2018 FAQs. Prescription drug program. Frequently Asked Questions from employees

Transcription

1 2018 FAQs Prescription drug program Frequently Asked Questions from employees September 2017

2 Prescription drug program Questions we ve heard our employees ask Here are some commonly asked questions about the Prescription Drug Program that our employees have raised. To find a particular topic, click on the subject or category below to go directly to that section of the FAQ. About the Prescription drug program Prescription drug benefits Retail pharmacy network Specialty pharmacy Using Mail Service Prescription drugs and Medical plan coverage Pharmacy Advisor Program Accessing CVS Pharmacy Important If there is ever a conflict in the information provided in this FAQ, the plan documents and summary plan descriptions will govern. In addition, participation in the benefits program does not constitute a right to continued employment with the Company. While it is the Company s intent to continue these programs, we reserve the right to amend or terminate any plan at any time, for any reason. 2

3 Prescription drug program About the Prescription drug program Q. What is the Prescription drug program? The medical plans through Blue Cross Blue Shield of Illinois (BCBSIL) also include prescription drug benefits. The prescription drug program is provided through CVS/caremark. You are not eligible for the prescription drug program if you waive Dover medical coverage. What s this Dover offers two types of medical plans: PPO, which gives you a choice of getting care in-network for a higher benefit level or going to a provider outside of the network; CDHP, which also has in-network and out-of-network benefits levels but a higher deductible so premiums can be kept lower. See the Medical Plan Benefits FAQs for more information. BCBSIL PPO and CDHP include prescription drug benefits provided by CVS/caremark. Q. What prescription drug benefits are covered? Your benefit level under the prescription drug program depends on: Your medical plan election and the amount of deductible copay or coinsurance. Where you fill your prescription in-network or out-of-network, retail pharmacy or mail-order service. Whether your prescription is filled with generic, brand primary/preferred or brand non-primary/preferred. Prescription drug program For details on your prescription program, see your Benefits Enrollment Decision Guide. Network Copays/coinsurance CVS/caremark network pharmacies CVS/caremark Administers prescription plan for BCBSIL PPO and CDHP Visit caremark.com/dover Call Participating network retail pharmacies You pay in-network* Generic Up to 30-day supply: $5 co-pay Brand primary/preferred Up to 30-day supply: 25%, $60 max. Brand non-primary/preferred Up to 30-day supply: 50%, $100 max. CVS/caremark Mail Service You pay in-network Generic 90-day supply: $10 co-pay Brand primary/preferred 90-day supply: 25%, $120 max. Brand non-primary/preferred 90-day supply: 50%, $200 max. *For long-term medications purchased at a retail pharmacy, you will pay double the copay or coinsurance starting with the fourth fill (after initial fill plus 2 refills), unless purchased through CVS/caremark Mail Service or select CVS Pharmacy stores. 3

