July 28, 2010

2010
Benefit Topics:

Official Brochure

Benefits at a Glance

Medicare at a Glance

Physicians

Hospital

Prescription Drugs

Catastrophic Protection

Other Benefits

2010 Prescription Drugs

Prior approval is required for certain specialty drugs including biotech drugs. Call Caremark Specialty Pharmacy Services at 1-800-237-2767 to obtain approval.

The
NALC Prescription Drug Program—
A Convenient Money-Saving Way To Fill Your Prescriptions.

Say good-bye to claim forms and runaway prescription costs! The NALC Health Benefit Plan has two easy choices for your prescription needs, both designed to save you time and money.

Refer to the 2010 NALC Health Benefit Plan brochure (RI 71-009) for complete details. 2009 Prescription Drugs Benefits and Previous brochures are also available.

When NALC is the Primary Carrier

When you use:	You pay:	Claim Filing:
A network retail pharmacy for the 1st or 2nd fill of (up to) a 30-day supply of medication	Generic: 25% of cost Brand name: 30% of cost	N/A
Maintenance Choice Program	you may purchase up to a 90-day supply (84-day minimum) of covered drugs and supplies at a CVS/Caremark pharmacy through this program. You will pay the applicable mail order copayment for each prescription purchased.	N/A
A network retail pharmacy to refill a prescription more than once or A non-network retail pharmacy	Full cost at time of purchase	Submit a completed claim form to receive 50% reimbursement* of the Plan allowance. No deductible.
The NALC Mail Order Prescription Program	60-day supply: $8 generic/$43 name brand 90-day supply: $5 NALCSelect generic 90-day supply: $12 generic/$65 brand name	N/A

*This coinsurance counts toward a $4,000 annual retail prescription out-of-pocket maximum. Once this is met, the Plan will pay 100% for prescriptions purchased at a NALC CareSelect Network retail pharmacy.

When Medicare Part B is the Primary Carrier

When you use:	You pay:	Claim Filing:
A network retail pharmacy for the 1st or 2nd fill of (up to) a 30-day supply of medication	Generic: 10% of cost Brand name: 20% of cost	N/A
Maintenance Choice Program	You may purchase up to a 90-day supply (84-day-minimum) of covered drugs and supplies at a CVS/Caremark pharmacy through this program. You will pay the applicable mail order copayment for each prescription purchased.	N/A
A network retail pharmacy to refill a prescription more than once or A non-network retail pharmacy	Full cost at time of purchase	Submit a completed claim form to receive 55% reimbursement* of the Plan allowance. No deductible.
The NALC Mail Order Prescription Program	60-day supply: $7 generic/$37 name brand 90-day supply: $4 NALCSelect generic 90-day supply: $10 generic/$55 brand name	N/A

When Medicare Part D is the Primary Carrier

When Medicare Part D is primary payer and covers the drug, we waive:

Retail limitations
Day supply

Your out-of-pocket costs will never exceed the Plan's Medicare prescription drug copayments or coinsurance.

Drug Program—
For Your Short-Term And Immediate Prescription Drug Needs

NALC Participating Network Pharmacies—

With more 57,585 NALC CareSelect network and 18,388 preferred NALC retail pharmacies, most Plan members have an NALC CareSelect Network Pharmacy near their home. In many cases, your current pharmacy already participates. Locating a participating pharmacy near you is easy—simply call 1-800-933-NALC (6252).

There are no claim forms to file and no waiting for reimbursement when you purchase your prescriptions at a network pharmacy. Using your NALC Health Benefit Plan identification card, you can purchase up to a 30-day supply of covered medication, plus one refill. You will pay 20% of cost for generic medications and 30% of cost for brand name medications. When Medicare Part B is your primary payer, you will only pay 10% of cost for generic medications and 20% of cost for brand name medications. There is no deductible associated with our Prescription Drug program.

