Pharmacy Benefit

logoCaremark Logo Updated 03.03.16

The Prescription Drug Program provides eligible active and retired members of Local 150 and their eligible dependents, benefits through the Midwest Operating Engineers Welfare Fund. We proudly partnered with CVS/caremark to provide, you and your family, all of your pharmaceutical needs.

Filling a Prescription

  • Short-Term Medication: These prescriptions can be filled at any in-network pharmacy (CVS, Target, Walgreens etc.):
    • Indicate to your physician which pharmacy you would like your prescription filled at along with the location so they can call, fax or electronically submit your prescription to be processed.
    • You may receive up to two 30-day supplies of a short-term medication, but if you seek a third refill of that medication it is no longer considered short-term. When seeking a third refill it is now considered a long-term medication (maintenance medication), and you must transition to a CVS or Target Pharmacy or the Caremark Mail Service Pharmacy to obtain a 90-day supply. Alternately, you can choose to stay at your current pharmacy for that refill; however, for any future refills you will be responsible to pay 100% of the cost of the medication. Please note, if you choose to pay the 100% of the cost no reimbursement will be allowed.
    • To locate an in-network pharmacy closest to you login at www.caremark.com and click on the “Pharmacy Locator” at the top right hand corner of the page.
  • Long-Term Medication (Maintenance Medication): These prescriptions can be filled at CVS and Target Pharmacies:
    • Indicate to your physician which CVS or Target Pharmacy you would like your prescription filled at along with the location so they can call, fax or electronically submit your prescription to be processed.
    • These medications can only be filled as 90-day supplies.
  • Long-Term medication can also be filled at the Caremark Mail Service Pharmacy:
    • Indicate to your physician that you would like to use the Caremark Mail Service Pharmacy.
    • Your physician can call, fax or electronically submit your prescription to them for processing.
    • You can contact their Customer Care Call Center at (855) MYRX150 to answer any questions, update your form of payment, track an order, update your address, and much more.

4- Tier Program

Effective April 1, 2017 two additional tiers have been added to our Prescription Drug Program for both the Welfare Fund and the Retiree Welfare Plan. We moved from the traditional two-tier copayment structure, which included generic and preferred brand medications, to a four-tier structure, by adding a non-preferred brand (Tier 3) and specialty medications (Tier 4). Please note, the copayments for generic (Tier 1) and preferred brand (Tier 2) will remain the same for the 2017-2018 Plan Year.  The 4-tiers are as follows:

  • Generic Medication (Tier 1)
  • Preferred Brand Name Medication (Tier 2)
  • Non-preferred Brand Name Medication (Tier 3)
  • Specialty Medication (Tier 4)

The CVS Caremark® Performance Drug List is a guide within select therapeutic categories for Plan members and health care providers.  Ask your physician to consider prescribing generic medication as a first line option, when medically appropriate, from the CVS Caremark® Performance Drug List. Generic medications are typically a lower cost to the plan, and these savings are immediately passed directly to the membership.  If there is no generic available, there may be a preferred brand name medication listed.

Click here to view the CVS Caremark® Performance Drug List.  Be sure to take this list along when you or an eligible family member has a doctor visit.

Specialty Medication

These medications are typically high in cost, treat rare conditions, require special handling (like refrigeration), or are infused or injectable medications. The specialty medication copayment change effective April 1, 2017 will help the plan control costs and help members effectively manage their conditions. To help with the transition, the Board of Trustees has decided that if you are currently using a specialty medication before April 1, 2017, your specialty drug copayment for a 30-day supply of that medication will continue at the preferred brand copayment of either $10 or $40, depending on the Plan you are enrolled in (as shown in the chart below). The new copayment will apply to any new users of specialty medications or existing users that are prescribed a different specialty medication starting on or after April 1, 2017.

Specialty Medications require a Prior Authorization in order to be filled.  For additional information please contact the Pharmacy Benefit Department at (708) 387-8331.

Limitations/Exceptions- Dispense As Written (DAW) Penalty

When available, generic medications will be substituted for all brand name medications. If a Participant requests a brand name medication, or if the prescribing physician indicates “no substitutions”, when a generic equivalent is available, the Participant will be required to pay the brand name copay plus the difference in cost between the brand name medication and its generic equivalent unless proven medically necessary through the appeals process.

Copay Schedule

Copay Chart Updated

Billing Information

Please be sure to present your vendor card to your local pharmacist when dropping or picking uvendor-card-snip-backp a prescription.  These cards contain all of the information needed to bill your pharmacy claims properly. The required billing information is located on your vendor card under the Pharmacy Benefit tab and reads as follows:rx billing info

 

Additional Resources

The CVS retail app can make getting your prescriptions easier.  It’ll even remind you when to take them.

-Refill Prescriptions-Scan to refill or order from your account on the go.CVS mobile app pic

NEW! Pick Up Prescriptions with Your Phone- Mobile prescription pickup is quick, easy and private. How It Works

NEW! Stay on Schedule with Medication Reminders- Keep yourself and those you care for on track with personalized reminders. How It Works

-Manage Prescriptions- Easily manage your own and family members’ prescriptions.

Download the CVS retail mobile app now!  apple store logo       google play store logo

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caremark mail service pharmacy mobile app image

Caremark has the tools to help you manage your family’s health anywhere, anytime.

– Refill and renew mail service prescriptions from yourself and family members

– ID unknown pills with the pill identifier

– Check for potential drug interactions among medications

– Check order status and view your prescription history

– Check drug coverage and cost under your plan

– Find local pharmacies in your plan’s network

Download the Caremark mobile app now!  apple store logo       google play store logo   

 

Retiree Benefits and Medicare Prescription Drug Benefits (Part D)

If you enroll with Medicare for Medicare Prescription Drug Coverage, you will lose prescription drug coverage through the Midwest Operating Engineers Welfare Fund. Enrolling in Medicare Part D will not affect your other Fund health care benefits. For more information see the Notice of Prescription Drug Creditable Coverage.

If you have any questions regarding the Prescription Drug Program please contact the Pharmacy Benefit Department at (708) 387-8331.