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 60,000 retail pharmacies or choose the CVS Caremark® mail service pharmacy to have their prescriptions filled.


UMWA Health and Retirement Funds Prescribing Guide


 To ePrescribe choose:


CVS Caremark MAILSERVICE Pharmacy

NCPDP ID: 0322038

9501 E Shea Blvd.

Scottsdale, AZ 85260

 

See Link below to fax:

RX FAX FORM​



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 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 link below.


Generics First Speciality Preferred Product Program Drug List​

 

Specialty Pharmacy Program


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:

 
1.      Call CVS Specialty Pharmacy at 1-800-237-2767.
2.      Email CVS Specialty Pharmacy at customerservicefax@Caremark.com
3.      Fax CVS Specialty Pharmacy at 1-800-323-2445
4.      ePrescribe:

CVS Specialty Pharmacy

NCPDP ID 1466033

800 Biermann Court

Mount Prospect, IL 60056

 

 

The 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

 

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.

 

  • Lipid Lowering Agents (Cholesterol Drugs)
  • ARB/ARB Combinations (Blood Pressure Drugs)
  • Hypnotics (Sleep Aids)
  • DPP-4 Inhibitors and Combination (Diabetes Drugs)
  • Nasal Steroids (Allergies)
  • Urinary Antispasmodics (Overactive Bladder)
  • Irritable Bowel Syndrome with Constipation/ Chronic Idiopathic Constipation
  • 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 cost difference of the non-preferred drug and the preferred drug.

 

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 the Preferred Product Program. To obtain a prior authorization call 1-800-294-5979.



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