How do I fill a prescription?
Show you ID card to a participating pharmacy. These pharmacies have agreed to
charge a discounted amount. Most major pharmacy chains participate in the
aremark
network. To locate a participating pharmacy, check the
Caremark
web site or call Caremark
1-866-498-2247.
How do I get a new ID card.
Contact Allied: 1-800-288-2078 or click on get ID card.
What is a Generic drug?
Generic drugs are regulated by the FDA to produce the same effect on the body
and have the same active ingredients, strength and absorption rate as the brand
name drug. According to the FDA, brand name manufacturers account for almost 75%
of all generic drug production, actually making duplicate version of their own
or other companies' brand name drugs, but selling them without the brand name
label and packaging. You will usually make the lowest copayment if you receive a
generic drug.
How do I get a Generic drug?
You may ask for the generic equivalent from the retail pharmacist. Ohio law
permits pharmacists to substitute a less expensive generically equivalent drug
for a brand name drug, unless your physician checks (DAW) dispense as written on
the prescription or you direct otherwise. Your prescription will automatically
be filled generically through Caremark
mail order unless you or your physician direct otherwise.
What if I choose a Brand Name drug with a Generic available?
If you get a brand drug when a generic is available, you will pay the cost of
the generic plus the cost difference between the brand and generic drug. If you
have an annual prescription out of pocket maximum, the cost difference does not
count toward your out of pocket. You will pay the difference between the cost of
the generic and brand.
What is Caremark Preferred Formulary Drug List?
The Caremark
Preferred Formulary Drug List is a list of prescription drugs that are
therapeutically sound, available and offer the best health outcomes at an
affordable cost. New drugs and the current list are constantly monitored and
reviewed by the Caremark
panel of practicing doctors and pharmacists for safety, effectiveness and
affordability. Your co-pay for a formulary drug is less than your copay for a
non formulary drug. If you have a prescription out of pocket, the non formulary
copay does not count toward your prescription out of pocket maximum.
How does my doctor know what drugs are on the formulary?
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The
Caremark
Preferred Formulary Drug List is distributed to participating doctors and
pharmacies.
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A list is mailed to your home annually.
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Ask your doctor to review and select the appropriate
medication for you from the Caremark
formulary list. If your doctor has any questions about the formulary,
he/she may call Caremark
at 1-866-498-2247. Your co-pay for a formulary drug is 20 percent.
My medication is not listed on the Caremark Preferred
Formulary List? What should I do?
-
The Caremark
Preferred Formulary list is just a summary.
-
For the complete list, call PharmaCare
customer service at
1-866-498-2247or check the
Caremark
web site.
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The formulary is not mandatory, but a non-formulary drug
co-pay costs more money. In the BCHP Classic Plan, your plan will pay only
60% of non-formulary drugs when you meet your annual out of pocket
prescription maximum.
A drug that I have taken for two years is not on Caremark Direct member
list, can I continue with my drug at the higher benefit level of 20%?
-
If your physician determines that there are medical reasons
why you should remain on a non-formulary drug, he/she may FAX an
Caremark
prior authorization form to
Caremark
at 1-(412)-967-2346 documenting the
medical necessity. The BCHP member's name and social security number must be
included. A statement like "my patient wants to take Brand A" does
not constitute a reason for medical necessity.
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A pharmacist will review your physician's request to
determine if the the non-formulary copay may be waived. If approved, you
would pay the formulary copay,
What drugs are covered?
All Federal Legend drugs including contraceptives and insulin prescribed by your
doctor are covered by BCHP except for the exclusions listed below:
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Prescription vitamins, except pre-natal
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Any covered drug in excess of the quantity specified by the
physician, or any refill dispensed after one year from the physician's order
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Any devices or appliances (e.g. orthotics and other
non-medical substances)
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Therapeutic Devices or Appliances
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Diagnostic medications
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Experimental drugs
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Fluoride preparations
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Gold compounds
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Irrigation solutions
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Medications furnished on an inpatient basis covered under
any other carrier providing group coverage for Prescription Legend Drugs or
insulin through a coordination of benefits provision (e.g. major medical,
home health care benefits, outpatient benefits)
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Medical supplies (e.g. ostomy supplies)
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Over-the-counter products excluding insulin
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More than a 30-day supply of a non-maintenance covered drug
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More than a 90-day supply of a covered maintenance drug
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Pharmaceutical products used for cosmetic purposes
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Serums, toxoids, and vaccines
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Smoking/tobacco Cessation (Exception-"Smoking/tobacco
Cessation.")
