drugs or medications are covered under the UMWA Funds’ benefit plans. You may
select from over 64,000 retail pharmacies or choose the CVS Caremark® mail
service pharmacy to have your prescriptions filled. See link below.
UMWA Health and Retirement Funds Prescribing Guide
Making sure you have access to affordable medications is our priority. Hyperinflation Medications-drugs seeing very high price inflation or big price tags compared to clinically eequivalent alternatives-require a medical necessity review before coverage by the Funds. Medications requiring medical necessity review may change. See link below for the current list.
Hyperinflation Medication List
There is a
generic substitution program for both non-specialty and specialty drugs. A
quality, generic prescription drug product will be dispensed to Funds
beneficiaries whenever possible for the standard Funds copayment.
For non-specialty drugs, if a brand name drug is prescribed where
a generic equivalent is available, the Generic Drug Substitution Program
requires you to pay the copayment plus additional cost of the brand name drug
over the cost of the generic substitute. For either non-specialty or specialty drugs
in the program, an exception to the use of a generic drug can be obtained if
the physician submits a Medical Necessity Request/Prior Authorization Form and
it is approved by the Funds. Your doctor should
fax a letter of medical necessity to 1-888-487-9257 to provide medical
information as to why the generic medication should not be dispensed. If
approved, the beneficiary will not be required to pay the difference in cost
between the brand name drug and the generic drug. See link below.
are used to treat long-term illnesses. Such as; Ankylosing Spondylitis, Crohn’s
Disease, Rheumatoid Arthritis, and Multiple Sclerosis. These conditions require
long-term monitoring and special testing during treatment. Pharmacists at CVS
Specialty can work with you and your doctor to ensure proper dosing and testing
to achieve maximum effectiveness of the drug while minimizing side effects. You
can enroll in CVS Specialty by calling 1-800-237-2767 or you doctor can
E-Prescribe. All specialty drugs are limited to a 30-day supply. See the link
Product Program allows you to obtain “preferred” medications from select drug
classes for the standard copayment. “Non-preferred” medications can be obtained
for the standard copayment plus an additional charge, depending on the dosage
and the quantity prescribed.
Preferred Product Program includes the following classes:
Lowering Agents (cholesterol)
Combinations (blood pressure)
Inhibitors and Combination (diabetes)
Antispasmodics (Overactive Bladder)
Product Program ONLY applies to medications listed in select drug classes. See
A Medical Necessity
Request/Prior Authorization process is available if your doctor believes you
must have the brand name drug or the non-preferred product for medical reasons.
Your doctor may call CVS Caremark® at 1-800-294-4741 with questions about
the Preferred Product Programs.
value of your prescription drug benefit through use of the mail service. Depending
on your plan, copayments may be reduced if you use the mail service pharmacy
depending on your plan. You may learn more about your Prescription Drug benefits
by calling the UMWA Health and Retirement Funds Call Center at 1-800-291-1425.