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Prescription Drug Plan Benefits – Providers

Retail and Mail Service Pharmacy Services

Most prescription drugs or medications are covered under the UMWA Funds benefit plans. 你可以从64个以上中选择,000 retail pharmacies or choose the CVS Caremark mail service pharmacy to have your prescriptions filled. Copayments are lower when you use the mail service pharmacy for your medications.

处方指南 适用于以下受益人:
  • American Consolidated Natural 资源 Plans
  • Crimson Oak Grove 资源 Plans
  • UMWA国际计划
处方指南 for all other beneficiary plans.
If you are unsure about your plan please contact our call center at (800)-291-1425.

选择:

CVS Caremark MAILSERVICE Pharmacy
NCPDP id: 0322038
谢伊大道东9501号.
斯科茨代尔,AZ 85260

请参阅以下连结传真:

新的rx传真表格

​Making sure your patients have access to affordable medications is our priority. Hyperinflation Medication drugs seeing very high price inflation or big price tags compared to clinically equivalent alternatives require a medical necessity review before coverage by the Funds. Medications requiring medical necessity review may change. See link below for the current list.

恶性通货膨胀药物清单

通用替代程序

A generic drug is identical to a brand name drug in safety, strength, quality and performance. The generic drug substitution program requires that generic drugs be dispensed. 因此, if a beneficiary chooses a brand name drug when a generic drug is available, they will need to pay the difference between the costs of the brand name drug and the generic drug.

If a beneficiary has already tried and cannot take the generic drug due to a specific medical reason(s), their doctor should fax a letter of medical necessity to 1-888-487-9257 to provide medical information as to why the generic medication should not be dispensed. 如果得到批准, the beneficiary will not pay the difference between the brand name drug and the generic drug.

检讨医疗需要表格 在这里.

专业药房计划

的资金 utilizes CVS专业药房 to receive specialty medications to beneficiaries. Pharmacists at this pharmacy work with you and the beneficiary to ensure proper dosing and testing to achieve maximum effectiveness of the drug while minimizing side effects. You can enroll a Funds’ beneficiary in CVS Caremark’s® 特殊药物计划 by one of the following methods:

1. Call CVS专业药房 at 1-800-237-2767
2. Email CVS专业药房 at (电子邮件保护)
3. Fax CVS专业药房 at 1-800-323-2445
4. ePrescribe:
CVS专业药房
NCPDP id 1466033
比尔曼广场800号
Mount Prospect, IL 60056

的资金 currently participates in a Specialty 首选产品计划. The program requires the use of a preferred product in select categories before a non-preferred medication will be covered. The select categories of medications are those that treat autoimmune diseases, 多发性硬化症, Hepatitis C and Growth Hormone. To see the complete list of specialty drugs covered under the Funds’ Specialty 首选产品计划. 请参阅下面的连结.

Advanced Controlled 首选产品计划 Drug List

首选产品计划

The 首选产品计划 allows Funds’ beneficiaries to obtain preferred medications from five drug classes for the standard copayment.

  • ARB/ARB Combinations (Blood Pressure Drugs)
  • 催眠药(助眠药)
  • DPP-4 Inhibitors and Combination (Diabetes Drugs)
  • Urinary Antispasmodics (Overactive Bladder)
  • Irritable Bowel Syndrome with Constipation/ Chronic Idiopathic Constipation

The program only applies to the medications listed in the specified drug classes. The program is administered in two different ways, depending on the which plan the beneficiary is enrolled in.  It requires either a prior authorization or some plans allow for a surcharge.

Review Standard Formulary 首选产品计划 Drug List 在这里.

Review Supplemental Formulary 首选产品计划 Drug List 在这里.

之前的授权

A prior authorization review process, which is based upon medical necessity, is available if you believe that the beneficiary must have the brand or the non-preferred product for medical reasons. 您可以致电CVS Caremark® 1-800-294-4741 with questions about the 首选产品计划. To obtain a prior authorization call 1-800-294-5979.

事先授权表格