Here is some advice on how best to maximize your prescription drug benefit.
At your doctor visits
Bring a copy of the Express Scripts Preferred Formulary for the UFT Welfare Fund, which is sent to all members each December. The formulary is a great tool that lists the most commonly prescribed drugs. The listing includes brand-name drugs, generic drugs and drugs that might need a prior authorization.
Our drug program has three different co-pay amounts: for generic drugs, brand-name drugs on the formulary and brand-name drugs not on the formulary. If you share this with your doctor, he or she can write a prescription for the most appropriate drug and you will know prior to visiting the pharmacy what your co-pay will be.
Please remember that most plans have their own drug formularies 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.
Review your Rx with your doctor
It is important to review your prescription with your doctor before you leave the doctor’s office 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 most common calls received at the Welfare Fund regarding prescription drugs are 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/ESI 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 also 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 can come up if you have not added a new dependent to the Welfare Fund’s database. You may have notified your city health plan about the new dependent, but remember that the Welfare Fund has a separate database and procedure. To add the new dependent to your Welfare Fund coverage, you can use the Update Your Information (Change of Status) online form.
Obtaining maintenance drugs
After receiving the original prescription and two refills at your local pharmacy, maintenance drugs (drugs taken over an extended period of time) must be ordered through the Medco/ESI by Mail home delivery service. You should have your doctor write your prescription for either 100 doses or a 90-day supply, whichever is greater.
If you are concerned that you will not be home to receive delivery, it can be sent to a family member, to your school or to a PO box at your local post office. A post office box will cost about $88 a year, or roughly $7.30 a month.
Another option would be to receive it by general delivery, which allows you to pick it up at the post office. If you choose this option, your mail should be addressed: Name, General Delivery, Town, State, ZIP Code-9999. In areas with multiple ZIP codes, use the ZIP code for the area’s main post office. The ZIP+4 extension 9999 indicates general delivery.
To find the main post office in your area, call 1-800-275-8777.
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.