Welcome UNITE HERE HEALTH, Culinary Heath Fund, and Neighborhood Health Center employees!
Copays
Find a Pharmacy
| Retail1 | Mail Order2 | |
|---|---|---|
| Certain preventive drugs/ supplies | $0 | $0 |
| Generic | $5 copay | $10 copay |
| Preferred brand name drugs | $25 copay | $50 copay |
| Non-preferred brand name drugs | $40 copay | $80 copay |
| Specialty brand name drugs | $25 copay | N/A |
1 Retail: Up to a 34-day supply 2 Mail order: Up to a 90-day supply
Brand name drug with generic available
If you or your healthcare provider insist on a brand name drug when a generic equivalent is available, you must pay the generic copay plus the difference in cost between the brand and generic drug.
Example:
If the generic copay is $10, the brand name drug is $80 and the generic is $50, you will pay $40. $10 copay plus $30 difference in cost.
|
In Network |
Out of Network |
| View your network pharmacies here | Wal-Mart Sam's Club Certain independent local pharmacies |
Remember: Don't go out of network, you will pay 100% of the cost!
Other Information
Forms
You can get a free glucometer once every 12 months through Hospitality Rx. The manufacturers provide one free glucometer every 36 months. Please note, manufacturer program details like glucometer mode, order code, and other details may change from time to time.
Contact OneTouch (by LifeScan):
- Visit www.OneTouch.orderpoints.com or call (800) 668-7148
- Use order code: 573EXP333
- Take your voucher and glucometer prescription to a network pharmacy.
Contact FreeStyle (by Abbott):
- Visit www.ChooseFreeStyle.com or call (866) 224-8892
- Use order code: RAFITLWP
- Your meter will be sent to the address you provide during the ordering process.
If you need a glucometer sooner than the manufacturer allows: - Call Welldyne Rx at (866) 240-2204 to get prior authorization for a new glucometer (the 12-month limit still applies).
- You’ll need a prescription for the glucometer then go to your in-network pharmacy to get your free glucometer.
These are programs your doctor MUST use:
- Prior Authorization. Your doctor must request approval for all Specialty and Biosimilar drugs and some Preferred and Non-Preferred Brand Name drugs before the prescription is picked up. If you need to take a drug that requires prior authorization, your doctor must call (888) 479-2000.
- Step Therapy. Before using some drugs that are very expensive, you and your doctor must try less expensive drugs that are proven to work just as well—sometimes they even have the same ingredients.
- Quantity Limit Program. This is sometimes called “dispensing limits.” If you are receiving more than what is considered safe (by the U.S. Food and Drug Administration), the Fund will not pay for it unless your physician can justify why you need a higher quantity limit.
These programs save you and your health fund money, keep you safe, and prevent abuse and fraud.
We know it is sometimes medically necessary to take a drug even if it is the more expensive option. In these situations, your doctor must get approval by calling (888) 479-2000.
If you have already gone through prior authorization or step therapy for a specific drug, you may not need to go through it again. In addition, medications may be added to the step therapy list every January 1st and to the prior authorization list throughout the year.
Specialty Drugs
These include drugs used to treat health conditions such as growth hormone deficiency, hepatitis C, immune deficiency, hemophilia, multiple sclerosis and rheumatoid arthritis.
- We work with Welldyne Specialty Pharmacy to get the best service and the best prices. If you need a specialty drug, you MUST get them through this specialty pharmacy. Your doctor MUST first get approval by calling: (800) 641-8475.
- We will help you with this transition process. If you are currently taking a Specialty drug, have your doctor call us at (844) 857-5772 to learn how to transition to Welldyne Specialty Pharmacy.
- Because of an exciting new program we are using, you may pay less some months for your Specialty drugs than the listed maximum copay—we will provide details when we contact you.
Mail order pharmacy program:
- Your plan will send medicine straight to your mailbox and it costs less!
- To enroll, call our Mail Order Pharmacy partner, WelldyneRx, at (888) 479-2000.