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 OptumRx to provide, you and your family, all your pharmaceutical needs.
Filling a Prescription
4- Tier Program
Our program offers a convenient 4-tier structure to meet all your medication needs. The 4-tiers are as follows:
OptumRx’s Select Formulary List
The OptumRx Select Formulary 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 OptumRx Select Formulary 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 for the OptumRx Select Formulary list effective January 1, 2020. Be sure to mention to your provider that your plan uses the OptumRx Select Formulary for your prescription drug coverage.
Specialty Medication
Specialty Medications require a Prior Authorization before they can be filled. For additional information regarding Specialty Medication and the Prior Authorization process, 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.
Prescription Copayments
Each time you obtain a medication there is a copay due based on the plan you are enrolled in. The chart below is a break down of the copay structure for Short-Term and Long-Term medications by plan.
Billing Information
Please be sure to present your vendor card to your local pharmacist when dropping or picking up a prescription. The “Pharmacy Benefit” tab of this card contains all the information needed to bill your pharmacy claims properly.
Processing a Prescription Through the Prescription Drug Program
If your prescription does NOT go through the insurance, for any reason, after you have presented your Vendor Card to the Pharmacy Staff, then call the Pharmacy Benefit Department at 708-387-8331 IMMEDIATELY. There is a reason that the prescription is not going through so please be sure to promptly contact us so our staff can investigate what is going on. Claims can be re-processed at a Pharmacy within 7 days that the prescription was originally processed, and an accurate refund can be issued. The Pharmacy Benefit Department cannot issue a reimbursement for anything that was paid out-of-pocket after 7 days that the prescription was picked up, and there is no reimbursement through the Family Supplemental Benefit (FSB).
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.