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    October 18, 2010      
2011
Benefit Topics:
 

Official Brochure

 

Benefits at a Glance

 

Medicare at a Glance

 

Physicians

 

Hospital

 

Prescription Drugs

 

Catastrophic Protection

 

Other Benefits

 

 

2011 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 2011 NALC Health Benefit Plan brochure (RI 71-009) for complete details. 2011 Prescription Programs,.2010 NALCSelect Generics List, Specialty Pharmacy Drugs List, 2010 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: 20% 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 55% reimbursement of the Plan allowance. No deductible.
The NALC Mail Order Prescription Program

 

  • 60-day supply: $8 generic/$43 brand name
  • 90-day supply (only): $5 NALCSelect generic
  • 90-day supply (only): $7.99 NALCPreferred generic
  • 90-day supply: $12 generic/$65 brand name
  • N/A

Specialty drugs – including biotech, biological, biopharmaceutical, and oral chemotherapy drugs.

Note:  All specialty drugs require prior approval.  Call Caremark Specialty Pharmacy Services at 1-800-237-2767 to obtain prior approval.
  • Caremark Specialty Pharmacy Mail Order
    • 30-day supply: $150*
    • 60-day supply: $250*
    • 90-day supply: $350*
  • N/A

* Coinsurance amounts you pay for prescription drugs dispensed by an NALC Preferred or CareSelect Network pharmacy, and mail order copayment amounts for specialty drugs, count toward a $4000 annual retail prescription out-of-pocket maximum.  When you have met the $4000 annual retail prescription out-of-pocket maximum, retail coinsurance amounts and specialty drug mail order copayment amounts are waived for the remainder of the calendar year.


 

When Medicare Part B is the Primary Carrier

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

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

A network retail pharmacy for unlimited fills of up to a 30-day supply of NALCSenior antibiotic generic medications

Nothing
  • N/A
Maintenance Choice Program You may purchase up to a 90-day (84-day minimum) supply 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 brand name
  • 90-day supply (only): $4 NALCSelect generic
  • 90-day supply (only): $4 NALCPreferred generic
  • 90-day supply: $10 generic/$55 brand name
  • N/A

Specialty drugs – including biotech, biological, biopharmaceutical, and oral chemotherapy drugs.

Note:  All specialty drugs require prior approval.  Call Caremark Specialty Pharmacy Services at 1-800-237-2767 to obtain prior approval.
  • Caremark Specialty Pharmacy Mail Order
    • 30-day supply: $150*
    • 60-day supply: $250*
    • 90-day supply: $350*
  • N/A

* Coinsurance amounts you pay for prescription drugs dispensed by an NALC Preferred or CareSelect Network pharmacy, and mail order copayment amounts for specialty drugs, count toward a $4000 annual retail prescription out-of-pocket maximum.  When you have met the $4000 annual retail prescription out-of-pocket maximum, retail coinsurance amounts and specialty drug mail order copayment amounts are waived for the remainder of the calendar year.

 

When NALC or Medicare Part B is the Primary Carrier
  • FDA-approved prescription medications for smoking cessation
  • Over-the-counter medications for smoking cessation (prescription required)

 

You pay:

Preferred network/Network retail pharmacy:  Nothing
60-day mail order supply:  Nothing
90-day mail order supply:  Nothing

 

 

When Medicare Part D is the Primary Carrier

When Medicare Part D is primary payor 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.

 

SPECIALTY DRUGS

We cover specialty drugs, including biotech, biological, biopharmaceutical, and oral chemotherapy drugs only through Caremark Specialty Pharmacy Mail Order.  You must purchase specialty drugs through the Caremark Specialty Pharmacy Services.  All specialty drugs require prior approval to ensure appropriate treatment therapies for chronic complex conditions.  Decisions about prior approval are based on guidelines developed by physicians at the FDA or independent expert panels and are administered by Caremark’s pharmacy experts.  Call Caremark Specialty Pharmacy Services at 1-800-237-2767 to obtain prior approval.


LOWER COST GENERICS

The NALC Health Benefit Plan has partnered with CVS/Caremark, our pharmaceutical benefit manager, to maximize your prescription coverage in 2011 by offering new low cost options for prescription generic medications.  


NALCPREFERRED GENERICS

In 2011, we’re making 90-day fills of thousands of generic drugs available through the CVS Maintenance Choice Program and through our Caremark mail order program for only $7.99 when we are your primary payer and for only $4.00 when Medicare Part B is the primary payer.  Call Caremark at 1-800-933-NALC (6252) to find out if your generic medication is currently available on our NALCPreferred generics list.


COST-FREE GENERICS AT RETAIL WHEN MEDICARE PART B IS PRIMARY

Our 2011 NALCSenior Antibiotic generic list offers prescription generic medications at no cost when a 30-day supply is purchased at a local NALC Preferred or CareSelect pharmacy, and Medicare Part B is the primary payer.


2011 NALCSELECT GENERIC LIST 
              
When a generic medication is appropriate, ask your physician to prescribe a generic drug from our NALCSelect generic list. In 2011, the amount you pay for a 90-day supply of an NALCSelect generic medication purchased through our mail order program, or at a CVS/ Caremark Pharmacy, including Longs Drugs, through our Maintenance Choice Program is just $5 or $4 when Medicare Part B is your primary carrier.   

 
SMOKING CESSATION

When you’re ready to quit smoking the Plan can help.  In 2011, you will pay nothing for FDA-approved prescription medications prescribed for smoking cessation.  These medications will be available to you at any NALC Preferred or NALC CareSelect retail pharmacy or through our Caremark mail order program. 


DRUG PROGRAM —
For Your Short-Term And Immediate Prescription Drug Needs

NALC Participating Network Pharmacies—

With more than 58,250 NALC Preferred and NALC CareSelect network pharmacies, most Plan members have a 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 pay nothing for (up to) 30-day fills of generic drugs available on our NALCSenior Antibiotic generic list, and just 10% of cost of other generic medications and 20% 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

Giant Pharmacy

Ralphs Pharmacy

Bi-Lo Pharmacy

Hilander Pharmacy

Randalls Pharmacy

CarePlus CVS Pharmacy

Jay C Plus Pharmacy

Rite Aid Pharmacy

Carrs-Gottstein Foods

Kessel Pharmacy

Safeway Pharmacy

City Market Pharmacy

King Soopers Pharmacy

Scott’s Pharmacy

CVS Pharmacy

Kmart Pharmacy

Smith’s Pharmacy

Dillon Pharmacy

Kroger Drugstore

Stop & Shop Pharmacy

Dominicks Pharmacy

Kroger Food & Drug

Super G Discount Drug

Food 4 Less Pharmacy

Kroger Sav-on

Target Pharmacy

Fred Meyer Pharmacy

Longs Drug Stores

Tom Thumb Pharmacy

Fry’s Food & Drug Store

Martins Pharmacy

Vons Pharmacy

Genuardis Pharmacy

Pavilions Pharmacy

 

Gerbes Pharmacy

QFC 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. For prescriptions that are not listed on either our NALCPreferred or NALCSelect generic lists, 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 or just $7.99 for a 90-day supply of NALCPreferred generics.  You pay $12 for other generics 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 or NALCPreferred generics. You pay $10 for other generics 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.

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.