Local 1262’s Prescriptions are managed by Express Scripts
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FREQUENTLY ASKED QUESTIONS ABOUT PRESCRIPTIONS
Q. What is a generic medicine?
A. A generic medicine is a Food and Drug Administration (FDA) approved copy of a brand name medicine. The FDA reviews each generic medicine to assure that it is the same as the brand name medicine in safety, effectiveness, quality and performance (how it works in the body). The generic version is available for the same use (high blood pressure, allergies, etc.) and in the same form (pill, liquid, cream, etc.) as its brand name equivalent.
By law in the United States, a generic medicine cannot look exactly like the brand name medicine, but it must be equal to the brand name product in safety, effectiveness, performance and quality.
Q. Does every brand name medicine have a generic equivalent?
A. No, only about 35% of all brand name medicines have a generic equivalent.
Q. Are generic drugs made as well as brand name drugs?
A. Yes. Brand name and generic drug manufacturers must meet the same standards of good manufacturing practices. The FDA conducts about 3,500 inspections a year to monitor how all medicines “generic” and “brands” are made, processed, tested, packaged and labeled. FDA standards are the same whether the pharmaceutical company manufactures brand or generic medicines and some companies manufacture both.
Q. What if the medication I am taking is a brand name drug with a generic equivalent?
A. If the medication you are taking is a brand name drug and it has a generic equivalent you should discuss with your doctor taking the generic medication. The cost to you can be significant if you obtain a brand name drug when there is generic equivalent available.
Q. What is the cost of a brand name drug that has a generic equivalent?
A. If you get the brand name drug instead of the generic equivalent you will pay the difference in the wholesale price of the generic drug and the brand name drug plus the highest tier co-pay, $30.00. Choosing the generic product will result in the lower co-payment.
Example: Ziac tablet is the brand name for a medicine to treat hypertension (high blood pressure). The generic equivalent is bisoprolol. A 34 day supply of Ziac will cost $93.12 as opposed to the generic equivalent of $5.00 for the same 34 day supply. Generic drugs use the same active ingredients as brand name drugs and work in the same way. Generic drugs are considered to be just as effective as the brand name equivalent and carry the same risks and benefits as their brand name equivalent.
Q. What is a “preferred” drug?
A. A preferred medicine has been clinically reviewed and approved for inclusion in the preferred drug guide by ESI (Express Scripts). The medications included are based on their proven clinical and cost effectiveness.
Q. What is a “non-preferred” drug?
A. A non-preferred medicine is a medication that has been reviewed by ESI (Express Scripts) and has been determined to have an alternative drug available on the preferred list.
Medicines that are newly approved by the Food and Drug Administration (FDA) are initially designated as non-preferred until they are reviewed by the P&T Committee.
Q. Who are the physicians and pharmacists that review and update the guide?
A. The ESI (Express Scripts) is an independent group of physicians and pharmacists that regularly reviews new and existing medicines and evaluates them based on clinical safety and efficacy (how well it works). This committee makes decisions that determine the tier status of medications.
Q. What Is the “Over the Counter Assistance Program”?
A. The Over the Counter Assistance Program is for two types of medication: allergy relief and acid reflux disease.
For those members taking Clarinex, Allegra or Zyrtec they will be able to purchase Claritin OTC (over-the-counter) for $5 for a one month supply, or $10 either through mail at retail or mail order for a three (3) month supply. You will be able to purchase a package of 42 pills for $5.00 or three (3) boxes of 42 for $10 at the mail at retail or through the mail order pharmacy. If you choose to continue using the brand name prescription drugs, the co-pay will be $30 for a one month supply and $60 for a three month supply.
In addition to the allergy relief medication you will also be able to purchase Prilosec OTC instead of Aciphex, Prevacid, Nexium, Protonic and Prescription Prilosec for either $5 for a one month supply or $10 for a three month supply instead of the non-preferred co-pay of $30 (1 month) or $60 (3 months).
Q. What is a “maintenance” medication?
A. Maintenance medications are typically prescribed to a person who is required to take the drug for an extended period of time. The Plan has a specific list of maintenance medications that are part of the mail at retail and mail order programs. Not all medications that a person takes for an extended period of time are on the mail at retail / mail order maintenance drug list.
You should bring a copy of the preferred drug list and the maintenance drug list to your doctor so he can review the medications when prescribing for you.
