difference between the costs of the brand name drug and the generic drug.

If a beneficiary cannot take a generic drug due to a specific medical reason, the beneficiary’s doctor should contact Caremark’s Prior Authorization number at 1-800-294-5979 to provide medical information as to why generic medication should not be dispensed.

If approved, the beneficiary will not pay the difference between the brand name drug and the generic drug.

Funds' Prescribing Guide

 The Prescribing Guide is a reference and informational tool to assist medical providers in selecting clinically appropriate and cost-effective products for their patients. Specific drug selection for an individual patient rests solely with the medical provider. However, medical providers are encouraged to prescribe drugs listed in the Prescribing Guide.

Preferred Product Program (PPP)

The Preferred Product Program allows Funds’ beneficiaries to obtain “preferred” medication products from five (5) classes of drugs for their standard co-payment. The five classes include drugs for cholesterol, blood pressure, the stomach, sleeping and allergies. Non-preferred” products may be obtained for an additional charge plus the co-payment.

If a beneficiary cannot take a preferred product medication due to a specific medical reason, the beneficiary’s doctor should contact Caremark’s Prior Authorization number at 1-800-294-5979 to provide medical information as to why the preferred product should not be dispensed. If approved, the beneficiary will be authorized to receive one of the “non-preferred” products at the standard co-payment.

Quantity limits may apply. For example, beneficiary under the 1992 Benefit Plan must obtain a 30-day drug supply before obtaining a 90-day drug supply.

• 2008 PPP List

• Preferred Product Program Question and Answers
  
  
  * What drugs were chosen for this program?
  
  About a third of all prescriptions written for Funds’ beneficiaries are for drugs for the stomach, cholesterol, blood pressure, allergies and sleeping. The Funds’ Pharmacy and Therapeutics Committee, a committee of physicians and pharmacists, carefully selected a list of preferred drugs for each condition. The preferred drugs are: 1) clinically effective and similar to other drugs that treat the same condition; and 2) the drugs are the least expensive for the Funds.

  * How will my doctor know which drugs to order?

  The view a complete list of all the drugs that are preferred and non-preferred click on 2008 PPP List . Your doctor can order a drug on the preferred list if it is right for you.

  * What if I cannot take the drug on the preferred list?

  You doctor can contact Caremark at 1-800-294-5979 to ask for a “PPP” request form to explain why you cannot take one of the preferred drugs. The request will be reviewed by a Caremark pharmacist. If approved, you will receive one of the non-preferred drugs at your standard co-pay. If not approved, you have the right to appeal.

  * If I do not receive approval for a non-preferred drug does this mean the UMWA Funds will not pay for my drug?

  No. You will still be able to get your drug. However, for a non-preferred drug you will be charged an amount in addition to your standard co-payment. The amount will be approximately the difference between the preferred drug cost and the non-preferred drug cost.

  * I have tried some of the preferred drugs and they did not work. Why do I have to try them again?

  If you have already tried a preferred drug and it did not work for you, you may qualify for a non-preferred drug at your standard co-payment. You doctor can contact Caremark at 1-800-294-5979 to ask for a “PPP” request form to explain why you cannot take one of the preferred drug.

  * Please note: If you are on a drug that is not on the list, this program will not affect you.

Iscribe Program

The iScribe program allows physicians to review drug history information of their Funds’ patients. The program allows physicians to:

• Access up-to-date patient medication histories from Caremark dispensed claims database. The 50 most recent prescription claims will appear.
• Review prescriptions written by all providers.
• Update patient charts with complete drug histories for easy drug interaction review.

Besides Funds’ beneficiaries, physicians can access information for patients with other insurers who use Caremark as their pharmacy benefit manager. Physicians may also prescribe electronically. There is no charge for the physician to use the iScribe program.

iScribe website