Prescription Drug Benefits
Prescription drug benefits are available to all active
and retired participants and their qualifying dependents who
meet the Welfare Fund eligibility requirements. Your
prescription drug benefits are administered by Express
Scripts which covers almost all drugs prescribed by
a licensed medical doctor, osteopath, dentist or podiatrist
for their generally accepted medical use.
This program, which includes both a drug card and mail
service plan, was instituted in an effort to increase
benefits, alleviate the claim filing burden and reduce costs
when you or your dependents require prescription drugs. At
the time your coverage becomes effective, you will receive a
plastic identification drug card and mail service order
forms. The program works as follows:
Express Scripts Drug Program
Prescriptions filled at a local, retail pharmacy will
have the following co-payments:
||$10 for a 21 day fill or refill (one re-fill
||$30 for a 21 day fill or
refill (one re-fill limit)
||$43 for a 30 day fill or refill (no limit)
Prescriptions filled through the Express Scripts Delivery mail
order program will have a $60 co-payment for a 90 day fill
Both retail and mail order prescriptions
must be filled generically if a generic equivalent drug is
available. If you have a prescription filled with a brand
name drug when a genericis available FOR ANY REASON
you will pay the brand name co-payment plus the
difference between the cost to the Welfare Fund for the
generic and the brand. Using a brand name drug when a
generic is available will cost you a great deal of
Please keep in mind that if you
have a prescription filled with a brand name drug when a
generic drug is available the difference which you must pay
does not accrue towards your annual deductible.
Utilization Management Program
Certain drugs require prior approval through Medco's
Utilization Management Program. You or your doctor can reach
Express Scripts Utilization Management Program at 1-800-753-2851.
Prescription drugs available under both the Mail Service
and the Card Program include:
- Federal Legend Drugs
- State-Restricted Drugs
- Compounded Medications [can be purchased through
retail pharmacy only]
- Insulin and insulin syringes only
Drugs not covered by the program include:
- Contraceptives, oral or other, whether medication or
devices, regardless of intended use.
- Non-Federal Legend Drugs including all "over the
counter" items, regardless of whether they are
- Charges for the administration or injection of any
- Needles and syringes, support garments, and other
non-medical substances (such items may be covered under
your medical benefits coverage).
- Prescriptions which are entitled to receive without
charge under any Workers' Compensation Laws or any
municipal, state or federal program.
- Medication taken by, or administered to, a person
while an inpatient in a licensed hospital, hospice, rest
home, sanitarium, extended care facility, nursing home
or similar institution which operates on its premises,
or allows to be operated on its premises, a facility for
dispensing pharmaceutical products.
- Drugs labeled "Caution - limited by federal use to
investigational use" or experimental drugs.
- Blood, blood plasma or biological sera.
- Vitamins, except those which by law require a
- Any prescription filled in excess of the number
specified by the physician, or any refill dispensed
after one year from the physician's original order.