Q. What drugs are on the maintenance drug list?
A. The common types of drugs that are on the maintenance drug list are those for high blood pressure, cholesterol reduction, asthma, diabetes, cardiovascular disease stomach/intestinal disorders and pain management. These drugs can be obtained through either the mail at retail or mail order programs at a significant savings to you.
Q. How do I obtain the prescription if my medication is on the maintenance list?
A. When you are prescribed a drug that is on the maintenance list, you may obtain the drug either through the mail at retail or ESI (Express Scripts) mail order program. Your physician must write a prescription for a 90 day supply and you will pay only 2 co-pays.
Q. How Do I use the “Mail at Retail” Program?
A. It is no different than filling a regular prescription at the pharmacy. When you are prescribed a maintenance drug, your physician would write the prescription for a 90 day supply (3 months). You would then fill the prescription at one of the “Mail at Retail” pharmacies and you will pay only two (2) co-pays for the 90 day supply. You must use one of the “Mail at Retail” pharmacies in the network for this benefit.
Q. How do I obtain my medications from the Mail Order Program?
A. The first time you use the mail order pharmacy you must obtain a new prescription from your doctor. You mail that prescription to the pharmacy in a pre-addressed envelope. You call the Fund Office toll free at 1-800-522-4161, to obtain a mail order envelope. Where you send your prescription is dependent upon who your employer is (see the Mail Order Program list below).
Q. What is the co-pay for the Mail Order prescriptions?
A. Generally, any prescription filled at the mail order pharmacy will be for a 90 day supply (3 months). For this three (3) month supply you will pay 2 times the regular co-pay.
Example: If the medication you are receiving is a generic drug and you were obtaining the prescription at a retail pharmacy, over a three (3) month period you would be paying 3 times $5.00 for a total of $15.00. If you were getting the same prescription through the mail at retail or mail order program, you will be able to obtain a three (3) month supply for 2 co-pays ($10.00).
There is no difference in co-pays between the mail at retail and the mail order. It is simply your choice as to which method you prefer.
Q. How do I pay the prescription co-pay for the mail order?
A. The mail order envelope has a section where you can designate your preferred payment method. You can pay by check or credit card. You cannot pay by cash.
You must pay the co-pay before the mail order pharmacy can ship the prescription. This is no different than at a retail pharmacy; you must pay the co-pay before the pharmacist will release the prescription to you.
Q. How do I know how much to pay for the mail order prescription?
A. If the medication you are taking is a brand name drug and it is on the preferred list you will be paying $30 (tier 2) for the mail order prescription. If the medication is the generic form you will be paying $10 (tier 1). If the medication is a non-preferred drug, you will pay $60.00 (tier 3). Remember, this is the cost for a three (3) month supply of medication.
If you do not know what category your medication falls into you can call the mail order pharmacy directly for that information and they will tell you how much your co-pay will be.
Q. How do I get my mail order prescription refilled?
A. Your prescription bottle will contain the information on the date when the prescription can be refilled and the number of refills left on that prescription.
You can send in a new envelope requesting a refill or you can call the toll free number for the mail order service and renew the prescription over the telephone.
Remember, there are three (3) mail order service providers. Which one you use will depend on who your employer is.
Q. How are prescriptions shipped through the Mail Order Program?
A. Mail at Retail Program
The Mail at Retail program enables you to obtain your “maintenance” drugs directly from specific retail pharmacies in the Local 1262 Customized Pharmacy Network. When you utilize this program, you will be asked to pay 2 co-pays and you will receive a 90 day supply of your maintenance medication. Your physician must write the prescription for a 90 day supply. A prescription written for a 30 day supply with 2 refills is not acceptable and will not be filled under the 2 co-pay discount.
This program began on June 1, 2006 and was set up to make it more convenient for members to obtain their maintenance medications. Under this program, you have more control over your written prescription and do not have to factor in the mailing time to and from the mail order pharmacy.
The retail pharmacies that are part of the network and can dispense maintenance drugs include:
- Shop-Rite pharmacies
- Stop & Shop pharmacies
Mail Order Program
This service is still provided as an alternative to the Mail at Retail program. In order to utilize this program, you must complete a Mail Service Order form. You would send the form along with the original prescription written by your physician for a 90 day supply directly to the appropriate mail order pharmacy depending upon where you are employed. You would make payment in the mailing via credit card, check or money order (cash is not accepted).
Once your order is received in the mail, you can expect your medication to arrive approximately 10 to 14 calendar days later. There is no additional charge for standard shipping.
For refills, you may order them by internet, phone or mail. The information included with your previous order will show the date you can request a refill and the number of refills you have left on the prescription.