Prescription Drug Benefits Overview - Providers
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UMWA Health and Retirement Funds

Prescription Drug Benefits Overview - Providers

 
Retail and Mail Service Pharmacy Services
Most prescription drugs or medications are covered under the UMWA Funds benefit plans. Beneficiaries may select from over 64,000 retail pharmacies or choose the CVS/caremark mail service pharmacy to have their prescriptions filled. Beneficiary copayments are lower when mail service pharmacy is used for maintenance medications.
 
Generic Substitution Program
The Generic Drug Substitution Program requires Funds beneficiaries to pay the co-payment plus the price difference for the brand product, when either you or the beneficiary requests the brand product, unless a Medical Necessity Request/Prior Authorization Form is submitted and approved by the Funds.
 
Specialty Pharmacy Program
The Funds recommends use of CVS/caremark's Specialty Pharmacy to receive specialty medications. Pharmacists and nurses at this pharmacy work with you and the beneficiary to assure 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 Specialty Drug Program by calling 1-800-237-2767.
 
The Funds currently participates in a Specialty Preferred Products Program.  The program requires use of a preferred product in four (4)  categories before a non-preferred medication will be covered.  The  four categories of medications are those that treat autoimmune diseases, Multiple Sclerosis,  Hepatitis C and Growth Hormone.  To see the complete list of specialty drugs covered under the Funds' Specialty Preferred Products Program, click here.  You may fax a new prescription directly to CVS/caremark Specialty Pharmacy toll-free at 1-800-323-2445.     
 
Preferred Product Program
The Preferred Product Program allows Funds beneficiaries to obtain preferred medications from seven drug classes for the standard copayment. Beneficiaries can obtain non-preferred medications for an additional charge plus the copayment.
 
The Preferred Product Program includes the following seven drug classes:
 
1.    Lipid Lowering Agents
2.    ARB/ARB Combinations
3.    Sedative Hypnotics
4.    DPP-4 Inhibitors and Combination
5.    Nasal Sterioids
6.    Urinary Antispasmodics
7.    Opioid-Induced Constipation
 
The program only applies to the medications listed in the specified drug classes. To see the complete Preferred Product Program drug list, click here.
 
The cost of a non-preferred drug is based on the difference in cost of the non-preferred drug and the cost of the preferred drug. The cost for the non-preferred drug varies depending on the strength and quantity of the drug prescribed.
 
Prior Authorization
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. You may call CVS/caremark at 1-800-294-4741 with questions about these programs and to obtain a prior authorization.