Prescription Benefits
International Union of Operating Engineers Local 399
Health & Welfare Fund
Summary of Prescription Drug Benefit
Effective January 1, 2019
| |
Pharmacy Benefit
Manager |
|
OPTUM RX |
| |
|
|
|
| |
Deductible |
|
None |
| |
|
|
|
| |
Plan Pays at the Retail
Pharmacy |
|
70% generic; 60% brand name
50% after 3rd retail fill of same drug |
| |
|
|
|
| |
Plan Pays at Mail Order
or CVS Pharmacy |
|
70% generic and brand name
for 90-day supply |
| |
|
|
|
| |
Excluded Prescription Drug
Catagories
|
|
Cosmetic or weight loss
Fertility, i.e., Clomid
Impotency, i.e., Viagra
Vitamins
Smoking cessation
Experimental or not approved by
FDA |
| |
|
|
|
| |
Plan Exclusion |
|
Prescriptions filled at Wal-Mart &
Sam's Club |
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| How to Use Your Prescription Drug Benefit |
| |
Retail: Present your prescription and your OptumRX ID card at any pharmacy
in the OptumRX network (most major chains are included). You will be asked
to pay your 30% or 50% coinsurance.
Maintenance Drugs: Long-term medications can be filled for 90-day supplies at
any CVS pharmacy or through the OptumRX mail order program. 90-day supplies
are covered at 70% and typically cost the amount of two 30-day fills.
Prescription mail order forms are available at the Fund Office or view download
the OptumRX mail service order form below:
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Click form image to view/download |
For additional information, click here to view/download a copy of our
2019 Summary Plan Description Book
Please keep your contact information updated