4 Q. Can you explain about generics and preferred brands, what do they mean? To get the best value from the prescription drug program, it s helpful to understand the terms used in describing medications and how they are covered under the plan. Prescription Drug Program Glossary Generic drugs are approved by the FDA to be safe and effective and have the same active ingredients as their brand name counterparts. Your prescriptions are automatically filled with a generic drug. If you choose to fill your prescription with a brand name drug when a generic is available, you ll pay the plan s generic drug copay plus the full cost difference between the brand and generic. Brand primary/preferred includes brand-name medications determined to provide the most effective treatment outcome, quality and value, and meets FDA safety standards. CVS/caremark s review committee regularly evaluates drugs selected. If no generic is available, ask your doctor to prescribe a medication from this list for a lower cost option. Brand non-primary/preferred drugs are typically covered by the plan but may not provide equally effective treatments or may vary greatly in cost. Long-term or maintenance drugs are medications used for chronic conditions on a long-term or ongoing basis. For savings and convenience, purchase long-term medications through CVS/caremark Mail Service. Maintenance choice lets you fill prescriptions at certain CVS Pharmacy stores or through CVS Mail Service for up to a 90-day supply. Network retail pharmacy where you are allowed 3 refills of a 30-day supply before the copay or coinsurance minimums and maximums double. Specialty pharmacy medications are specially engineered drugs or used for managing complex, chronic or genetic conditions; these medications are available from CVS/caremark Specialty Pharmacy locations only. Mail service pharmacy for drugs used on a long-term basis to receive up to a 90-day supply. Quick Tip To find a network pharmacy or sign up for Mail Service, visit caremark.com/dover or call CVS/caremark Customer Care at Prescription Drug Benefits Q. Why did I receive a generic when my doctor prescribed a brand? When your doctor wrote the prescription, it specified that the pharmacist may substitute and is able to fill your prescription with a generic equivalent. Keep in mind that your prescription benefit is provided to ensure that you receive appropriate and effective treatment for your condition while managing costs for you and Dover. An effective way to manage costs is through the use of generic medications. When you use a generic, you will typically pay less and receive a medicine that is identical to a brand name in dosage, safety, and strength. While a generic medicine will look different and have a different name, it undergoes the same evaluation process and approval by the FDA. Q. What if my doctor requests a brand name instead of a generic? If you or your doctor requests a brand name, you pay the difference in cost between the brand name and the generic drug, in addition to any copay/coinsurance. The excess amount does not count toward the medical out-of-pocket limit in the CDHP or prescription out-of-pocket limit in the PPO. Q. What is the CVS/caremark Value Priced Generics Drug List? The CVS/caremark Value Priced Generics Drug List offers access to select generic medications at a lower cost either through a network retail pharmacy or through Mail Service. To find the list of value priced generics, visit caremark.com/dover or call CVS Customer Care at

5 Q. Are birth control pills covered by the plan? Under healthcare reform, women are entitled to a range of preventative services, including certain birth control products and services. The plans cover, in full, generic contraceptives, as well as brand-names that do not have a generic substitute. For more information on what s covered by the plan, visit caremark.com/dover or call CVS Customer Care at Q. Are over-the-counter medications covered by the plan? No. Over-the-counter medications are not covered, including antihistamines, allergy and sinus medications, anti-parasitic, sleep aids and sedatives and other over-the-counter treatments, even if prescribed by your doctor. However, some exceptions apply and may be covered, such as insulin, prenatal vitamins or single entity vitamins used to treat certain diseases. If you have questions about a particular medication, visit caremark.com/dover or call CVS/caremark Customer Care at Quick Tip You can get reimbursements for over-the-counter medications, if prescribed by your doctor, through a standard Health Care FSA or HSA (must be enrolled in a CDHP). Q. Where can I find list of brand primary/preferred drugs? You can obtain a list of primary/preferred medications by visiting caremark.com/dover or calling CVS/caremark Customer Care at Q. Can the brand primary/preferred drug list change? Yes. New drugs may be added or a generic version may replace the brand name. Some drugs may also be removed from the primary/preferred list if new information about a drug s safety or effectiveness is released. If a change does occur, CVS/caremark will notify all affected members. Quick Tip You should always check whether the medication you need is a primary/preferred medication or ask your doctor to prescribe a generic instead. Retail Pharmacy Network Q. Is my pharmacy in the CVS/caremark network? Most likely your current pharmacy is part of the CVS/caremark extensive retail pharmacy network. You are able to access a nationwide network of over 64,000 participating pharmacies that includes CVS Pharmacy stores. Remember that using a network pharmacy gives you the advantage of discounted prices so that your cost is generally lower than if you go out-of-network. When you use an in-network pharmacy, you ll be asked to show your prescription ID card, and pay the applicable deductible, copay or coinsurance. For a listing of in-network pharmacies, visit caremark.com/dover or call CVS/caremark Customer Care at Q. When should I use a retail network pharmacy instead of CVS/caremark Mail Service? You should use your local retail pharmacy for your short-term prescription needs. Always use Mail Service for your long-term or maintenance medications or use select CVS Pharmacy stores to fill a 90-day supply of medication for the same cost as Mail Order. For longer-term medications or when you need to take your medication right away, ask your doctor for two prescriptions: one for a short-term supply of up to 30 days; and one for up to a 90-day supply with three refills, if appropriate. Fill the short-term supply at a local network pharmacy, and send the 90-day supply prescription to be filled thorough CVS/caremark Mail Service. 5

