Prescription Drug Coverage
Understanding Pharmacy Options
Pharmacy Benefits : Use this benefit to purchase short-term or 30-day prescriptions . Navitus ’ retail network includes over 68,000 pharmacies around the United States . Choose a participating retail pharmacy close to home or work .
Mail-Order Benefits : Use this benefit for maintenance medications that will continue for at least three months at a time . Medications are delivered directly to your home in three-month quantities ; so , it may save time and money at the pharmacy . Mail order prescriptions will be available through Navitus ’ mail-service partner , NoviXus .
90-Days Retail : Provides members with an alternative to mail order . Members may fill a three-month supply of maintenance medication ( s ) at Walgreens pharmacies , physician must write prescription for a 90-day fill .
Prior Authorizations / Step Therapy / Quantity Limits : Some prescriptions require prior authorization from Navitus . A drug listed on the formulary with a label of “ PA ” requires prior authorization before the drug will be covered by the plan . A label of “ ST ” means the drug falls under the step therapy program . Usually this means the member may need to first try a safe and more cost-effective drug before moving to a costlier treatment . A “ QL ” label identifies drugs that have quantity limits applied . For more information , contact Navitus Customer Care toll-free at 866- 333-2757 or visit www . navitus . com .
Preventive Drug List : A list of medications chosen to be included in the High Deductible Health Plan Preventive Drug list that help protect against or manage some high risk medical conditions . Taking these medications as directed by your prescriber can help avoid serious health problems . That may mean fewer doctor visits and hospitalizations , reducing the total health care cost .
Mandatory Specialty Program : Navitus SpecialtyRx , a specialty pharmacy program offered through a partnership with Lumicera Health Services , helps manage high-cost and injectable drugs with a focus on patient care . To order specialty medications call 1-855- 847-3553 .
Generic Equivalents : Cost-effective generic equivalents are dispensed unless the health plan provider specifies the brand name drug should be used . The provider must also require that no substitutions may be made . If both conditions are met , the brand name drug will be covered at the copay specified in the Formulary .
Getting the Most From Your Pharmacy Benefit
Members may choose between brand-name medications and saving money with a generic equivalent medication . Generics have the same active ingredients ( the chemicals that make the medications work ) as their brand equivalents , and both brandname and generic medications must meet identical strict standards for quality of the United States Food and Drug Administration ( FDA ). Sometimes generic medication manufacturers use different inactive ingredients , such as fillers and dyes , which provide the medications ’ shape , color and taste . However , those ingredients do not change the effectiveness of the medication . As long as the doctor does not tell the pharmacy to dispense as written , when there is a generic equivalent prescription available , the pharmacy will fill with the generic medication .
Required Notice If you have Medicare or will become eligible for Medicare in 2020 , federal law gives you choices about prescription drug coverage . Please see page 24 for more details or the HR portal – Documents and Forms – Required Notices .
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