Changes in Prescription coverage for the Legacy B Retirees 01/12/10

As you know on Jan. 1, 2010 there were changes in Prescription coverage for the Legacy B retirees. Here is some information that may help your retirees.

If you are taking a maintenance drug, (medicines usually prescribed to treat conditions of a long-term or chronic nature, such as diabetes, arthritis and high blood pressure), you may only get the first 2 fills (30 days) of the drug during a 12 month period a pharmacy. After that the drugs will not be covered unless purchased though the mail order prescription drug program, even if the prescription is written for a period of less than 30 days. If the member retired post 1992 they can go to a CVS pharmacy and get a 90 day supply at the same cost as mail order. Members who retired before 1992 will have to use the mail order program.

If you are taking a brand name drug and a generic is available you will be charged the full price of the brand drug if you do not take the generic. If your doctor writes dispense as written it will not make a difference. If you are not able to take a generic drug then your doctor would need to send in an appeal, explaining why you can not medically take the generic. When sending in an appeal be sure to include the member ID from the Caremark Card. The address for the appeal is: Appeals AT&T MC109, P O Box 52084, Phoenix AZ 85072-2084, or fax number 1-866-689-3092. An appeal could take up to 30 days, but most of the appeals should not take 30 days, this is the amount of time that is allowed. If the member is out of their medication, the doctor can write urgent on the appeal an a decision should be made with in 72 hours.

If the retiree is on Medicare, and go to the website to order medication the prices will show a $75.00 deductible on each medication. This is because the $75.00 deductible has not been met yet. Once that has been met then the correct copays will show. The deductibles change for each year as well as the copays a chart is attached. Once the member has reached their out of pocket maximum ( $1,500 individual/$3,000 family) they will get their prescriptions at no cost. The only money that will be applied to the out of pocket maximum are copays for generic and preferred retail or mail order, non-preferred will not apply.

For the non-Medicare retirees, who took the Existing Regional Medical Option, the deductible is only required for prescription filled at a retail store. The copays are different from the retiree's on Medicare also, a chart is attached to show the difference. The Caremark website will show the correct copays since the deductibles are only for retail stores. The out of pocket maximum is the same amounts with the same rules.

For Non-Medicare retirees who took the Alternative Medical Option the deductible would be required for both retail and mail order prescriptions also the deductibles and copays change each year on this plan. The out of pocket maximum is the same amounts with the same rules.

I have also attached a copy of the January-March preferred drug list from Caremark.


Thanks
Anne Strickland
CWA Managed Care Specialist

The overall goal of the Retired Members' Council is to improve the conditions of its membership and the membership of the Communications Workers of America (CWA); to pursue and further CWA labor programs; to disseminate information with respect to economic, social, political and other matters affecting the lives and welfare of its membership; to participate in educational, organizing, legislative, political, economic and community activities that advance and enhance the interests of its members and the CWA; and to advocate the enactment of laws beneficial to them and the defeat or repeal of laws detrimental to them.