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    January 13, 2014      
2014
Benefit Topics:
 

Official Brochure

 

Benefits at a Glance

 

Medicare at a Glance

 

Physicians

 

Hospital

 

Prescription Drugs

 

Catastrophic Protection

 

Other Benefits

 

 

2014 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.

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 2014 NALC Health Benefit Plan brochure (RI 71-009) for complete details. 2014 Prescription Programs, 2013 Prescription Programs, and Previous brochures are also available.

Your 2014 Drug Cost-Share When NALC is Primary Carrier
Generic Drug*: You Pay:
Network Retail up to 30 day supply 20% of Cost
Mail Order up to 60 day supply $8
Mail Order 61 - 90 day supply $12
Formulary Brand Drug: You Pay:
Network Retail up to 30 day supply 30% of Cost
Mail Order up to 60 day supply $43
Mail Order 61 - 90 day supply $65
Non-Formulary Brand Drug: You Pay:
Network Retail up to 30 day supply 45% of Cost
Mail Order up to 60 day supply $58
Mail Order 61 - 90 day supply $80

Specialty Drugs: Require Prior Approval

(Available only through Caremark Specialty Pharmacy Mail Order)

You Pay:
Mail Order up to 30 day supply $150
Mail Order 31 - 60 day supply $250
Mail Order 61 - 90 day supply $350
* Generic drug coverage shown above for those generic drugs not available at a reduced cost as listed on our NALCSelect, NALCPreferred, or NALCSenior Generic Drug Lists.

 

Your 2014 Drug Cost-Share When Medicare Part B is Primary
Generic Drug*: You Pay:
Network Retail up to 30 day supply 10% of Cost
Mail Order up to 60 day supply $7
Mail Order 61 - 90 day supply $10
Formulary Brand Drug: You Pay:
Network Retail up to 30 day supply 20% of Cost
Mail Order up to 60 day supply $37
Mail Order 61 - 90 day supply $55
Non-Formulary Brand Drug: You Pay:
Network Retail up to 30 day supply 30% of Cost
Mail Order up to 60 day supply $52
Mail Order 61 - 90 day supply $70

Specialty Drugs: Require Prior Approval

(Available only through Caremark Specialty Pharmacy Mail Order)

You Pay:
Mail Order up to 30 day supply $150
Mail Order 31 - 60 day supply $250
Mail Order 61 - 90 day supply $350

* Generic drug coverage shown above for those generic drugs not available at a reduced cost as listed on our NALCSelect, NALCPreferred, or NALCSenior Generic Drug Lists.

SPECIALTY DRUGS

Specialty drugs are generally considered high-cost injectable, infused, oral or inhaled drugs that require close supervision and monitoring. You must purchase specialty drugs, including biotech, biological, biopharmaceutical, and oral chemotherapy drugs, through the Caremark Specialty Pharmacy Services.

All specialty drugs require prior approval to ensure appropriate treatment therapies for chronic complex conditions. Call CVS Caremark toll-free at 1-800-237-2767 for specific medications available through CVS Caremark Specialty Pharmacy, or to obtain prior approval. Specialty drugs available through CVS Caremark Specialty Pharmacy are subject to change.


NALC PREFERRED GENERICS

In 2014, we continue making 90-day fills of thousands of generic drugs available through the CVS Maintenance Choice Program and through our Caremark mail order program for only $7.99 when we are your primary payor, and for only $4 when Medicare Part B is the primary payor. Call Caremark at 1-800-933-NALC (6252) to find out if your generic medication is currently available on our NALCPreferred generics list.


COST-FREE GENERICS AT RETAIL WHEN MEDICARE PART B IS PRIMARY

Our 2014 NALCSenior Antibiotic generic list offers prescription generic medications at no cost when a 30-day supply is purchased at a local NALC Preferred or CareSelect pharmacy, and Medicare Part B is the primary payor.


