Prescription Drug Plan Overview
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UMWA Health and Retirement Funds

Prescription Drug Plan Overview


Most prescription drugs or medications are covered under the UMWA Funds benefit plans. You may select from over 64,000 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.

  

Generic Substitution Program

  
There is a generic substitution program for both non-specialty and specialty drugs. A quality, generic prescription drug product will be dispensed to Funds’ beneficiaries whenever possible for the standard Funds co-payment.
 
For either non-specialty or specialty drugs in the program, an exception to the use of a generic drug can be obtained if the physician submits a Medical Necessity Request/Prior Authorization Form and it is approved by the Funds. 
 
For non-specialty drugs, the Generic Drug Substitution Program requires you to pay the co-payment plus the price difference for the brand drug when either the you or your physician request the brand drug, unless a Medical Necessity Request/Prior Authorization Form is submitted and approved by the Funds.
 

Specialty Pharmacy Program

 
Specialty Drugs are used to treat long-term illnesses, for example multiple sclerosis, leukemia, and rheumatoid arthritis, and require long-term monitoring and special tests during treatment. The Funds recommends use of CVS/caremark’s Specialty Pharmacy to receive these medications. Pharmacists and nurses at this pharmacy work with you and your doctor to assure proper dosing and testing to achieve maximum effectiveness of the drug while minimizing side effects. You or your doctor can enroll in CVS/caremark’s Specialty Drug Program by calling 1-800-237-2767.
 
Preferred Product Program
 
The Preferred Product Program allows you to obtain “preferred” medications from seven drug classes for the standard copayment. “Non-preferred” medications can be obtained for an additional charge plus the copayment. 
 

The Preferred Product Program includes the following seven classes:

 
  1. Proton Pump Inhibitors (PPIs)
  2. Lipid Lowering Agents
  3. ARB/ARB Combinations
  4. Sedative Hypnotics
  5. DPP-4 Inhibitors and Combination
  6. Nasal Steriods
  7. Urinary Antispasmodics (Overactive Bladder)
 

The program ONLY applies to the medications listed in the specified drug classes. Preferred Product Program Drug List

  

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.

  

A Prior Authorization review process, which is based upon medical necessity, is available if your doctor believes that you must have the brand or the non-preferred product for medical reasons. Your doctor may call CVS/caremark at 1-800-294-4741 with questions about these programs.

  

Mail Service Pharmacy

  

Maximize the value of your prescription drug benefit through use of the mail service, preferred products and generic drugs, and the Funds’ preferred Specialty Pharmacy. To learn more about your Prescription Drug and other benefits, call the Funds Health Call Center at 1-800-291-1425