Know your benefits

Prescription drugs, Part 2

Feb 19, 2009 10:21 AM

Getting the most from your program

Now that we have reviewed the drug plan design for in-service members [see Oct. 29 issue], here is some advice on how best to maximize your prescription drug benefit.

At your doctor visits

Bring a copy of your formulary

Should your doctor decide you need medication, you should share a copy of the UFT Welfare Fund Drug Formulary (list of preferred drugs) with him or her. Most of the time there is either a generic drug or a brand drug on the formulary that will be acceptable to your doctor. This will provide you with the correct drug as well as save you money on co-pays.

Please remember that most plans have their own drug formulary and, therefore, your doctor does not know what is and what is not covered by the UFT Welfare Fund’s prescription drug plan. Sharing the formulary at the visit arms your doctor with the information needed to provide you with the best course of treatment. A copy of the formulary is available at the Fund’s Web site, www.uftwf.org.

Review your Rx with your doctor

Most of us are happy to leave the doctor’s office as quickly as possible with the hopes that a prescription will cure an ailment. However, it is important to review your prescription with your doctor before you leave to make sure that it is correct.

The Welfare Fund often receives calls saying that the quantity or supply of a member’s drug is less than he or she usually gets. In just about every case, when the original prescription is reviewed, the member has received exactly the amount that the doctor ordered. So take a moment to review your prescription with your doctor before leaving.

At the pharmacy

The No. 1 call received at the Welfare Fund regarding prescription drugs is that the member is told either that his or her card is no good or that the drug is not covered. It is very important to make sure you show your Medco card instead of your health plan card and that the pharmacist is not billing your health plan, another union or a different plan whose member has the same name as you since that information is in the pharmacy’s computer.

It is important to ask your pharmacist to explain in detail what the problem is. Most of the time, you have exhausted your refills, or the drug requires prior authorization or step therapy.

Another eligibility issue that sometimes crops up is that the pharmacy tells you that your child is no longer eligible for prescription drug coverage. Remember that unmarried, full-time college students from ages 19 to 23 remain covered by the Welfare Fund, but it is not automatic. You must submit a Dependent Student Verification Form to the Welfare Fund every year to maintain that coverage.

A third eligibility issue is that you have not added a new dependent to the Welfare Fund’s database. You may have added the new dependent to your health plan or the union, but remember that the Welfare Fund has a separate database and Change of Status procedure from the city health plan.

Obtaining maintenance drugs

There are two ways to get your maintenance drugs (drugs taken over an extended period of time):

• Use the Medco by Mail home delivery service; or
• Get your 90-day prescription (or 100 pills/capsules) filled at a participating local Retail Maintenance Network Pharmacy. (The co-pays for preferred brand and nonpreferred brand drugs ordered through the pharmacy are slightly higher.)

In either case, you should have your doctor write your prescription for either 100 doses or a 90-day supply, whichever is greater.

You can track your prescription and find out what your co-pay will be prior to home delivery by signing up at www.medco.com.

Even if you usually use home delivery, the local Retail Maintenance Network Pharmacy may come in handy in an emergency. For instance, you are leaving in a day for vacation and have forgotten to reorder your prescription. You can have your doctor call in a 90-day prescription and you can pick it up at a local network pharmacy that same day.