2014 NALCSELECT GENERIC LIST 
              
When a generic medication is appropriate, ask your physician to prescribe a generic drug from our NALCSelect generic list. The amount you pay for a 90-day supply of an NALCSelect generic medication purchased through our mail order program, or at a CVS Caremark Pharmacy, including Longs Drugs, through our Maintenance Choice Program is just $5 or $4 when Medicare Part B is your primary carrier.   

 
SMOKING CESSATION

When you’re ready to quit smoking the Plan can help.  You will pay nothing for FDA-approved prescription medications prescribed for smoking cessation.  These medications will be available to you at any NALC Preferred or NALC CareSelect retail pharmacy or through our Caremark mail order program. 


DRUG PROGRAM —
For Your Short-Term And Immediate Prescription Drug Needs

NALC Participating Network Pharmacies—

The NALC CareSelect Network is a nationwide pharmacy network that offers over 68,000 retail pharmacies which includes over 18,000 NALC Preferred retail pharmacies. Our network includes most large retail chain drug stores. In many cases, your current pharmacy already participates. Locating a participating pharmacy near you is easy—simply call 1-800-933-NALC (6252).

There are no claim forms to file and no waiting for reimbursement when you purchase your prescriptions at a network pharmacy. Using your NALC Health Benefit Plan identification card, you can purchase up to a 30-day supply of covered medication, plus one refill. You will pay 20% of cost for generic medications and 30% of cost for formulary brand medications. When Medicare Part B is your primary payor, you will pay nothing for (up to) 30-day fills of generic drugs available on our NALCSenior Antibiotic generic list, and just 10% of cost of other generic medications and 20% for formulary brand medications. There is no deductible associated with our Prescription Drug program.

Preferred NALC Retail Pharmacies—

Consider using a 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, out-of-pocket expense will be reduced:

Baker’s Pharmacy

Giant Pharmacy

QFC Pharmacy

Bi-Lo Pharmacy

Jay C Plus Pharmacy

Ralphs Pharmacy

Care Plus CVS Pharmacy

Kessel Pharmacy

Randalls Pharmacy

Carrs-Gottstein Foods

King Soopers Pharmacy

Rite Aid Pharmacy

City Market Pharmacy

Kmart Pharmacy

Safeway Pharmacy

CVS Pharmacy

Kroger Drugstore

Scotts Pharmacy

Dillon Pharmacy

Kroger Food & Drug

Smith’s Pharmacy

Dominicks Pharmacy

Kroger Sav-on

Stop & Shop Pharmacy

Eagle Pharmacy Longs Drug Stores Super G Discount Drug

Food 4 Less Pharmacy

Martins Pharmacy

Target Pharmacy

Fred Meyer Pharmacy

Owen's Pharmacy

Tom Thumb Pharmacy

Fry’s Food & Drug Store

Pavilions Pharmacy

Vons Pharmacy

Genuardis Pharmacy

Payless Pharmacy

Wellness Works Pharmacy

Gerbes Pharmacy

Postal Prescription Svcs

 

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 claim forms to submit, and NO waiting for reimbursement. For prescriptions that are not listed on either our NALCPreferred or NALCSelect generic lists, you pay $8 generic and $43 brand name for up to a 60-day supply.  You pay $5 for a 90-day supply of NALCSelect generics or just $7.99 for a 90-day supply of NALCPreferred generics.  You pay $12 for other generics and $65 brand name for up to a 90-day supply.

When Medicare Part B is your primary payor, you pay $7 generic and $37 brand name for a 60-day supply.  You pay $4 for a 90-day supply of NALCSelect or NALCPreferred generics. You pay $10 for other generics and $55 brand name for a 90-day supply.

Maintenance Choice Program—

You may purchase up to a 90-day supply (84-day minimum) of covered drugs and supplies at a CVS/Caremark Pharmacy or Longs Drugs through our Maintenance Choice Program. You will pay the applicable mail order copayment for each prescription purchased.