6 Q. How many refills can I get at a retail pharmacy? Your prescription plan lets you use your retail pharmacy for up to three fills an initial fill and two refills. Starting with the fourth refill at a retail pharmacy, you will pay double the plan copay or coinsurance amount. So while you can use the retail pharmacy as often as you wish, you ll get the most savings by using CVS/caremark Mail Service or a select retail CVS Pharmacy that lets you fill a 90-day supply of medication; see also the next question. Quick Savings Tip Select CVS Pharmacy stores let you fill a 90-day supply of medication for the same low price as Mail Service, and even help you get started using Mail Service. Q. When can I get a 90-day supply at a retail pharmacy? You can get a 90-day supply of medication at select CVS Pharmacy stores. You can choose to fill the 90-day prescription at over 7,300 CVS Pharmacy store locations or through CVS/caremark Mail Service for the same cost. To receive a 90-day supply through retail, you must use a select CVS Pharmacy store. (You can get up to 3 refills of a 30-day supply at any retail network pharmacy before the copay and coinsurance doubles.) Q. Can I be reimbursed for prescriptions bought from an out-of-network pharmacy? In most instances you will not need to visit a non-participating pharmacy because of the extensive pharmacy network. When you use a pharmacy that s not in the network, you pay the full amount at the time of purchase. You then submit a claim for reimbursement. Remember that you will pay more because you pay for the amount charged above the discounted network price, in addition to any deductible, copay or coinsurance. Also, the excess charge does not count toward your annual medical plan deductible or out-of-pocket limit in the CDHP, or the annual prescription out-of-pocket limit in the PPO. Specialty medications are not covered out-of-network. Claims forms are available at caremark.com/dover or by calling Caremark Customer Care at Q. How can I transfer my prescription to a network pharmacy from an out-of-network pharmacy? If you have an existing prescription at an out-of-network pharmacy with refills remaining, you can ask your new pharmacy to transfer the prescription for you. You can bring your prescription vial to the new pharmacy or provide the necessary information to the pharmacist by phone. Please Note For some medications, such as compounds, expired prescriptions or prescriptions with no refills, you will need a new prescription. Specialty Pharmacy Q. What is the Specialty Pharmacy? For those who live with a serious chronic or genetic illness, such as Crohn s Disease, Cystic Fibrosis, Cancer and certain other conditions, CVS/caremark specialty can offer support and home or office delivery of certain medicines. You will also have access to services that can help manage your condition, review dosage and medication schedules, and discuss side effects and more. Specialty medications must be filled at a CVS/caremark Specialty Pharmacy. There is no out-of-network coverage. To learn more about Specialty Pharmacy, visit caremark.com/dover or call CVS/caremark Customer Care at

