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.

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

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:

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.