The eligibility and enrollment rules for the U

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Retiree Health Care SPD Effective January 1, 2012 • Prescriptions are not held by Medco. Once a prescription is received, it will be processed per the guidelines of this Program. 2. Be sure the strength, dosage and instructions are on the prescription and that it is clearly legible. Class II Controlled Substance medications (which require a new prescription with each fill) have special mandated requirements. Examples include pain control medications (e.g. Percocet, Demerol, oxycodone, or morphine), attention deficit disorder medications (e.g. Ritalin, Adderall, or Concerta), and miscellaneous agents (e.g. Dexedrine). Please check with your doctor for specific state requirements for Class II Controlled Substance medications, including whether the doctor needs to include the diagnosis code on the face of the prescription. The Medco Pharmacy will automatically dispense a generic, unless your doctor writes “DAW” or “dispense as written” on the prescription. Other substitutions or alternative (preferred) drugs may also be made by the pharmacist after consulting with your doctor. 3. Write the member’s name and member ID number found on the Medco ID card on the back of the original prescription. 4. Complete the Personal Information section of the Medco by Mail Order Form. This section is essential and must be completed the first time a member utilizes the Medco Pharmacy. It allows patients to share any allergies or medical conditions so that the pharmacist can conduct a thorough drug utilization to ensure patient health and safety. Be sure that the member’s ID number is clearly seen at the top left corner of the form. 5. Complete each section of the Medco by Mail Order Form. Be sure to provide a shipping address. Medco can ship orders to different locations within the United States as requested. Please provide a daytime phone number in the event a pharmacist needs to reach someone. 6. Enclose your credit card information or a check for the correct copayment/coinsurance with the order. If you are uncertain what the copayment/coinsurance will be, call Medco at 1-800- 864-1404. A representative will be able to confirm the amount. 7. Allow up to 14-21 days turnaround time on the initial order. The initial order will always take a little longer as Medco needs to enter profile information into the member’s family history account. In addition, they may have to confirm new prescription(s) with your doctor if they have a question. Subsequent refills typically take one week to ship. 8. You cannot cancel an order once it has been placed. Frequently Asked Mail Order Questions Can mail order prescriptions be faxed? Yes, your doctor can fax prescriptions for up to a 90-day supply to the Medco Pharmacy (Medco’s mail order service) if he/she is willing to do so. However, faxing a prescription will not necessarily reduce the overall time it takes for you to receive an order. Your doctor should call 1-888-EASYRX1 (1-888-327-9791) and follow the prompts for fax submission. The doctor must include the following information along with the prescription(s): Patient’s name and date of birth, member’s ID number found on the Medco ID card, doctor’s name, office phone number and fax number, time and date, doctor’s address, doctor’s DEA number, doctor’s signature, and complete name of the person faxing the prescription. If it’s incomplete or missing, Medco will fax the prescription back to the doctor requesting the necessary information. Please note that some states (such as New York) do not allow the faxing of controlled substance prescriptions. Can I order or request easy open caps on my medication bottles? Safety caps are required by law on medication bottles whenever medication is being shipped. If you would like Medco to send easy open caps along with your prescriptions, indicate that request on your order. 74
Retiree Health Care SPD Effective January 1, 2012 How are temperature-sensitive materials shipped? These types of medications are packaged in insulated packaging appropriate for the medication being shipped. It will be shipped either next day or second day depending upon the medication needs. What if my doctor writes my prescription for a 30-day supply? Medco cannot dispense a quantity greater than what was written by your doctor, even though your pharmacy mail order benefit allows up to a 90-day supply. Why did I receive a drug other than what was prescribed by my doctor? Medco may substitute a generic medication or alternative formulary (preferred) for the brand-name medication originally prescribed by your physician. When a substitution is made, you will receive a letter describing that substitution. If you have any questions about the medication you receive, you may contact Medco at 1-800-864- 1404 and speak with a pharmacist. What happens if I return my medication to Medco? The medication will be destroyed by Medco and you will be responsible for the copayment. Medco cannot restock returned medication. Education and Safety You will receive information about critical topics like drug interactions and possible side effects with every new prescription mailed to you. By visiting www.medco.com, you also can access other health-related information. Any written health information cannot replace the expertise and advice of health care providers who have direct contact with a patient. All Medco health information is designed to help you communicate more effectively with your doctor and, as a result, understand more completely your situation and choices. Retail Pharmacy When to use a Retail Pharmacy You are encouraged to use a Retail Pharmacy when you need a prescription on a short-term basis only – for example, an antibiotic to treat strep throat or if your prescription is covered by Medicare Part B (see section titled “When You Have Other Coverage – Medicare Part B Program”). For medications needed longer than short-term, see the “Mail Order Maintenance Drug Provision” and “Specialty Drug Provision” sections 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 the prescribed amount, up to a 31-day supply. 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 are enrolled in, 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. 75
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