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PRESCRIPTION DRUG BENEFIT
In This Section:
Pharmacy Consultation Program
Self-Funded For All Participants
Services are provided through a Pharmacy Benefit Management firm (PBM) for retail and mail prescriptions.
Schedule of Outpatient Prescription Drug Benefits |
| |
Pipe Trades PPO Plus Participants |
Kaiser Participants |
| Lifetime Maximum Benefit |
Included in $2M lifetime maximum
for medical plan |
$1M |
YOUR PAYMENT1 |
| |
At Retail PBM Pharmacy2 |
Through PBM
Mail Service Pharmacy
|
| Generic |
20% of cost |
20% of cost up to $20 |
| Preferred Brand |
30% of cost |
30% of cost up to $50 |
| Non-Preferred Brand |
50% of cost |
50% of cst up to $140 |
| Maximum Supply |
34 days |
90 days |
1 Your payment is due at due at time of purchase. No claim form required.
2 No benefit available at PBM pharmacies if you fail to show your PBM ID Card unless you have your PBM number
with you.
Using the Network Pharmacies
To obtain a prescription at a PBM Network pharmacy, you must present your drug plan identification card and your doctor’s
prescription at the pharmacy. You will be asked to pay the appropriate copayment for your prescriptions.
If you do not show your card or if you use a non-Network pharmacy, you will pay 100% of retail price, and the Plan will
reimburse you 50% of the retail price if the prescriptions were obtained in conjunction with emergency services provided
out-of-area (i.e., more than 30 miles from the nearest PBM pharmacy).
If you obtain a prescription at a Network pharmacy without presenting your drug ID card and pay 100% of the cost, you
may return to the pharmacy within 14 days and present your ID card. In some cases and based upon the rules of each
pharmacy, you may be able to obtain reimbursement up to the amount of your copay.
