Prescription Drug

Kaiser Members
Your Prescription Drug benefits are provided by Kaiser. For more information, see Fund Kaiser.

Health Net Members

Your Prescription Drug benefits are provided by Health Net.  For more information, see Health Net.

Comprehensive Health Plan Members

The Plan contracted with OptumRx to provide you with prescription drugs at negotiated contract rates when you use one of the pharmacies participating in the OptumRx network. Get the comprehensive prescription drug formulary information for pensioned participants at the OptumRx Pensioned Participant formulary link now.

Using a participating pharmacy works to your advantage in two ways:

  • Your payments are limited to the amounts shown on the Benefit Schedules.
  • You don’t have to worry about submitting a claim for reimbursement – you pay your copayments at the time of purchase, and the pharmacy bills the Fund for the remaining cost.

How to Use the Prescription Drug Program

  • If you need medication immediately for acute, short-term use, such as antibiotics, take your prescription and your OptumRx Identification Card to one of over 62,000 participating retail pharmacies. The pharmacy will check your eligibility electronically, fill your prescription, and charge you the applicable copayment only. If you do not have your ID card with you, you will need to pay the full cost of the prescription(s) and submit a claim to OptumRx for reimbursement.
  • For medication you need immediately, but will continue taking on a long-term basis, ask your physician for two prescriptions. The first should be written for a 7-14 day supply to be filled at a participating retail pharmacy. The second should be written for the balance up to a 60-day supply, with refills, to be sent to the OptumRx Mail Service Pharmacies. Complete a mail service order form, and send it to OptumRx along with the original long-term prescription. Using Mail Order whenever possible will help reduce your prescription drug costs.
  • Refills at a retail pharmacy can be ordered by internet, phone or mail. The information included with your last order will show the date you can request a refill and the number of refills you have left.
  • For the OptumRx Mail Service Program, you can order refills online at www.OptumRx.com, by calling your Customer Care number, or by mail. Make sure to attach the refill label provided with your last order to a mail service order form. Enclose payment with your order, if your plan requires a payment.
  • Additional ID cards can be obtained by calling OptumRx Customer Care at 1-888-79-4258.
    • OptumRx Contact Information
    • Toll Free Customer Care1-855-672-4258
    • Specialty Pharmacy1-866-218-5445
    • Dr. Pre-Authorization1-800-711-4555 Option 1
    • Websitewww.OptumRx.com
    • Mail Service Address
    • OptumRx Claims Department P. O. Box 29044
      Hot Springs, AR 71903
    • Prescription Reimbursement

Comprehensive Prescription Drug Plan Summary

Prescription Drug Benefits

Participating Retail Pharmacy (Your copayment) Generic Drug - $10

Brand Name Drug when no Generic equivalent drug is available - $15

Brand Name Drug when a Generic equivalent drug is available - $35 plus cost difference between the generic and brand name drug*

* If the doctor specifies no generic substitution may be made, you will not be charged the difference in price between the generic and brand name drugs.

Copayment applies to each 34-day supply

Non-Participating Retail Pharmacy You pay the copayments shown above for drugs from participating pharmacies plus any amount the pharmacy charges beyond the contract amounts the participating pharmacy would have charged.
Mail Order (Your copayment) Generic Drug - $0

Brand Name Drug when no Generic equivalent drug is available - $10

Brand Name Drug when a Generic equivalent drug is available - $40

Copayment applies to each 90-day supply

Certain drugs are covered for a supply limit of up to 100 tablets.

   


Refer to the Summary Plan Description for a complete list of benefits, limitations and exclusions.

Kaiser Prescription Drug Plan Summary

The following summary is intended only as a general description of Plan benefits. For a complete description of benefits and Plan exclusions and limitations, please refer to the Kaiser "Evidence of Coverage.    

Prescription Drug Benefit

$10 Co-pay, per 100-day supply of generic or prescribed medically necessary brand name drugs, in accordance with Health Plan formulary guidelines and when obtained at Plan pharmacies. Mail order: refills only, usually 2x the plan pharmacy cost sharing per 100-day supply

Health Net Prescription Drug Plan Summary

The following summary is intended only as a general description of Plan benefits. For a complete description of benefits and Plan exclusions and limitations, please refer to the Health Net "Evidence of Coverage".    

Prescription Drug Benefit

$5 co-pay for generic drugs, 
$10 for brand name drugs, 
per 30-day supply; must be prescribed by Plan physician and obtained at Plan pharmacies in accordance with formulary guidelines     Mail order: 90 day supply for 2 times the co-pay amount shown above   Note: As of January 1, 2008, the Health Net Seniority Plus prescription drug plan is administered by Caremark. This is not the same plan as the Caremark drug plan offered by the Trust Fund for participants in the Comprehensive Medical Plan.

Wyoming/South Dakota Prescription Drug Plan Summary

Prescription Drugs

Retail Contract Pharmacy or Mail Order Brand Name Drugs - 30% co-payment
Generic Drugs - 15% co-payment
   
Non-Contract Retail Pharmacy

Brand Name - Plan pays 70% of amount payable to a contract pharmacy. Your copayment may be higher than 30%.

Generic - Plan pays 85% of amount payable to a contract pharmacy. Your copayment may be higher than 15%.

Drugs are not subject to the annual deductible or to the lifetime maximum. 

Copayments apply to each 34-day supply for retail pharmacies and 90-day supply for mail order.

Refer to the Summary Plan Description for a complete list of benefits, limitations, and exclusions.