A “Prescription Drug” or “Drug” means a Medically Necessary take-home medication or article (including insulin, syringes, diabetic testing supplies, glucose monitoring equipment and self-administered injectables) that may be lawfully dispensed as provided under the federal Food, Drug, and Cosmetic Act (FDA), upon the written prescription of a Physician licensed by law to administer it, and dispensed by a licensed pharmacy.
A brand-name Prescription Drug is sold under a trademark name or created by the manufacturer who may hold a patent on the Drug. There is not always a generic version for every brand-name drug. In order to achieve maximum savings to both you and the Plan, the Pharmacy Program includes a special list of brandname drugs called “Preferred” drugs. These drugs are selected by the Pharmacy Program Manager to be on the list primarily based on drug effectiveness and then cost. The prescription drug benefit requires different copayment amounts for a “Preferred Brand-Name Drug” and a “Non-Preferred Brand-Name Drug.” You may still have your prescription filled with a Non-Preferred Brand-Name Drug; however, your copayment will be significantly higher.
A generic Prescription Drug is chemically the same (has the same active ingredients) as the brand-name Drug, and are usually referred to by their common chemical names. Generic Drugs can be produced and sold after the patent has expired on a brand-name Drug. Generic Drugs must meet the same FDA standards as their brandname counterparts.
A “copayment” is the charge you pay for each prescription as part of the cost sharing arrangement with the Plan. You are responsible for the copayment at the time your prescription is filled.
- PARTICIPATING RETAIL PHARMACY (34-Day Supply): At a participating retail pharmacy, your copayment is 20% for a generic Drug, 35% for a preferred brand-name Drug and 50% for a nonpreferred brand-name Drug.
- MAIL ORDER PHARMACY: If using the preferred mail order pharmacy program, your copayment for a 90-day supply of maintenance medication is $20 for a generic Drug, $50 for a preferred brandname Drug and $100 for a non-preferred brand-name Drug.
If you don’t use your prescription drug card or you use a non-participating pharmacy when you could have used a network pharmacy you pay 100%.
Certain Prescription Drugs require review or “prior authorization” before they may be obtained through the Plan’s Prescription Drug Benefit. If your pharmacist tells you that a medication your Physician has prescribed requires prior authorization, ask your pharmacist or Physician to call the Pharmaceutical Provider (see the Quick Reference Table at the front of this booklet).
Important Note: If your dependents have other health coverage that includes prescription drugs benefits, they must use that program if it is their primary coverage. Dependents with primary drug coverage provided through their employer plan or other trust plan may not use the Alaska Teamster Employer Welfare Trust Prescription Drug Program described below. In addition, copayments or any out of pocket expenses not paid by the primary plan are not covered by the Trust.