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    January 15, 2008      
2008
Benefit Topics:
 
Official Brochure
Benefits at a Glance
Medicare at a Glance
Physicians
Hospital
Prescription Drugs
Catastrophic Protection
Other Benefits

 

 

2008 Prescription Drugs

Prior approval is required for certain specialty drugs including biotech drugs. Call Caremark Specialty Pharmacy Services at 1-800-237-2767 to obtain approval. More information.

The
NALC Prescription Drug Program—
A Convenient Money-Saving Way To Fill Your Prescriptions.

Say good-bye to claim forms and runaway prescription costs! The NALC Health Benefit Plan has two easy choices for your prescription needs, both designed to save you time and money.

Refer to the 2008 NALC Health Benefit Plan brochure (RI 71-009) for complete details. 2007 Prescription Drugs Benefits and Previous brochures are also available.

When NALC is the Primary Carrier
When you use:
You pay:
Claim Filing:

A network retail pharmacy for the 1st or 2nd fill of (up to) a 30-day supply of medication
  • 25% of cost*
    (no deductible)
  • N/A

A network retail pharmacy to refill a prescription more than once

or

A non-network retail pharmacy
  • Full cost at time of purchase
  • Submit a completed claim form to receive 50% reimbursement* of the Plan allowance (after deductible is met)
The NALC Mail Order Prescription Program
  • $8 generic/$24 name brand for 60-day supply of medication (no deductible)
  • $12 generic/$35 name brand for
    90-day supply of medication (no deductible)

 
  • N/A

 

When Medicare Part B is the Primary Carrier
When you use:
You pay:
Claim Filing:

A network retail pharmacy for the 1st or 2nd fill of (up to) a 30-day supply of medication
  • 15% of cost*
    (no deductible)
  • N/A

A network retail pharmacy to refill a prescription more than once

or

A non-network retail pharmacy
  • Full cost at time of purchase
  • Submit a completed claim form to receive 50% reimbursement* of the Plan allowance (no deductible)
The NALC Mail Order Prescription Program
  • $7 generic/$20 name brand for 60-day supply of medication (no deductible)
  • $10 generic/$30 name brand for
    90-day supply of medication (no deductible)

 
  • N/A
*A 30-day dispensing limit.

 

When Medicare Part D is the Primary Carrier

When Medicare Part D is primary payer and covers the drug, we waive:

  • Retail limitations
  • Out-of-network prescription drug deductible
  • Day supply

Your out-of-pocket costs will never exceed the Plan's Medicare prescription drug copayments or coinsurance.

 

Drug Program—
For Your Short-Term And Immediate Prescription Drug Needs

NALC Participating Network Pharmacies—

With more than 57,200 participating network pharmacies, most Plan members have an NALC CareSelect Network Pharmacy near their home. In many cases, your current pharmacy already participates. Locating a participating pharmacy near you is easy—simply call 1-800-933-NALC (6252).

You'll have no claim forms to file and no waiting for reimbursement when you purchase your prescriptions at a network pharmacy. Using your NALC identification card, you can purchase up to a 30-day supply of covered medication, plus one refill, paying 25% of the cost for both generic and name brand medications. You'll pay 15% if Medicare Part B is primary. There is no deductible.

Preferred NALC Retail Pharmacies—

For 2008, we are offering the Preferred NALC Retail Pharmacy Network. From our broad network of participating pharmacies, the following pharmacies have stepped up to offer members of the NALC Health Benefit Plan an additional discount. When you fill your prescription at one of the following preferred pharmacies, you will reduce your out-of-pocket expense:

Baker's Pharmacy

Genuardis Pharmacy

Ralphs

Bell Markets

Gerbes Pharmacy

Randalls Pharmacy

Bi-Lo

Giant Food Stores

Rite Aid Pharmacy

Brooks Maxi Drug

Giant of Maryland

Safeway Pharmacy

Brooks Pharmacy

Hilander Pharmacy

Smith's Pharmacy

Bruno's

Jay-C Food Store

Stop & Shop Pharmacy

Carrs

Kessel Pharmacy

Super G Discount Drug

City Market Pharmacy

King Soopers Pharmacy

Target Pharmacy

CVS

Kmart Pharmacy

Tom Thumb Pharmacy

Dillons Pharmacy

Kroger Food & Drug

Tops Pharmacy

Dominicks Pharmacy

Kroger Sav-On

Vons Pharmacy

Eckerd Drugs

Martins Pharmacy

Food 4 Less Pharmacy

Owens Pharmacy

Fred Meyer Pharmacy

Pavilions Pharmacy

Fry's Food & Drug

QFC Pharmacy

These preferred pharmacies recognize the value of the NALC Health Benefit Plan's retail business and have agreed to lower prices. This means our members will typically see lower priced brand name drugs at these pharmacies.

If you request a name brand drug when a generic drug is available, you will have to pay the difference in cost between the name brand and the generic.

You may choose to continue to purchase your prescriptions at your local participating or non-participating pharmacy, but benefits will be reduced. You will need to file a claim for reimbursement.

Mail Order Drug Program—
For Your Long-Term And Ongoing Prescription Drug Needs

Your savings begin with the very first prescription you order because there are NO deductibles to satisfy, NO claim forms to submit, and NO waiting for reimbursement. You pay $8 generic/$24 name brand for up to a 60-day supply. You pay $12 generic/$35 name brand for up to a 90-day supply. When Medicare Part B is primary; you pay $7 generic/$20 name brand for a 60-day supply and $10 generic/$30 name brand for a 90-day supply.

Medicare: When Medicare is the primary carrier, the deductible for a paper claim filed for reimbursement will be waived. Copayments and coinsurance for prescriptions are not waived.

Specialty Drugs: We cover specialty and biotech drugs used for treatment therapies only under the prescription drug benefit. To receive the maximum benefit for these medicines NALC Plan members must purchase them from Caremark, our NALC Plan prescription drug benefit manager (PBM). Specialty medicines will be administered through Caremark's Specialty Pharmacy Services (SPS) program. The SPS programs ensure appropriate therapy and promote patient safety for chronic medical conditions.

Prior approval is required for specialty drugs used to treat the following chronic complex conditions: allergic asthma, hepatitis C, psoriasis, growth hormone disorder, rheumatoid arthritis, and respiratory syncytial virus. You pay the same low copayment for specialty drugs approved and purchased through Caremark's SPS program as for any other mail order medication.

CaremarkDirect click here for more information
(Noncovered Prescriptions and Over-the-Counter Medications and Products)

We are pleased to offer members of the NALC Health Benefit Plan the CaremarkDirect Program that supports convenient access to competitively priced over-the-counter (OTC) medication, as well as prescription lifestyle drugs that are not covered by the Plan, i.e., prescriptions used to treat hair loss or obesity. CaremarkDirect is a value-added program that supports effective drug trend management by providing members safe, convenient access to non-covered prescriptions and certain OTCs. All products purchased through CaremarkDirect require a physician's prescription. Call 1-800-933-NALC (6252) to check the availability of a particular product.