7 Q. What are Specialty Pharmacy benefits? Your benefit level, deductible, copay and coinsurance, depends on the medical plan in which you enroll BCBSIL CDHP or PPO. You must fill your specialty medication using a CVS/caremark Specialty Pharmacy. Specialty Medications Specialty Generic Specialty Preferred Specialty Non-Preferred Must be filled at a CVS/caremark network pharmacy Up to 30-day supply: $5 co-pay Up to 30-day supply: 25%, $60 max. Up to 30-day supply: 50%, $100 max. Q. What if I need my specialty medication in advance of a scheduled vacation or business trip? The CVS/caremark specialty pharmacy team will work with you so that you can receive your medication or refill in advance of your travel plans. However, because it takes 24 to 48 hours for approval to receive medications or refills in advance, you should contact CVS/caremark as soon as possible to avoid any delays or disruption in your treatment. You can also request overnight shipment of specialty pharmacy medicines to any address that accepts UPS or Federal Express delivery. Please keep in mind that the employee will be responsible for the cost of overnight shipping of specialty pharmacy medicines. Using Mail Service Q. What are the benefits of Mail Service Drugs? There are advantages to buying maintenance drugs (drugs used on a long-term, ongoing basis) through CVS Mail Service. It s convenient you can receive up to a 90-day supply delivered to your home at no cost (compared with a 30-day supply if purchased through retail). You can save money your overall prescription is usually less. For example, the cost of a 90-day supply generic medication at a retail network pharmacy would cost you $15 ($5 generic copay x three 3 30-day refills); the cost of a 90-day supply generic medication by Mail Service would cost you $10 ($10 for 90-day supply); so, you save $5. You can order refills online or by phone anytime, day or night. You avoid paying double the copay or coinsurance amount after the third fill You will pay double the copay/coinsurance at a retail pharmacy starting with a fourth fill (the initial fill plus 2 refills). Q. Am I required to use CVS Mail Service to fill my long-term prescriptions? You are not required to use CVS/caremark Mail Service for long-term prescriptions. However, starting with the fourth refill (initial fill plus 2 refills) at a retail pharmacy, you will pay twice the copay or coinsurance amount. Remember that you will save money through Mail Service. You or your doctor can easily set up Mail Service through FastStart by calling CVS/caremark at Q. How do I set up CVS/caremark Mail Service? It s easy to set up Mail Service using FastStart : 1. Go online to caremark.com/dover, and Register or Sign In. Have your prescription ID card ready, 2. Follow the steps to request a prescription. Once your information is entered, CVS/caremark will contact your doctor for a 90-day prescription of your current medicines, or 3. Call in your information by contacting CVS Customer Care at Q. How long does it take for my prescription to arrive by mail? You can expect to receive your prescription in about 10 days from the date Mail Service receives your order. 7

8 Q. Do I need my doctor to write a new prescription from a 30-day to 90-day supply of maintenance medication? Yes, you may have to get a new prescription from your doctor if your current prescription is written for a 30-day or less supply of maintenance or long-term medication. Q. Can I check on the status of my prescription order? Yes, you can check on the status of your order by visiting caremark.com/dover or calling CVS/caremark Customer Care at Both are available 24 hours a day, seven days a week. Q. What if I want to cancel my prescription after I place my order? You can call CVS/caremark at Mail Service prescription orders cannot be cancelled after they have been shipped. Prescription Drugs and Medical Plan Coverage Q. How does the CDHP cover prescriptions? The CDHP generally pays benefits (including prescriptions) after you satisfy your annual medical plan deductible. Your share of prescription drug costs does apply to your medical plan deductible and out-ofpocket limit. However, there are certain preventive classes of drugs, based on IRS guidelines that are not subject to the deductible. You would pay just the copay or coinsurance for these preventive medications. These preventative drug costs do not apply to your deductible but do apply to your out-of-pocket limit. For a list of eligible preventive drugs, see CVS/caremark s Preventive Drug List at caremark.com/dover/?prescription-manager or call Important Just because you take a medicine every day doesn t mean that it meets the IRS definition of preventative medication. Q. How does the PPO plan cover prescriptions? In the PPO, the annual deductible does not have to be met before coinsurance or copay benefits apply to for your prescriptions. Your share of prescription drug costs does not apply to your medical deductible and out-of-pocket limits. Your share of eligible prescription drug costs does apply to your separate prescription out-of-pocket limit during the year. If you reach the drug out-of-pocket limit during the year, the plan will pay 100% of eligible prescription drugs for the rest of the year. Pharmacy Advisor Program Q. What is the Pharmacy Advisor Program? The Pharmacy Advisor Program is designed to help plan members with chronic conditions, such as diabetes or cardiovascular disease manage their conditions, and achieve better health outcomes through improved medication adherence. Q. How does CVS Pharmacy Advisor Program work? If you are diagnosed with diabetes or cardiovascular disease, and fill your prescription through CVS Pharmacy or through Mail Service, you will receive support and counseling as follows: First prescription counseling Your pharmacist will provide information on the medication and why taking it as prescribed is important. If you re at a CVS Pharmacy, the counseling takes place in person. If you re using Mail Service, a member of the Pharmacy Advisor Team (part of CVS/caremark s clinical center) will contact you by phone. Whether, in person or by phone, you will receive information about the medication, the possible side effects and how to manage them, and you have the opportunity to ask any questions. 8

