Prescription Drug Plan
| Plan Administrator |
Express Scripts
|
| Participating Retail Pharmacies | - Locate participating retail pharmacies at www.express-scripts.com.
- Present your Express Scripts identification card.
- No need to submit a claim form, just pay the copayment. |
| Preferred Medication List | Express Scripts' list of preferred brand-name drugs is available at www.express-scripts.com. |
| Required Pre-Authorization | Certain drugs must be pre-authorized. If you have questions about which drugs require pre-authorization, only your physician should contact Express Scripts at 800-417-8164 or send a fax to 800-357-9577 |
| What the Plan Covers |
Retail Pharmacy
- 30-day supply
- Generic drug: $5 copay
- Preferred brand-name: $15 copay
- Non-preferred brand-name: $25 copay
- Copayment for any refills beyond the third refill will be 50% of the cost.
The Fund covers the remaining cost.
|
Mail-order Service
- 90-day supply
- Generic drug: $10 copay
- Preferred brand-name: $30 copay
- Non-preferred brand-name: $50 copay
The Fund covers the remaining cost.
|
| Filing a Claim | If you use a participating retail pharmacy or the mail-order service, you do not need to file a claim. If you use a non-participating pharmacy, you must file a claim within 90 days from the date of purchase. Contact Express Scripts for a claim form at www.express-scripts.com or 800-467-2006. |
| Summary Plan Description |
Copyright © 2006 Massachusetts Laborers' Benefit Funds
