ASEA AFSCME Local 52 Health Benefits Trust is in Alaska

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The cost of prescription drugs can be a significant portion of total health care costs, so it is important to understand your coverage.

Caremark is the Prescription Benefit Manager for the ASEA Health Trust’s prescription plan. Caremark has a web site specifically for ASEA/AFSCME Local 52 Health Benefits Trust members. Using this site, you can refill a prescription, check on the status of your prescription, locate a pharmacy, and more. To access the Caremark website:

  • If you are NOT currently logged in to the secure section of this ASEA website: You must first login, then navigate to Your Account > Your Claims > Prescription Drug Claims page and click on the "Caremark Single Sign-On" link.
  • If you are currently logged in to the secure section of this ASEA website: Click to visit the Prescription Drug Claims page and click on the "Caremark Single Sign-On" link.

This is a single sign-on site, which means that once you log into the secure portion of the ASEA Health Trust’s web site, you can link directly to the secure section of Caremark’s site without signing in again.

Amount Covered by Plan Option

The amount the Plan pays for prescription drugs is based on the Plan’s Allowable Expenses of the Medical Plan Option in which you are enrolled.

Formulary Exclusions: The Caremark drug formulary is a list of generic and brand name prescription drugs that are evaluated by a committee of experts and chosen for their safety and effectiveness. Drugs that are not in the formulary are excluded from coverage.

 

PLAN A

Full Plan for Employees and Family

PLAN B

Full Plan for Employees Only

PLAN C

Supplemental Plan for Employees and Families with Other Coverage

PLAN D

Low Option Plan for Employees and Families

Generic Copay

RETAIL OR
MAIL ORDER

Your Copay

Plan Pays

 

 
 

10%

90%

 

 
 

10%

90%

 

 
 

80%

20%

Paid Under the Medical Benefit at 100% after deductible

Brand Copay*

RETAIL OR
MAIL ORDER

Your Copay

Plan Pays

 

 
 

20%

80%

 

 
 

20%

80%

 

 
 

80%

20%

 

Paid Under the Medical Benefit at 100% after deductible

Maximum Copay per Prescription**

$60

$20 per 30-day supply of Specialty Medications

 $60

$20 per 30-day supply of Specialty Medications

 

N/A

 

N/A

Maximum Copay per Person per Benefit Year*

 

$600

 

$600

 

N/A

 

N/A

Maximum Supply per Prescription

90 days or 100 units
30 days for Specialty Medications

90 days or 100 units
30 days for Specialty Medications

90 days or 100 units
30 days for Specialty Medications

90 days or 100 units
30 days for Specialty Medications

* Plan pays 80% of the generic equivalent if generic equivalent is available. The difference in cost between the brand-name and generic will not apply to your out-of-pocket total.
**The Allowable Expense at an out-of-network pharmacy will be the negotiated network rate. Any amount above the Allowable Expense will be your responsibility and will not apply to the maximum copay per prescription or per person per benefit year. Also, prescription drug copayments do not contribute to the Medical Annual Out-of-Pocket Limit.

$1,500 Claim Threshold

Effective July 1, 2018, prescriptions for non-specialty drugs that cost more than $1,500 will be reviewed by a CVS/caremark pharmacist prior to allowing benefits for the medication. This may include dosage, quantity, days’ supply and/or billable amounts.

Diabetic Test Trip Quantities Are Limited

Effective July 1, 2018, you will initially be allowed up to 200 strips per month or up to 300 steps per month following prior authorization.

Drugs Requiring Prior Authorization

Certain medications require prior authorization. These include:

Medical Condition Medications

ADHD/ Narcolepsy

Concerta, Daytrana, Focalin Products, Metadate Products, Methylin Products, Quillivant XR Susp, Ritalin Products, Strattera, Adderall, Adderall XR, Adzenys XR-ODT, Desoxyn, Dexedrine, LiQuadd/ProCentra, Vyvanse, Amphetamine-Dextroamphetamine, Amphetamine-Dextroamphetamine SR, Dextroamphetamine Oral Solution, Dyanavel XR, Evekeo, Methamphetamine Tablets, Zenzedi

Narcolepsy – Other

Provigil, Nuvigil, Xyrem

ED Drugs

Caverject, Edex, Muse, Cialis, Levitra, Staxyn, Stendra, Viagra

Infertility (non-specialty)

Clomid, clomiphene, serophene, Crinone, Prochieve, Cetrotide, Bravelle, Follistim AQ, Ovidrel, Chorionic gonadotropin, HCG, Novarel, Pregnyl, Milophene, Serophene, Ganirelix Acetate, Gonal-F Injection

Acne

Atralin, Avita, Differin, Fabior, Retin-A, Retin-A Micro, Tazorac, Tretin-X, Tretinoin, Veltin, Ziana

BPH (Benign Prostatic Hyperplasia)

Proscar

Oral Acne

Absorica, Amnesteem, Claravis, Myorisan, Sotret, Zenatane, Differin, Fabior

Diabetic Foot Ulcer

Regranex

Growth Hormone

Iplex

 

Specialty Prescription Medication Guidelines

Specialty medications are used by about 1% of participants for less common conditions such as multiple sclerosis, rheumatoid arthritis, and hepatitis, among others. To help facilitate the safe and effective use of these drugs, the Health Plan requires prior authorization and limits the quantity covered to a 30-day supply. This ensures specialty medications are used in accordance with approved clinical guidelines. For certain specialty drugs, the Plan requires you to try a preferred medication before using non-preferred medications. If you don't follow these steps, you may have to pay the full cost of the non-preferred medication. Click here for a Specialty Pharmacy drug list by condition. This list is inclusive of all drugs currently considered specialty medications by Caremark and may include drugs for conditions not covered by the Health Plan. Click here for a Specialty Guideline Management Therapy and Drug Overview list that gives information about the conditions that are treated by the program drugs. Caremark will contact participants currently using specialty medications regarding these guidelines.

Retail Prescription Drugs

For a 90-day or 100-unit supply, you can get your prescription drugs either from a Participating Caremark Retail Pharmacy or any other pharmacy. If you obtain your prescriptions at a Participating Caremark pharmacy, you will only need to pay your prescription drug copay. The pharmacy will file the claim for you. Simply present your Health Benefits Identification Card to the pharmacist for verification.

If you obtain your prescriptions at a non-participating pharmacy, you must pay for the prescription yourself and then file a claim with Caremark. In addition, you must pay any amount charged above the Allowable Expense.

Use the Prescription Reimbursement Claim Form – ASEA as Secondary Coverage if you also receive prescription drug benefits through an organization other than the ASEA Health Trust.

Unless otherwise indicated by the physician, some retail pharmacies automatically substitute the generic equivalent when available and permissible by law.

Mail-Order Prescription Drugs

If you take a medication on an ongoing basis, it is usually more cost effective to obtain your prescription from a Caremark mail order pharmacy. Complete the Prescription Mail Service Order Form and send it to the pharmacy along with your physician’s prescription. Or, provide the form to your physician; in most cases, they can electronically submit your prescription to Caremark.

Unless otherwise indicated by the physician, you will receive the generic equivalent when available and permissible by law.

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