9 Follow-up assistance About two weeks after getting your first prescription, you will be contacted by a pharmacist from a local CVS Pharmacy or member of the Pharmacy Advisor Team (if using Mail Service) to ask whether you have any questions or need additional information. Gaps in care counseling Your local pharmacist or Pharmacy Advisor Team member (if through Mail Service) will contact you if clinical guidelines show there are certain gaps or additional medications that might help your condition. For example, most patients with diabetes take a medication that increases blood flow to the kidneys. If you are not taking this medication, the pharmacist will ask whether it was ever recommended by your doctor, or your pharmacist may contact your doctor to notify the provider of the gap in care. Adherence counseling This will happen if you have not refilled your prescription to treat a chronic condition to determine whether you are experiencing any issues or concerns about care. Q. Is CVS Pharmacy Advisor Program available through non-cvs Pharmacy stores? No. The Pharmacy Advisor Program support and counseling for managing chronic conditions is available only through CVS Pharmacy store locations or CVS/caremark Mail Service. To find a location, visit caremark.com/dover or call Caremark Customer Care at Q. What happens if a family member picks up the prescription for me, can I still benefit from the CVS Pharmacy Advisor? The pharmacist will provide information on dosage and side effects to the individual who picks up your medication. You will receive any additional materials by mail, with follow-up counseling to take place as described. Q. Can I get a flu shot through CVS/caremark pharmacy? Yes, you have access to over 50,000 participating pharmacies nationwide where you and your eligible family members can receive a flu vaccine from a certified pharmacist, at no cost to you. You can also get flu shots by visiting CVS Minute Clinic where a nurse practitioner will administer the vaccine. You should check your medical plan coverage to determine cost. To find a listing of participating pharmacies, visit caremark.com/dover or call Caremark Customer Care at Quick Tip You should also contact the pharmacy directly to determine vaccine availability. Additionally, because state laws that regulate the ages for vaccinating children differ, check with the pharmacy before bringing in your child to get immunized. 9

10 Accessing CVS/caremark Q. How can I acces CVS/caremark? You have access CVS/caremark online or by phone, anytime day or night. Prescription drug program CVS/caremark administrator for Blue Cross Blue Shield of Illinois (BCBSIL) PPO and CDHP Go online DoverHealthandWellness.com>Benefits>Prescription Drugs - BCBSIL or Call , customer service representatives are available 24 hours a day, 7 days a week Going online has its advantages. You can: Find plan details, including copays and coinsurance information; Sign-up for Mail Service and get order forms; Locate a network pharmacy near you; Find CVS Pharmacy locations for 90-day supplies or a Specialty Pharmacy; Print a temporary prescription ID card; Find drug lists primary/preferred, preventive, value generics drug list, specialty pharmacy; questions directly to a CVS/caremark customer care representative; Check and compare drug costs; Learn about medications and side effects; Get information on the latest health news and trends. Q. Does CVS/caremark offer language assistance if needed? Yes, language assistance services are available by calling CVS/caremark at