West chester area school district prescription plan
WEST CHESTER AREA SCHOOL DISTRICT PRESCRIPTION PLAN BOOKLET
$20/$40 Copay – 90 Days Supply Mail Order or CVS Pharmacy
UNDERSTANDING YOUR MANAGED PRESCRIPTION DRUG PROGRAM
A special part of your medical coverage is the Caremark managed prescription drug plan. Under this coverage, West Chester Area School District pays a large part of the cost of medically necessary drugs and medicines. Caremark has established a nationwide network of preferred pharmacies that participate in the Managed Care Pharmacy (MCP) program. This network has been established to serve you and your covered family members. Each of the participating pharmacies has agreed to charge you preferred prices and offer a high level of service to ensure that you receive cost—effective, quality care. Please familiarize yourself with the specific terms and conditions of your prescription drug coverage. You will receive the maximum benefit that you are entitled to under the terms of your plan when you fill your prescription at any participating pharmacy. Please ask your benefits coordinator for a directory of participating pharmacies.
• Go to a participating MCP pharmacy. • Present your prescription and your prescription card to the pharmacist. • Make sure the pharmacist has full, correct information about you and your family members, including their sex and accurate
• When you have received your medicine, sign the pharmacy signature log.
• Your share of the cost is transmitted electronically and displayed on the pharmacist’s terminal with no claim form required. • Take your prescription drug and your Caremark card with you. How Do I Use My Benefit? Maintenance Drug (S) - Mail Order Service • You are required to use the mail order service for all future refills of a maintenance type drug after the 1st refill at a pharmacy.
• The mail order service is a cost savings to you since you will be able to get a 90-day supply for the same cost you would have
had to pay at the pharmacy for only a 60-day supply.
• You will need to get a new prescription from your doctor. The prescription should indicate a 90-day supply on it with 3 or 4
• Fill out a mail order form attach your prescription and a check or credit card # (for the same amount you paid at the pharmacy)
and mail in the envelope provided with the form.
• Mail order refills can be done over the internet at or through regular mail. How Much Will Your Prescription Cost?
You will pay a $10 co-payment for generic prescription drugs and a $20 co-payment for brand name prescription drugs. In addition, if you choose a brand name drug when a generic is available, you will be responsible for paying the cost difference in between the brand name and the generic in addition to your $10 generic co-payment. If a generic equivalent is available but your physician requests a brand name drug because he/she believes it is medically necessary, or if a generic is not available, you will pay your $20 brand name drug co-payment only. If you purchase your prescription at a pharmacy that is not in the Caremark Managed Care Pharmacy (MCP) network, you will pay 100% of the retail prescription cost. No reimbursement will be made for prescriptions purchased at a pharmacy not participating in the MCP Network. What Drugs Are Covered?
The West Chester Area School District Drug Program covers the drugs listed below: • Legend drugs (federal law requires these drugs to be dispensed by prescription only). These drugs are not sold over—the counter
and can only be prescribed by your doctor or other licensed prescriber. Examples of legend drugs: antibiotics (penicillin, erythromycin), antidepressants (Prozac, Zoloft), narcotic analgesics (percondan, Anacin with codeine).
• Compound drugs containing at least one legend drug ingredient • Insulin
What Drugs Are Not Covered?
The program does not cover the drugs listed below. • Anti-wrinkle agents • Contraceptives non-oral dosage forms • Cosmetic hair removal products • Growth hormones • Hair growth stimulants Rogaine (treatment for baldness) or similar products • Immunization agents (i.e. vaccines), blood or blood plasma • Levonorgestrel (Norplant) • Therapeutic devices or appliances unless listed as a covered product • Charges for the administration or injection of any drug. • Over-the-counter items • Therapeutic devises or appliances, including needles, syringes, support garments, braces, prosthetics, ramps, handrails, and other
What Is The Difference Between Generic And Brand Name Drugs?
A generic drug is the chemical copy of a brand name prescription drug. Generic drugs cost about 50 percent less than brand-name drugs and, like their brand name counterparts, they are: • Dispensed in the same dosage
Because generic drugs generally cost less than brand name drugs, you will save money when you purchase generic drugs. As part of a continuing effort to control costs and preserve quality in the health care program, you are encouraged to use generic drugs whenever your physician and/or pharmacist feels they are medically correct for your illness or condition. Your choice will affect the amount you pay for your prescription. Please remember, your choice will affect the amount you pay for your prescription.
If you choose a brand name drug when a generic equivalent is available, you will be responsible for paying the cost difference between the generic and the brand name drug in addition to your $10 generic drug copayment. (However, if you doctor prescribes a brand name drug that he/she believes is medically necessary for your condition or illness and indicates ―dispense as written‖ ((DAW) on the prescription, you will pay only your $20 brand name drug co-payment.)
How Is The Quality Of My Care Monitored?
Your prescription drug benefit includes a special feature called Drug Utilization Review. Occasionally a prescription drug may cause a problem. The problem may be predictable, perhaps avoidable, if your physician and pharmacist are aware of your medical history, current medications and the many different combinations that cause harmful drug reactions. But even top professionals cannot be constantly alert for every patient and every drug. The Caremark system electronically alerts your pharmacist to important information, such as your individual drug history, possibilities of interaction among various drugs and how long it’s been since your last prescription was filled. If the potential for drug-related illness exists, a message is sent to your pharmacist. The pharmacist can then inform you, check with your doctor, or make a professional judgment about whether to dispense your prescription. Who Do I Call If I Have Questions About Prescriptions Drugs? Of course, you’ll want to discuss your prescriptions with your doctor during your appointment. If you have additional questions, or cannot remember the exact instructions, your pharmacist can help. Pharmacists are well informed about prescription drugs and can advise you about dosages (how often and how long to take the medicine), possible side effects, and so forth. Be sure to ask the pharmacist if you have any questions or concerns about your prescription drug. For assistance or more complete information, contact your benefits coordinator.
Health Insurance Portability And Accountability Act — (HIPAA)
HIPAA restricts the uses and disclosures of protected health information (PHI) to certain Plan functions or as otherwise permitted or required by law. The confidentiality of your PHI is very important to us. The Plan is able to use or disclose your PHI for treatment, payment, and health care operations. All of this is explained in the ―Notice of Privacy Practices‖. If you are concerned that your privacy rights have been violated or you need additional information regarding your rights contact the Benefits Office at (484) 266-1010.
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