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Do you have asthma or allergies?

It’s that time of year when allergens are in the air and people who have allergic-asthma (i.e., asthma triggered by an allergy) may experience more frequent attacks. Since asthma and allergies can develop at any time—as a child or later in life—it’s a good idea to discuss any symptoms you are experiencing with your doctor. If you need mediation, here’s how it’s covered:

For Asthma…

If you have a prescription for an asthma medication, the Fund’s Prescription Drug Benefit will apply as shown below. Coverage may be subject to pre-authorization and other limits as described in the Summary Plan Description for the medical plan in which you are enrolled.

 

Program Generic Drugs Preferred Brand Name Drugs Non-Preferred Brand Name Drugs
Retail Program

Up to a 34-day supply or 100 units, whichever is greater

You pay 10% with a $10 minimum*/$100 maximum copay per initial fill and refill You pay 20% with a $15 minimum*/$100 maximum copay per initial fill and refill You pay 30% with a $30 minimum*/$100 maximum copay per initial fill and refill
Mail Order Program

Up to a 90-day supply

You pay a $15 copay per initial fill and refill You pay 20% with a $40 minimum*/$200 maximum copay per initial fill and refill You pay 30% with a $60 minimum*/$200 maximum copay copay per initial fill and refill

*Note: If the cost of a medication is less than the minimum copay amount, you are responsible for the actual cost of the medication, plus the dispensing fee. For example, if a preferred brand name medication costs $7 (the Plan’s minimum copay is $15 retail/$40 mail order), you will pay $7, plus the dispensing fee—not the applicable minimum copay.

Benefits are only payable for prescriptions filled at pharmacies in the Sav-Rx network. Check to make sure that your pharmacy is part of the Sav-Rx network before filling your prescription. Important: Not all chains/pharmacies are in the Sav-Rx network, including Wal Mart, Sam’s Club, and certain Rite-Aid locations.

For Allergies…

  • If you are taking an over-the-counter medication, you can be reimbursed through your HRA, as long as you have a doctor’s prescription or written order.
  • If you have a prescription for a non-sedating antihistamine, you will have to pay 100% of the retail cost at the time of purchase. While not covered by the Prescription Drug benefit, the cost can be reimbursed through your HRA, as long as proper documentation is provided. In addition, a Sav-Rx discount may apply.
  • If you have a prescription for another type of medication, it may be covered by the Prescription Drug benefit.

If you have any questions about the Prescription Drug Plan or want to share your tips on how to manage asthma or allergies, use the “Contribute to the Discussion” section below.