Most prescription drugs or medications are covered under the UMWA Funds benefit plans. You may select from over 64,000 retail pharmacies or choose the CVS Caremark mail service pharmacy to have your prescriptions filled. Copayments are lower when you use the mail service pharmacy for your medications.
Making sure you have access to affordable medications is our priority. Hyperinflation Medication-drugs seeing very high price inflation or big price tags compared to clinically equivalent alternatives require a medical necessity review before coverage by the Funds. Medications requiring medical necessity review may change. See link below for the current list.
There is a generic substitution program for both non-specialty and specialty drugs. A quality, generic prescription drug product will be dispensed to Fund’s beneficiaries whenever possible for the standard Funds’ copayment.
If a brand name drug is prescribed where a generic equivalent is available, the Generic Drug Substitution Program requires you to pay the copayment plus additional cost of the brand name drug over the cost of the generic substitute. For either non-specialty or specialty drugs in the program, an exception to the use of a generic drug can be obtained if the physician submits a Medical Necessity Request/Prior Authorization Form and it is approved by the Funds. Your doctor should fax a letter of medical necessity to 1-888-487-9257 to provide medical information as to why the generic medication should not be dispensed. If approved, the beneficiary will not be required to pay the difference in cost between the brand name drug and the generic drug.
Specialty Drugs are used to treat long-term illnesses. Such as: Cancer, Crohn’s Disease, Rheumatoid Arthritis, and Multiple Sclerosis. These conditions require special monitoring and testing during treatment. Pharmacists at CVS Specialty can work with you and your doctor to ensure proper dosing and testing to achieve maximum effectiveness of the drug while minimizing side effects. You can enroll in CVS Specialty by calling 1-800-237-2767 or you doctor can E-Prescribe. All specialty drugs are limited to a 30-day supply.
The Funds has a specialty drug preferred product program called the Advanced Control Specialty Formulary (ACSF). The preferred drugs in ACSF classes are available at the standard copay. If a non-preferred drug within these classes is selected, the prescriber will be asked to consider preferred drug(s) to be used before the non-preferred drug will be covered. If you have questions, please call CVS Caremark Customer Care at 1-800-294-4741. See the link below.
Advanced Control Specialty Formulary
The Preferred Product Program allows Funds’ beneficiaries to obtain “preferred” medication products from select classes of drugs for the usual copayment. “Non-preferred” medications may be provided for you and your doctor’s reference.
If a beneficiary cannot take a preferred product due to a specific medical reason(s), or if their doctor believes they must have the non-preferred product the doctor can request medical necessity for the non-preferred drug. If the drug is approved the beneficiary will receive the product for their usual copayment.
Please see the links below for specific Preferred Product Program information based on your plan. If you are unsure about your specific plan please contact our call center at (800)-291-1425.
Preferred Product Program for beneficiaries under:
Preferred Product Program for all other beneficiary plans.
A Medical Necessity Request/Prior Authorization process is available, if your doctor believes you must have the brand name drug or the non-preferred product for medical reasons. Your doctor may call CVS Caremark® at 1-800-294-4741 with questions about the Preferred Product Programs.
Maximize the value of your prescription drug benefit through use of the mail service. Depending on your plan, copayments may be reduced if you use the mail service pharmacy depending on your plan. You may learn more about your Prescription Drug benefits by calling the UMWA Health and Retirement Funds’ Call Center at 1-800-291-1425.
