Serving United Mine Workers of America retirees for over 65 years
I currently take a non-preferred drug or a
brand name drug because the other drug did not work for me. Do I have to pay
the additional charge?
The Funds has a process in place to have a drug approved
under a “medical necessity” provision by your doctor. Your doctor should fax a
letter of medical necessity to 1-888-487-9257 to provide medical information as
to why the non- preferred or brand
name medication should be dispensed, if authorized there is no
I was told by my pharmacist that the
medication that I am taking for (“birth control”, “acne”, “weight control”) is
not covered. Why?
How can I sign up for mail service?
If you are not currently using mail service, consider
signing up for your maintenance medication needs. Depending on your drug
benefit design, there may be a significant financial advantage to you if you do
so. This is in addition to the convenience of home delivery and savings on gas
and time. To enroll in the mail service program, you can contact the Funds’
“FAST START” department at 1-800-294-4741. Be prepared to provide information
about you, your doctor and the prescriptions that you routinely take. If you
prefer to use to mail service paper form to start your service, please
Am I required to use Generic Drugs?
Yes, the Funds requires that generic forms of medications
are used when available. If a brand name drug is filled when a generic is
available, then there is a charge equal to the difference of the cost of the
medication for the two prescriptions. This charge is in addition to your
copayment for the prescriptions.
If you cannot take a generic drug due to a specific medical reason, your doctor
should contact CVS Caremark’s Prior Authorization Department at
1-800-294-5979 to provide medical information as to why generic medication
should not be dispensed.
If approved, you will not pay the difference between the brand name drug and
the generic drug.
I received my card. It has the “CVS” name on
it. Am I required to use only CVS pharmacies, or can I continue to use my
The CVS Caremark logo appears on the card
because they are the Funds’ pharmacy benefit processor. You may continue to use
your current pharmacy. The Funds has elected a network of over 68,000
pharmacies for you to choose from including all of the major chains and many
hundreds of independent pharmacies, as well.
What drugs were chosen for the Preferred
About one third of all prescriptions written for Funds’
beneficiaries are for drugs for the stomach, cholesterol, blood pressure and
sleep. The Funds’ Pharmacy and Therapeutics Committee, a
committee of doctors and pharmacists, carefully selected a list of preferred
drugs for each condition. The preferred drugs are clinically effective and
similar to other drugs that treat the same condition
What if I cannot take the drug on the
Your doctor should fax a letter
of medical necessity to 1-888-487-9257 to provide medical information
as to why the preferred medication should not be dispensed. If
approved, the you will be authorized to receive one of the ”non-preferred”
products at the standard co-payment.
If I do not receive approval for a
non-preferred drug am I still able to receive my medication? How will I know which drugs my doctor can
No. You will still be able to get your drug. However, for
a non-preferred drug you will be charged an amount in addition to your standard
co-payment. The amount will be approximately the difference between the
preferred drug cost and the non-preferred drug cost.
How will my doctor know which drugs to order?
To view the complete list of the preferred and
non-preferred drugs click the link for the Preferred
Product Drug List. Your doctor can order a drug on the preferred
list if it is right for you.
I have tried some of the preferred drugs and
they did not work. Why do I have to try them again?
If you have already tried a preferred drug and it did not
work for you, you may qualify for a non-preferred drug at your standard
co-payment. Your doctor can contact CVS Caremark toll free at 1-800-294-5979 to
get a Preferred Product Program request form to explain why you cannot take one
of the preferred drug.
* Please note: If you are on a drug that is not on the preferred product list,
the requirement that you first try the preferred drug, in the absence of a
medical exception from your doctor, does not apply to you.