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Yohimbine
Prior Authorizations
Certain drugs require prior approval before prescriptions are filled and
coverage is provided. Generally, these are drugs that are limited by the FDA in
therapy, are very expensive, or may cause harm if not used correctly. Contact
the Pharmacy Benefit Manager if you have a question regarding the following
drugs:
How do I use Caremark mail order for maintenance drugs?
-
Submit the original prescription for maintenance medication
and complete the form supplied by the mail order facility for a 90-day
supply. You may call the mail order facility to request authorization to pay
your co-payment by check or credit card.
-
Mail order forms are available through your employee's
benefit office and the
Caremark
web site.
How do I determine when to have my
prescriptions filled through the Caremark mail service pharmacy?
BCHP Classic members must use mail order for maintenance
medications. You may call
Caremark
customer service or check the
Caremark
website to determine if you are on a maintenance medication. When you have a
maintenance medication filled for the first time at a retail pharmacy, you will
get a letter letting you know you have only two (2) refills remaining at retail
and any additional refills will need to be filled through mail service. This
applies to all maintenance or long-term medications for conditions such as
diabetes, arthritis, heart conditions, high blood pressure, etc. Your local
network pharmacy can be used for short-term or acute medication needs such as
antibiotics or pain relief medications.
Can I have a prescription filled at a local
network pharmacy for greater than 30 days?
No. You can only receive up to a 30-day supply.
If I order my prescription(s) through the mail or via the
web site, how long will it take?
You should typically receive your refill order within 7-10 days from the time
you submit your order. New prescriptions may take up to 10 to 14 days. To ensure
that your medication is received in ample time, please place your orders at
least two weeks in advance to allow for mailing time. If a new medication has
been prescribed for you and you must take it immediately, ask your doctor to
issue two prescriptions. One prescription should be written for a 30-day supply
and filled at your local pharmacy. The second prescription should be written for
up to a 90-day supply and mailed to Caremark's mail service pharmacy. Once the
prescription has been processed, one day shipping is available.
Do I have to mail my prescription order to Caremark when
using the mail service pharmacy?
You can mail your original prescription to our mail service pharmacy or you can
have your doctor fax it to us at 1-800-323-0161. To order refills of an existing
prescription, you have three options: mail in your refill order, call the
toll-free number on the back of our PharmaCare
membership card, or refill online
at the
Caremark
web site.
Can I order my refills by e-mail?
No, you cannot refill prescriptions by e-mail. Refill orders received by e-mail
will be returned. You may either use our online refill system or call Caremark
Customer Service to place your order.
What is the Specialty Pharmacy?
Caremark
Specialty Pharmacy has the experience to manage chronic conditions
and will work closely with you and your physician’s office to arrange delivery
of your specialty medications. The specialty pharmacy offers a full complement
of specialized prescription drugs and services for patients with: Hepatitis,
Cancer, Infertility, Growth Deficiency, Rheumatoid Arthritis, Crohn's Disease,
Multiple Sclerosis, RSV, Hemophilia, Organ Transplant, and HIV/AIDS.
The benefits of using the program include the following:
-
Free home delivery of up to a 30 day supply of your
medication (Retail copay applies)
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Ready access to a staff of pharmacists, nurses and care
coordinators who are trained specialists on the medications provided and the
conditions being treated
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Educational material, support or home instruction available
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Ancillary supplies such as syringes and needles
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A higher level of coordination of care with your physician
For more information call 1-800-621-4786 or go to the
Caremark
web site.
