Summary Plan Description

Teamsters Local 805 Welfare Fund

SUMMARY PLAN DESCRIPTION -

PRESCRITION DRUG BENEFITS

This Plan provides a prescription drug benefit that allows Participants and their eligible dependents to obtain prescription drugs with the co-payments listed below. This section does not provide benefits covering expenses incurred for all prescription drugs. A prescription drug may not be covered unless it is medically necessary for the prevention or treatment of al illness or condition. There are exclusions, co-payment features and, maximum benefit features. These are described further below.

A. AMOUNT OF COVERAGE

Three-tier co-payment on prescription drugs (30 day supply):

Generic drugs: $8
Preferred brand-name drugs: $15
Non-preferred brand-name drugs: $40

Mail order co-pay (90 day supply)

Generic drugs: $16
Preferred brand-name drugs: $30
Non-preferred brand-name drugs: $80

Mandatory generic and formulary drugs

If there is a generic or formulary drug available, but the member prefers the brand-name equivalent, the member will pay the Brand co-pay plus the difference in price between the brand-name drug and the generic or formulary drug.

Your Prescription Plan Covers:
1) Prescriptions which require compounding;
2) Prescriptions for legend drugs (drugs which, by law cannot be dispensed by a pharmacy without a prescription);
3) Insulin or prescriptions with specific dosage, but no other injectible or companion implements.

B. COVERED DRUGS

The following drugs are covered by this Plan:

Federal Legend Drugs (unless specifically excluded)
Compounded Medications of which at least one ingredient is a legend drug
Drugs related to the treatment of HIV and AIDS
Anabolic steroids (excluded for athletic use)
Epinephrine Kits
Fluoride Preps (Prescription strength)
Imitrex (limited to 48 kits per calendar year)
Insulin (including disposable syringes/needles; blood sugar diagnostic test strip; urine teststrips, lancets; alcohol swabs)
Isotretinoin (i.e. Accutane)
Oral Contraceptives
Self-injectibles
Prescription vitamins (including prenatal)

C. GENERAL EXCLUSIONS:

The following prescription drugs and devices are excluded from coverage:

Non-Federal Legend Drugs
Allergy Serums
Contraceptive jellies, creams, foams.
Non-Insulin Syringes
Fertility drugs, growth hormones, or sex hormones except for those in treatment of menopause. Prior Authorization is required.
Drugs to deter smoking, except anti-nicotine patches and Zyban will be made available to you once in your lifetime
Anorexiants
Anti-obesity drugs
Appetite suppressants
Biological drugs
For biological sera and blood products
Drugs for cosmetic purposes (i.e., Rogaine)
Retin-A (covered up to the age of 18)
Immunosuppressants
Immunization agents
Certain injectable drugs, including fertility drugs, allergy sera or extracts, and Imitrex, if it is more than the 48th such kit or 96th such vial dispenses to the person in any one year
Lifestyle drugs (performance enhancement)
Lost, stolen or damaged drugs
Nutritional/dietary supplements or supplies
For any drugs which do not, by federal or state law, require a prescription order (i.e. over-the-counter (OTC) drug, even if a prescription is written
Therapeutic devices or appliances
Drugs labeled "Caution-limited by Federal law to investigative use" or Experimental drugs, regardless of whether a charge is made to the individual
Medication which is to be taken by or administered to an individual, in whole or in part, while he or she is a patient in a licensed Hospital, rest home, sanitarium, extended care facility, skilled nursing facility, convalescent Hospital, nursing home or similar institution which operates on its premises or allows to be operated on its premises, a facility for dispensing pharmaceuticals
Any prescription refilled in excess of the number of refills specified by the Physician, or any refill dispensed after one year from the Physician's original order
Charges for the administration or injection of any drug
Medicines and other drugs which are patents
Durable equipment for administering medicine
Prescriptions for which an eligible person is entitled to receive without charge from any Workers' Compensation Laws, or any municipal, state or federal program
Anti-obesity medications, except in the case of morbid obesity (subject to approval from the Trustees)
Multi-vitamins, B-Complex vitamins, Hematinics, Vitamin B-12, other vitamins
A prescription drug dispensed by a mail order pharmacy that is not a preferred pharmacy
Any refill of a designated self-injectable drug not dispensed by or obtained through the Express Scripts CuraScript specialty facility. Call Express Scripts toll-free at (800) 467-2006, TDD (800) 899-2114 to obtain information on if your medication is a self-injectable to be dispensed through the Express Scripts CuraScript speciality facility. The list is subject to change by Express Script.
Any refill of a drug dispensed more than one year after the latest prescription for it or as permitted by the law of the jurisdiction in which the drug is dispensed

D. DISPENSING LIMITS

When receiving prescriptions through the retail pharmacy programs, the amount of drug (including Insulin) which is to be dispensed per prescription or refill will be in quantities prescribed for up to a 31-day supply.

E. GENERIC AND BRAND NAME DRUGS

The generic name of a drug is its chemical name. The brand name is the trade name under which the drug is advertised and sold. By law, generic and brand name drugs must meet the same standards for safety purity, strength and effectiveness. When authorized by your Physician, generic drugs save your Plan money, which helps to maintain your current prescription benefit.

