The eligibility and enrollment rules for the U

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Retiree Health Care SPD Effective January 1, 2012 All plans require the use of Accredo (a division of the Medco Pharmacy for specialty drugs) for coverage of certain specialty drugs. See the “Specialty Drug Provision” section that follows for more information about coverage. Specialty Drug Provision Specialty drugs are high cost genetically engineered injectables, selected compounds, and selected orals designed to target and treat small patient populations with chronic, often complex, diseases, which require challenging regimens and a high level of expertise. In order to be covered, certain specialty drugs used to treat complex conditions must be purchased through Accredo (a division of the Medco Pharmacy for specialty drugs) for all fills of your prescription, including your first fill. If you fill these specialty drugs at your Retail Pharmacy, you will receive no coverage and you will be responsible for the full cost of the prescription. Examples of such conditions include, but are not limited to: Multiple Sclerosis; Rheumatoid Arthritis; HIV/AIDS; cancer; hepatitis B & C; hemophilia; infertility; and growth hormone deficiency. To determine which specialty drugs are subject to these provisions, call Medco at 1-800-864-1404. For specialty drugs, you will be charged your regular mail order coinsurance for each 30-day increment. Some medications are dosed or packaged in a quantity/days supply that do not fall neatly into a one month, two month, three month category or increment. When this is the case, you will pay the applicable coinsurance once for day’s supply 1-30, the applicable coinsurance amount twice for day’s supply 31-60, and the applicable coinsurance amount three times for days supply 61-90. Accredo offers an enhanced level of service over your Retail Pharmacy. Features include: • Fast, easy service from a pharmacy dedicated solely to filling high-cost injectables, compounds and selected oral drugs. The pharmacy calls your doctor directly to get your prescription and to get you started on this program. Refills can be ordered by phone. • Your medication is sent to your home or your doctor free of charge, usually within two days, once your prescription order is received. • All supplies such as needles and syringes are free and sent along with your medication. • Eliminates concern over the Retail Pharmacy not having your drug in stock, a delay in receiving your medication and repeated trips to the pharmacy. • One-on-one member care through toll-free customer service available 24 hours a day, 365 days a year. You and your doctor can talk with specially trained staff to answer questions and receive consultation from experienced and knowledgeable pharmacists and nurses. • Automatic reminders, if you forget to refill, to ensure your medication gets to you on time. Call Medco at 1-800-864-1404 and a representative will get you started and answer your questions. They can also tell you if your drug is covered under this provision (e.g., insulin is not considered a specialty drug), should be ordered through the Medco Pharmacy (Medco’s mail order service) or obtained from a participating Retail Pharmacy. See the “Mail Order Maintenance Drug Provision” section in this SPD for more information. Any prescription drug excluded from coverage is also excluded under the Specialty Drug Provision. 70
Retiree Health Care SPD Effective January 1, 2012 Medco’s –Mail Order Service Pharmacy When to Use Mail Order You should use the Medco Pharmacy (Medco’s mail order service) if you are taking a maintenance medication for 90 days or longer to treat any ongoing health condition, such as high blood pressure, asthma, diabetes, if you take oral contraceptives or you need diabetic supplies. You may experience significant cost savings by taking advantage of the Medco Pharmacy rather than a Retail Pharmacy. See the “Mail Order Maintenance Drug Provision” section in this SPD for more information. For all options certain specialty medications require the purchase of all fills of your medication through Accredo (a division of the Medco Pharmacy for specialty drugs). See the “Specialty Drug Provision” section in this SPD for more information. Supply of Medication Subject to certain limitations as noted throughout the “Pharmacy” section in this SPD, you will generally receive up to a 90-day supply for each prescription/refill available through the Medco Pharmacy (Medco’s mail order service). Certain drugs are limited, however, to a set quantity – regardless of what your doctor prescribes. The allowed amount is based on FDA-approved dosing guidelines and medical literature or limited as per individual state regulations. Please call Medco at 1-800-864-1404 if you have questions about coverage and/or limitations on the quantity or dosage amount covered for a specific prescription drug. Copayment/Coinsurance Your copayment/coinsurance for each supply of medication depends on the option you have selected, the type of medication you receive and when/where you obtain the medication. See the “Pharmacy Coverage Summary” section in this SPD for more information. Ordering Mail Order Prescriptions Ask your doctor to prescribe up to a 90-day supply of your medication, plus refills, if necessary, up to one year (or six months for controlled substances). Mail your prescription and required copayment/coinsurance along with a Medco by Mail Order Form to: Medco P.O. Box 650322 Dallas, TX 75265-0322 To obtain an order form and pre-addressed envelope, contact Medco by phone at 1-800-864- 1404 or online at www.medco.com. Your doctor can also submit your mail order prescription on your behalf by calling Medco at 1-888-EASYRX1 (1-888-327-9791). Refilling your Mail Order Prescriptions Remember to reorder on or after the refill date indicated on the refill slip or on your medication container. If refills are authorized, a prescription may be refilled up to one year after the date it was written. For most controlled substances, it’s up to six months or five refills, whichever is less. If you request a refill before the allowed refill date, the pharmacy will hold your prescription and fill it on the date the refill is allowed. You may order refills in one of three ways: • Refills online – Go to www.medco.com. Once registered, login and select your prescriptions available for ordering. 71
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The eligibility and enrollment rules for the U

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