Retail and Mail
Service Pharmacy Services
Most prescription drugs or medications are covered under the UMWA Funds’
benefit plans. Beneficiaries may select from over 60,000 retail pharmacies or
choose the CVS Caremark® mail service pharmacy to have their
UMWA Health and Retirement Funds Prescribing Guide
CVS Caremark MAILSERVICE Pharmacy
See Link below to fax:
NEW RX FAX FORM
Making sure your patients have access to affordable medications is our priority. Hyperinflation Medications-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.
Hyperinflation Medication List
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 copayment.
For non-specialty drugs, if a brand name drug is prescribed where
a generic equivalent is available, the Generic Drug Substitution Program
requires the beneficiary to pay the copayment plus additional cost of the brand
name drug over the cost of the generic substitute. For either non-specialty or specialty
drugs in the program, an exception to the use of a generic drug can be obtained
if a Medical Necessity Request/Prior Authorization Form is submitted and it is approved
by the Funds. A letter of Medical Necessity should
be faxed to 1-888-487-9257 to provide medical information as to why the
generic medication should not be dispensed. If approved, the beneficiary will
not be required to pay the difference in cost between the brand name drug and
the generic drug. See
Generics First Speciality Preferred Product Program Drug List
The Funds recommends use of CVS Specialty Pharmacy to receive specialty
medications. 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® Specialty
Drug Program by one of the following methods:
Call CVS Specialty Pharmacy at 1-800-237-2767.
Email CVS Specialty Pharmacy at customerservicefax@Caremark.com
Fax CVS Specialty Pharmacy at 1-800-323-2445
Funds currently participates in a Specialty Preferred Products Program.
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, Multiple
Sclerosis, Hepatitis C and Growth Hormone. To see the complete list of
specialty drugs covered under the Funds' Specialty Preferred Products Program. Please
see link below.
Speciality Preferred Product Program Drug List
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.
Lowering Agents (Cholesterol Drugs)
Combinations (Blood Pressure Drugs)
Inhibitors and Combination (Diabetes Drugs)
Antispasmodics (Overactive Bladder)
- Irritable Bowel Syndrome with Constipation/ Chronic
The program only applies to the medications listed in the specified drug
classes. To see the complete Preferred Product Program drug list click here. See link below for the Prior Authorization Form.
cost of a non-preferred drug is based on the cost difference of the
non-preferred drug and the preferred drug.
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 the Preferred Product Program. To
obtain a prior authorization call 1-800-294-5979.
Prior Authorization Form