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    November 2, 2005      
2005
Benefit Topics:
 
Official Brochure
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Physicians
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Prescription Drugs
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2005 Prescription Drugs

New for 2005: Prior approval is required for certain specialty drugs including biotech drugs. Call Caremark Specialty Pharmacy Services at 1-800-237-2767 to obtain approval. More information.

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 2005 NALC Health Benefit Plan brochure (RI 71-009) for complete details.

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
  • 25% of cost*
    (no deductible)
  • 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 (after deductible is met).
The NALC Mail Order Prescription Program
  • $8 generic/$24 name brand for 60-day supply of medication (no deductible)
  • $12 generic/$35 name brand for
    90-day supply of medication (no deductible)

 
  • N/A

 

When Medicare Part B is the Primary Care
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
  • 15% of cost*
    (no deductible)
  • 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
  • $7 generic/$17 name brand for 60-day supply of medication (no deductible)
  • $10 generic/$30 name brand for
    90-day supply of medication (no deductible)

 
  • N/A
*A 30-day dispensing limit.

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

NALC Participating Network Pharmacies—

With more than 51,000 participating network 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).

You'll have no claim forms to file and no waiting for reimbursement when you purchase your prescriptions at a network pharmacy. Using your NALC identification card, you can purchase up to a 30-day supply of covered medication, plus one refill, paying 25% of the cost for both generic and name brand medications. You'll pay 15% if Medicare Part B is primary. There is no deductible.

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. The cost will not be applied to your deductible.

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 deductibles to satisfy, NO claim forms to submit and NO waiting for reimbursement. You pay $8 generic/$24 name brand for up to a 60-day supply. You pay $12 generic/$35 name brand for up to a 90-day supply. When Medicare Part B is primary you pay $7 generic/$20 name brand for a 60-day supply and $10 generic/$30 name brand for a 90-day supply.

Medicare: When Medicare is the primary carrier, the deductible for a paper claim filed for reimbursement will be waived. Copayments and coinsurance for prescriptions are not waived.

 

Specialty Drugs: Beginning January 1, 2005, we cover specialty and biotech drugs used for treatment therapies only under the prescription drug benefit. A complete list of all specialty drugs is enclosed for your review. 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.