Preferred NALC Retail Pharmacies—

Consider using a Preferred NALC Retail Pharmacy Network. From our broad network of participating pharmacies, the following pharmacies have stepped up to offer members of the NALC Health Benefit Plan an additional discount. When you fill your prescription at one of the following preferred pharmacies, out-of-pocket expense will be reduced:

Baker’s Pharmacy	Gerbes Pharmacy	Pharmacare Specialty Pharmacy
Bi-Lo Pharmacy	Giant Pharmacy	QFC Pharmacy
Bruno’s Pharmacy	Hilander Pharmacy	Ralphs Pharmacy
CarePlus CVS Pharmacy	Jay C Plus Pharmacy	Randalls Pharmacy
Carrs-Gottstein Foods	Kessel Pharmacy	Rite Aid Pharmacy
City Market Pharmacy	King Soopers Pharmacy	Safeway Pharmacy
CVS Pharmacy	Kmart Pharmacy	Scott’s Pharmacy
Dillon Pharmacy	Kroger Drugstore	Smith’s Pharmacy
Dominicks Pharmacy	Kroger Food & Drug	Stop & Shop Pharmacy
Food 4 Less Pharmacy	Kroger Sav-on	Super G Discount Drug
Fred Meyer Pharmacy	Longs Drug Stores	Target Pharmacy
Fry’s Food & Drug Store	Martins Pharmacy	Tom Thumb Pharmacy
Genuardis Pharmacy	Pavilions Pharmacy	Vons Pharmacy

These preferred pharmacies recognize the value of the NALC Health Benefit Plan's retail business and have agreed to lower prices. This means our members will typically see lower priced brand name drugs at these pharmacies.

If you request a name brand drug when a generic drug is available, you will have to pay the difference in cost between the name brand and the generic.

You may choose to continue to purchase your prescriptions at your local participating or non-participating pharmacy, but benefits will be reduced. You will need to file a claim for reimbursement.

Mail Order Drug Program—
For Your Long-Term And Ongoing Prescription Drug Needs

Your savings begin with the very first prescription you order because there are NO claim forms to submit, and NO waiting for reimbursement. You pay $8 generic and $43 brand name for up to a 60-day supply. You pay $5 for a 90-day supply of NALCSelect generics. You pay $12 generic and $65 brand name for up to a 90-day supply. When Medicare Part B is your primary payer, you pay $7 generic and $37 brand name for a 60-day supply. You pay $4 for a 90-day supply of NALCSelect generics. You pay $10 generic and $55 brand name for a 90-day supply.

Maintenance Choice Program—

You may purchase up to a 90-day supply (84-day minimum) of covered drugs and supplies at a CVS/Caremark Pharmacy through our Maintenance Choice Program. You will pay the applicable mail order copayment for each prescription purchased.

Medicare: When Medicare is the primary carrier, copayments and coinsurance for prescriptions are not waived.

Specialty Drugs: We cover specialty and biotech drugs used for treatment therapies only through Caremark Specialty Pharmacy mail Order. You must purchase specialty drugs, including biotech and oral chemotherapy drugs through the Caremark Specialty Pharmacy Services. Certain specialty drugs require prior approval to ensure appropriate treatment therapies for chronc complex conditions. Decisions about prior approval are based on guidelines developed by physican To receive the maximum benefit for these medicines NALC Plan members must purchase them from Caremark, our NALC Plan prescription drug benefit manager (PBM). Specialty medicines will be administered through Caremark's Specialty Pharmacy Services (SPS) program. The SPS programs ensure appropriate therapy and promote patient safety for chronic medical conditions.

Prior approval is required for specialty drugs used to treat the following chronic complex conditions: allergic asthma, hepatitis C, psoriasis, growth hormone disorder, rheumatoid arthritis, and respiratory syncytial virus. You pay the same low copayment for specialty drugs approved and purchased through Caremark's SPS program as for any other mail order medication.

CaremarkDirect click here for more information
(Noncovered Prescriptions and Over-the-Counter Medications and Products)

We are pleased to offer members of the NALC Health Benefit Plan the CaremarkDirect Program that supports convenient access to competitively priced over-the-counter (OTC) medication, as well as prescription lifestyle drugs that are not covered by the Plan, i.e., prescriptions used to treat hair loss or obesity. CaremarkDirect is a value-added program that supports effective drug trend management by providing members safe, convenient access to non-covered prescriptions and certain OTCs. All products purchased through CaremarkDirect require a physician's prescription. Call 1-800-933-NALC (6252) to check the availability of a particular product.