RX Beneficiary FAQ
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UMWA Health and Retirement Funds

RX Beneficiary FAQ

  • I was told by my pharmacist that the medication I am taking (for "birth control", "acne", "weight loss") is not not covered.  Why?

​​​​In certain plans birth control, acne and weight loss medications are covered. For more information call the Funds Call Center at 1-800-291-1425.
  • I currently take a non-preferred drug or a brand name drug because the other drug did not work for me. Do I have to pay the additional charge?

​​The Funds has a process in place to have a drug approved under a “medical necessity” provision by your doctor. Your doctor should fax a letter of medical necessity to 1-888-487-9257 to provide medical information as to why the non- preferred or brand name medication should be dispensed, if authorized there is no additional charge. 

  • How can I sign up for mail service?

​​If you are not currently using mail service, consider signing up for your maintenance medication needs. Depending on your drug benefit design, there may be a significant financial advantage to you if you do so. This is in addition to the convenience of home delivery and savings on gas and time. To enroll in the mail service program, you can contact the Funds’ “FAST START” department at 1-800-294-4741. Be prepared to provide information about you, your doctor and the prescriptions that you routinely take. If you prefer to use to mail service paper form to start your service, please click HERE.

  • Am I required to use Generic Drugs?

​Yes, the Funds requires that generic forms of medications are used when available.  If a brand name drug is filled when a generic is available, then there is a charge equal to the difference of the cost of the medication for the two prescriptions. This charge is in addition to your copayment for the prescriptions. 


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


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

 

  • I received my card. It has the “CVS” name on it. Am I required to use only CVS pharmacies, or can I continue to use my current pharmacy?

The CVS Caremark logo appears on the card because they are the Funds’ pharmacy benefit processor. You may continue to use your current pharmacy. The Funds has elected a network of over 68,000 pharmacies for you to choose from including all of the major chains and many hundreds of independent pharmacies, as well.

  • What drugs were chosen for the Preferred Product Program?

About one third of all prescriptions written for Funds’ beneficiaries are for drugs for the stomach, cholesterol, blood pressure and sleep. The Funds’ Pharmacy and Therapeutics Committee, a committee of doctors and pharmacists, carefully selected a list of preferred drugs for each condition. The preferred drugs are clinically effective and similar to other drugs that treat the same condition

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

​Your doctor should fax a letter of medical necessity to 1-888-487-9257 to provide medical information as to why the preferred medication should not be dispensed.  If approved, the you will be authorized to receive one of the ”non-preferred” products at the standard co-payment.

  • If I do not receive approval for a non-preferred drug am I still able to receive my medication?  How will I know which drugs my doctor can order?

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.

  • How will my doctor know which drugs to order?

​To view the complete list of the preferred and non-preferred drugs click the link for the Preferred Product Drug List​.​​ Your doctor can order a drug on the preferred list if it is right for you.

  • ​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. Your doctor can contact CVS Caremark toll free at 1-800-294-5979 to get a Preferred Product Program 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 preferred product list, the requirement that you first try the preferred drug, in the absence of a medical exception from your doctor, does not apply to you.​

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