Prescription Drug benefits
What are the network pharmacy benefits?
At a network retail pharmacy, once you have satisfied the deductible, you pay the required copayment, and the network pharmacy will submit your claim to Medco. For an overview of prescription drug benefits including the required annual deductibles and copayments, refer to the Prescription drug benefits at-a-glance page.
Also note that effective Jan. 1, 2011, prescriptions for long-term medications (taken for three months or more) must be filled at Medco Pharmacy after a maximum of two fills at a retail pharmacy (network or non-network). Also effective Jan. 1, 2011, prescriptions for specialty medications (drugs used to treat a broad array of complex diseases that may require special handling, administration by infusion or injection, or specialized patient support) must be filled through Accredo Health Group specialty pharmacy after a maximum of one fill (30 day supply) at a retail pharmacy.
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What are the non-network pharmacy benefits?
At a non-network retail pharmacy, you pay the full retail price, and then submit a claim for reimbursement to Medco. Claim forms are available from Medco Member Services by calling (800) 903-8343. Once you have satisfied the deductible, you pay the same copayments that apply to network pharmacy benefits, plus the difference between the discounted price and the actual charge. For an overview of prescription drug benefits including the required annual deductibles and copayments, refer to the Prescription drug benefits at-a-glance page.
Also note that effective Jan. 1, 2011, prescriptions for long-term medications (taken for three months or more) must be filled at Medco Pharmacy after a maximum of two fills at a retail pharmacy (network or non-network). Also effective Jan. 1, 2011, prescriptions for specialty medications (drugs used to treat a broad array of complex diseases that may require special handling, administration by infusion or injection, or specialized patient support) must be filled through Accredo Health Group specialty pharmacy after a maximum of one fill (30 day supply) at a retail pharmacy.
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Is there a deductible for the prescription drug program?
Yes. The retail deductible is $75 for an individual with a maximum of $150 for a family. Mail order service purchases are not subject to, and do not count toward, the deductible.
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If I lose my medication or need an early refill, what should I do?
The AFTRA Health Plan's prescription drug benefits has an “early refill option” that allows you to order prescriptions in advance for the normal supply allowed. If you need a prescription refilled early due to special circumstances (such as losing your medication or going on vacation), contact Medco at (800) 903-8343.
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