If you take any brand name medications, please ask your Physician to approve the generic equivalent by indicating the generic name on the prescription

F. NEW DRUGS

From time to time new drugs are developed and approved by the FDA. The Trustees will decide which of these drugs will be covered on a case by case basis.

G. MAIL SERVICE PRESCRIPTION DRUG PLAN: EXPRESS SCRIPT RX HOME DELIVERY

The Mail Service Prescription Drug Plan, Express Script-RX Home Delivery, is an expansion of your current Prescription Drug Plan. If you or your eligible dependents take prescription medication on an ongoing basis, such as Maintenance Drugs you can now enjoy several important advantages:

Immediate savings
Y ou can receive up to a 90-day supply of medication at one time
No claim forms to file
No waiting for reimbursement
Convenience of home delivery, postage paid
Security of receiving larger quantities of medication at one time
You can place your refill orders by phone: Toll-free at (800) 467-2006 (TTY (800) 899-2114), 24 hours a day, 7 days a week, 365 days a year.
You can also fill your refills on line at: http://www.ghi.com/, or by mail to the following address: Express Scripts, P.O. Box 1088, Bensalem, PA 1920-0866.

i. Procedure
1. Obtain a New Mail Order Prescription from your doctor. Be sure to ask your doctor for a 90-day prescription (with up to one year of refills, if appropriate).

2. Mail in your prescription – Simply complete the enclosed Home Delivery order form (included in your ID card packet), include your prescription and co-payment and mail it to Express Scripts OR

3. Express Scripts will call your doctor to get a new prescription for Home Delivery. Just visit: www.express-scripts.com/startnow or call (800) 467-2006.

ii. Ordering Refills
With your original prescription medication, you will receive a notice showing the number of times it may be refilled. Simply mail this re-fill notice to Express Script Home Delivery in the pre-addressed order envelope. To avoid the risk of running out, order your refills two (2) weeks before you need them. You can place refills 3 ways: by phone toll-free at (800) 467-2006 (you will need to provide your health plan member ID number, your prescription number and your credit card number), online Express Scripts.com, or by mail (Express Scripts, PO Box 1088/Bensalem, PA> 19020-0866.

iii. 90-Day Supplies of Medication
The law requires that pharmacists dispense the exact quantity prescribed by the Physician. Thus, to receive a 90-day supply of a medication, your Physician must prescribe sufficient dosage to last 90 days. If your Physician authorized refills, they can only be dispensed when your initial order has nearly expired, so be sure to ask your Physician to prescribe a 90-day supply, plus refills, whenever appropriate.

H. SPECIALTY AND INJECTIBLE MEDICATIONS: EXPRESS SCRIPTS SPECIALTY PHARMACY (CURA SCRIPTS)

Cura Scripts is Express Scripts Specialty Pharmacy that is dedicated to serving the needs of patients using oral and injectible specialty medications for conditions such as: oncology, hepatitis, rheumatoid arthritis, multiple sclerosis and other complex, chronic diseases. Specialty Pharmacy refers to a pharmacy that provides specialty oral medications, self-injectibles, and medications administered at your doctor's office. These medications often require special storage and handling and may not be readily available at the local drugstore. Sometimes these medications have side effects that require monitoring by a registered pharmacist or registered nurse. With Cura scprit, your medications will be delivered to your home, your doctor’s office or anywhere else you choose. Plus, you’ll receive many other services:

A Patient Care Coordinator who serves as your personal advocate and point of contact.
Provides the supplies to administer your medications-at no additional cost.
Offers care management programs to help you get the most from your medications.

If you require a specialty or injectible medication, your local pharmacy will allow up to two refills. After your 2 fills at a retail pharmacy, you will be required to obtain your medication from Cura script. (You will then be sent instructions on how to fill additional prescriptions through the GHI Specialty Pharmacy program.)

PLEASE NOTE: CERTAIN CONTROLLED SUBSTANCES AND SEVERAL OTHER PRESCRIBED MEDICATIONS MAY BE SUBJECT TO OTHER DISPENSING LIMITATIONS AND TO THE PROFESSIONAL JUDGMENT OF THE PHARMACIST.

Ordering your prescription medications through Aetna Specialty Pharmacy is fast and easy. Your physician may fax your prescription to 888-773-7386 . Or, you or your doctor may mail your prescription order to: CuraScript, Inc. 6272 Lee Vista Blvd. Orlando, FL 32822.

If you have any questions regarding your medications, please call the toll-free number 866-848-9870.

I. HOW TO CLAIM PRESCRIPTION DRUG BENEFITS

The Fund provides each Active Employee with a prescription card. This card must be presented to the pharmacist when filling a prescription. The Plan will pay the full cost less the co-payment listed on the card once you have met the Prescription deductible.

Keep in mind that Express Scipts Pharmacy Management administers a great variety of plan types. If you have questions related to your pharmacy benefits plan (for example, how much is your co-payment for a specific drug), call the toll-free Member Services number on your member ID card.

Keep in mind that Express Scripts Pharmacy management administers a great variety of plan types. If you have questions related to your pharmacy benefits plan (for example, how much is your co-payment for a specific drug), call the toll free Member Services number on your ID card.