Prescription Drug Benefits - POV

Establishing Shot...

Prescription drug benefits are part of your cove rage under the Fund's medical plans, as shown in the following chart :

The prescription drug program is administered by an outside Claims Administrator. You and your dependents are covered for the cost of prescription medication for all outpatient needs through our outside Claims Administrator. Certain medications that aren't on the preferred drug list (PDL) may be received through case management intervention. You can purchase your medication from retail pharmacies and through the mail-order service.

Who's Covered
You and your covered dependents are covered for prescription drugs if you're enrolled in the Regular Plan. Your coverage begins when you become eligible for medical benefits. Coverage for your dependents begins after you enroll them in the plan and pay the required dependent coverage premium.

How The Prescription Drug Program Works
There are three categories of prescription drugs under your prescription drug benefit:

• Generic - The equivalent to a brand-name original drug and containing identical active ingredients at the same dosage (you'll pay the least out of pocket);
• Preferred brand - A brand-name drug that appears on the PDL which identifies preferred choices in selected drug categories (you'll pay more out of pocket for preferred brand-name drugs than you would for generic drugs); and
• Non-preferred brand - A brand-name drug that doesn't appear on the PDL (you'll pay the most out of pocket).

You'll pay a lower copay for generic and preferred-brand drugs than you will for non-preferred drugs. You'll automatically receive a copy of the PDL at no charge. To obtain an additional copy of the PDL, go to the outside Claims Administrator's web site or call the number listed in the Summary Of Benefits.

You can fill your prescriptions in these three ways:

• For short-term medication, you can fill a prescription for up to a two month supply (initial plus one refill) at:
  • A participating retail pharmacy; or
  • A non-participating pharmacy.
• For long-term (maintenance) medication, you must use the mail-order service when you fill a prescription. Otherwise, you'll be required to pay the full cost of the medication.

Because both you and the Fund pay the least when you purchase prescription drugs through the convenient mail-order service, using this service whenever possible is the most cost-effective way to fill your prescriptions.

Getting The Most From Your Benefits

RETAIL PURCHASES
If you have a short-term illness or injury and need to fill a prescription for up to a 30-day supply and one refill, you can purchase your medication at a retail pharmacy. You may go to any retail pharmacy you wish, but if you use a participating pharmacy, you pay only a copay at the time of purchase. What's more, participating pharmacies have negotiated a lower rate for prescription drugs, so you pay less. If you go to a non-participating pharmacy, you'll pay more. You'll also have to pay the full cost of the medication up-front, and then send in your receipt (evidence of loss) for reimbursement.

When you go to a participating pharmacy:

• Present your medical ID card to the pharmacist whenever you need to fill up to a 30-day supply (and one refill) of a prescription.
• A participating pharmacy will automatically fill the prescription with a generic equivalent, unless your physician indicates "Dispense as Written" (DAW). If he/she makes that specification, your pharmacist is required to provide the exact brand and dosage indicated. Under these circumstances, dispensing a generic equivalent is not an option. You're responsible for paying the generic copay plus the difference in cost between the generic drug and the brand-name drug.
• The pharmacy will provide a pharmacy claim voucher for your signature and tell you the copay amount you owe.
• Sign the voucher and pay the appropriate copay - one for each prescription - depending on the type of drug dispensed. ( See "What You Pay".)

You'll automatically receive a list of participating pharmacies at no charge. For an additional copy, contact the outside Claims Administrator or the Administrative Office. (See the Summary Of Benefits for contact information for the outside Claims Administrator.) If you plan to travel outside your home state, contact the outside Claims Administrator or the Administrative Office for participating pharmacy information.

When you go to a non-participating pharmacy:

• Present the pharmacist with your prescription for up to a 30-day supply (and one refill) of medication.
• Pay the pharmacy the full amount of your prescription.
• Submit your receipt to the Fund, and the Fund will forward it to the outside Claims Administrator. You'll receive a reimbursement of the highest dollar amount according to the plan formula. (See "Filing a Claim".)

MAIL-ORDER PRESCRIPTIONS
The outside Claims Administrator, your mail-order service and online pharmacy, conveniently delivers your long-term maintenance medications for up to a 90-day supply - postage paid - to your home.

After you've completed the first month of your prescription plus one refill, the prescription drug program requires you to use the mail-order service for all maintenance medications. If you go to a retail pharmacy to refill a prescription for a third consecutive month, you'll be responsible for the entire cost of the prescription.

To avoid this situation:

• Ask your physician to prescribe a 90-day supply for your maintenance medications with the appropriate number of refills. You may want to share the PDL with your physician. This list is available upon request from the Administrative Office. Also ask if a generic equivalent is appropriate. The pharmacist will automatically fill the prescription with a generic equivalent, unless your physician specifies "DAW."
• If you need to begin a new maintenance medication immediately, have your physician write two prescriptions:
  • One for up to a 30-day supply to be filled immediately at a retail pharmacy; and
  • Another for up to a 90-day supply (plus up to three refills, if applicable) to be filled through the mail-order service.
• If your physician prescribes a 30-day or 60-day supply of medication and you send the prescription to the mail-order service, you'll be charged the full mail-order copay for a 90-day supply, so it may be more cost-effective to fill the prescription at a retail pharmacy.
• If you're currently on a maintenance medication that you want to start obtaining through the mail-order service, ask your physician to write a new prescription for a 90-day supply with three refills, if applicable.

You'll be asked to complete a Patient Profile Card the first time you use the mail-order service. Every time you fill a new prescription, you'll need to complete an order form. You get the form by calling the Administrative Office or by visiting the outside Claims Administrator's website. Remember to include your prescription drug ID card number on the form. Mail the following in the pre-addressed envelope:

• Patient Profile Card;
• Order form;
• Original prescription(s) written by your physician; and
• Your copay(s). Refer to the Summary Of Benefits for the correct amount.

You should receive your medication within 10 to 14 days from the date you mail your order. Because of this short delay, it's important to plan ahead for your long-term medication needs.

REFILLS
Your prescription label lists the date when you can request a refill and indicates the number of refills remaining. Refills will be filled only 30 days or less before your current supply runs out.

The fastest way to receive your refills through the mail-order service is to log on to the outside Claims Administrator's website. To order a refill, have the following ready:

• Prescription number;
• ZIP Code; and
• Credit card information.

You may also:

• Call the outside claims administrator; or
• Mail in an authorization (sent with your mail-order prescriptions) for refills for medication currently on file.

What You Pay
You're responsible for paying a copay for each prescription. What you pay depends on:

• Whether the drug is a generic, a preferred brand or a non-preferred brand;
• The quantity (e.g., 30-day or 90-day supply); and
• Whether you purchase it at a participating pharmacy or a non-participating pharmacy, or through the mail-order service.

Whether you use a retail pharmacy or the mail-order service, you don't have to meet a calendar-year deductible before benefits begin. The prescription drug program generally pays 100% of eligible prescription drug costs after you pay a copay for each prescription, and there's no out-of-pocket maximum.