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Prescription Drug Plan Benefits

Prescription Drug Plan Overview

Most prescription 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. Copayments are lower when you use the mail service pharmacy for your medications.

UMWA Health and Retirement Funds Prescribing Guide

Making sure you have access to affordable medications is our priority. Hyperinflation Medication-drugs seeing very high price inflation or big price tags compared to clinically equivalent 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

Generic Substitution Program

There is a generic substitution program for both non-specialty and specialty drugs. A quality, generic prescription drug product will be dispensed to Fund’s 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.

Generics First Specialty Preferred Product Program Drug List

Specialty Pharmacy Program

Specialty Drugs 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 your doctor can E-Prescribe. All specialty drugs are limited to a 30-day supply. See the link below.

Specialty Preferred Product Program Drug List.pdf​

The Preferred 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.

The Preferred Product Program includes the following classes:

  1. Lipid Lowering Agents (cholesterol)
  2. ARB/ARB Combinations (blood pressure)
  3. Hypnotics (sleep aids)
  4. DPP-4 Inhibitors and Combination (diabetes)
  5. Nasal Steroids
  6. Urinary Antispa​​smodics (Overactive Bladder)
  7. Opioid-Induced Constipation

The Preferred Product Program ONLY app​lies to medications listed in select drug classes. See link below.

Preferred Product Program Drug List ​​

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.

Mail Service Pharmacy

Maximize the 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​​​.​​​

RX FAX Form