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The Prescription Drug Program.

PLAN ONE and MEDICARE SUPPLEMENTAL ONLY - Prescription Drug Benefits are provided for covered drugs dispensed to the employee and their eligible dependents after the effective date of their coverage, regardless of the date on the prescription order. If a prescription refill is authorized by the subscriber and permitted under Government regulations, it will be refillable up to one year after the original prescription date, provided the employee is eligible on the refill date.

Covered Drugs - Covered drugs are those that are required under Federal Law to bear the legend: "Caution: Federal Law prohibits dispensing without prescription", or which are specifically designated by our prescription drug service providers.
Covered prescription drugs include:

  • Federal Legend Drugs.
  • State Restricted Drugs.
  • Compounded Medication.
  • Oral Contraceptives.
  • Insulin.
  • Insulin needles and syringes on prescription only.
  • Over-the-counter diabetic supplies.
  • Retin-A - See the Summary Plan Description.
  • Nicotine patches.

Covered drugs are paid under Prescription Drug Benefits when they are filled at a retail pharmacy or mail-order pharmacy. Payment for covered drugs will not be made under Prescription Drug Benefit if the employee uses a Home Medical Equipment Supplier.

Filling Prescriptions - Prescriptions may be filled at either:

  • A retail pharmacy, if the prescription is for up to a 34 day supply.
  • A mail-order pharmacy, if prescription is for maintenance drugs, a 30 to 90 day supply when medically appropriate.
  • Mandatory use of the mail order program is required after 3 fills of the same medication at a retail pharmacy.

Caremark Retail Pharmacies - The Welfare Fund has made arrangements with CVS Caremark, a company which specializes in the payment of prescription drugs with retail pharmacies. Each member will be able to receive up to a 34 day supply of a medication with a single co-payment of $20 for brand-name medications and a $10 co-payment for generic medications.

Within 7-10 days of the first day of eligibility for prescription drug benefits, a Caremark Identification Card will be sent to each eligible employee. Upon receipt of the I.D. card, please check to see that your name is correctly spelled. For lost cards, please contact the Fund Office at (412) 968-9750. The Fund Office will order a new card from Caremark. Please note that it takes 7-10 days to obtain the new card.

There is no expiration date on the Caremark I.D. card. It is only for identification purposes. The card will only be valid during those periods of time that the member  and their dependents are eligible for prescription drug benefits.

CVS Caremark Mail Order Pharmacy - The Welfare Fund has also made arrangements with Caremark to dispense prescription maintenance drugs by mail. Each member will be able to receive a 30 to 90 day supply of a medication with a single co-payment of $40 for brand-name medications and $20 co-payment for generic medications. For mail order, be sure to ask the doctor to prescribe maintenance drugs for a 90-day supply plus refills, whenever appropriate. All narcotics are limited to a 30-day supply.

No Identification Card is necessary to use the Caremark Mail Order Program. Each employee will only be able to use the Mail Order Program when they and their dependents are eligible under the Welfare Fund in PLAN ONE or the MEDICARE SUPPLEMENTAL PLAN.

To submit a new mail order prescription please obtain a Prescription Order Form from the Fund Office. Complete the form, attach the prescription order and mail both to the address listed on the form.

To order refills through Caremark mail order - each time medications are received via mail order, your package will include a new order form and an invoice if applicable. Employees may either call CVS/Caremark at the number listed on the prescription bottle to order the refill or mail in the refill order form to CVS/Caremark. In either case, please follow CVS/Caremark’s instructions in regard to any payment due.

For questions please concerning the mail-order pharmacy call CVS/Caremark at 1-800-549-5792.

To go to the Caremark website, or to get a mail order refill please click here.   Caremark