8.3 RETAIL PHARMACY PROGRAM
The Retail Pharmacy program is designed to meet your short-term (a 34-day supply or less) prescription drug needs. When your prescription is filled at a participating pharmacy, you will have to pay only your copayment to the pharmacy. You will not have to file a claim form and wait for reimbursement, as the retail pharmacy will bill the Plan directly for the remainder of the cost of your prescription. If you do not have a list of participating pharmacies (or a list of approved out-of-network pharmacies), contact the Trust Customer Service Office.
After receiving a short-term prescription from your Physician, go to any participating pharmacy and present your pharmacy ID card to the pharmacist who will check your eligibility for coverage from a list supplied by the Plan. You may receive up to a 34-day supply of medication per prescription through the Retail Pharmacy Program. You must have taken at least 75% of your prescription before a refill will be covered by the Plan.
If filled through a participating retail pharmacy, the Plan also covers medications and supplements that are designated as “preventive care” under Health Care Reform and which the Plan is required by law to provide. For a list of the covered medications and supplements, see www.hhs.gov/healthcare/prevention. These items are covered at 100% in-network, but you must have a prescription from your doctor (even for the over-the-counter items). Also, not all items are covered for everybody – for example, there are age restrictions, and some items are limited to generic only. Contact the Pharmaceutical Provider for more information.