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FAQ/Mail Order Prescriptions

Mail Order Prescriptions

1. Is there a deductible for brand medication when generic medications exist?

Yes, effective January 1, 2005, a $500 deductible will apply to prescriptions for brand medications when a generic equivalent medication exists. This type of brand medication is referred to as a “multi-source” brand medication because there are additional sources for the purchase of this medication. The other sources sell the medication under its generic name and these other medications are called “generic medications.” The active ingredients in generic medications are identical to the active ingredients in the brand name medication. This deductible will apply to the Basic Plan, the Premier Plan and the Pensioner’s Medicare Supplement Plan

The New CORE Plan effective January 1, 2006

Yes, effective January 1, 2006, a $500 calendar year deductible per individual that applies to all brand Drugs. It does not apply to generic drugs. There is no family limit to the prescription drug deductible.

2. What types of medication are considered for Mail Order?

Any medication you take on a regularly basis for chronic conditions can be ordered through mail order – for example: drugs to treat diabetes, high blood pressure, heart disorder, arthritis and asthma, to name a few.

3. Who must pay the $500 deductible?

Every MILA participant, whether actively employed or retired, will have to pay this deductible if he/she continues to purchase multi-source brand medications.

In most states, "controlled substances" such as narcotics have limitations on transferability. Under the MILA pharmacy program, such medications can be obtained at the local pharmacy - NOT THROUGH MAIL ORDER.

4. Is the $500 deductible a family deductible or must the $500 be paid by each person in a family?

The $500 deductible is a family deductible for the Basic Plan, the Premier Plan and the Pensioner’s Medicare Supplement Plan. It applies to each member whether he/she is single or if he/she has dependents. The total deductible that must be satisfied for each member and, if applicable, all of his/her dependents, is $500 during the calendar year 2005.

The New CORE Plan effective January 1, 2006

The $500 deductible is per individual that applies to all brand Drugs. It does not apply to generic drugs. There is no family limit to the prescription drug deductible

5. Can the local port pay the $500 deductible for the participants?

No. The participant must pay the $500 deductible. A port cannot pay the $500 deductible or reimburse a MILA participant if the MILA participant has paid the $500 deductible.

6. Is the $150 deductible for pharmacy benefits in the Basic Plan still payable in 2005?

No. The total deductible is $500, whether a MILA participant is receiving Premier Plan or Basic Plan benefits in 2005.

7. Is the $500 deductible applied to all brand name medications in Tier II and Tier III?

No. The $500 deductible applies only to multi-source brand medications; that is, brand medications for which there is an equivalent generic medication.

8. How can a participant determine if there is a generic equivalent for a brand name medication?

There are five (5) ways to determine if there is a generic substitute for a brand name medication:

  • When the doctor prescribes a brand name medication, ask the doctor if there is a generic substitute for the brand name medication.
  • When a brand name prescription is presented to a retail pharmacy to be filled, ask the pharmacist if there is a generic substitute for the brand name medication.
  • When a brand name prescription is received by a MILA participant, the participant can call CAREMARK at the number listed on the back of the participant’s MILA card.
  • When a brand name prescription is received by a MILA participant, the participant can contact the MILA office to determine if there is a generic substitute for the brand name medication.
  • When a prescription for a brand name medication is received by a MILA participant, that participant has access to the MILA website at www.milamhctf.com to determine if there is a generically equivalent medication.

Suggestion: A MILA participant should not contact the mail order pharmacy to ask whether a brand name prescription has a generic substitute.

9. How will the $500 deductible be charged on prescriptions filled by the mail order pharmacy?

A prescription will be subject to the new $500 deductible if the prescription is received by the mail order facility on or after January 1, 2005.

Suggestion: Prescriptions that are to be filled by the mail order facility should be mailed as soon as possible in order to arrive before January 1, 2005. If the prescription is to be refilled, you may fax the refill instruction to expedite its delivery. If you fax the refill request, be certain to retain the “confirmation of delivery” receipt in the unlikely event that your fax is lost. While prescriptions that are to be filled in the mail order facility should always be mailed when you have 15 to 30 days supply still on hand, it is essential that you allow sufficient time during the holiday mail season to ensure that your prescription is received no later than December 30, 2004 (the last mail day of the year) in order to avoid the $500 deductible. Remember that prescriptions may not be refilled by the mail facility more than 30 days before your supply runs out.

10. Who is responsible for deciding whether a brand name medication has a generic substitute?

CAREMARK is responsible for making these decisions.

11. After the $500 family deductible has been satisfied is the co-pay required on prescriptions for medications that have a generic substitute?

Yes.

12. Is the co-pay for a brand name medication which does not have a generic substitute applied towards the $500 family deductible?

No.

13. Is the $5 co-pay for a generic still payable?

Yes.

14. How does a MILA participant know if he or she has reached the deductible?

The participant can find out how much of the deductible he must still pay by doing any of the following:

  • Contact CAREMARK at the number listed on the back of the participant’s MILA card and asks the CAREMARK representative how much of the deductible is still owed/
  • Ask the pharmacist at the retail pharmacy to confirm how much of the deductible is still owed.
15. How can the MILA participant avoid paying the $500 deductible?

The MILA participant can avoid paying the deductible by using only generic drugs or by using brand name drugs for which no generic substitute is available.

16. When a brand name prescription is filled, how is the cost of the prescription applied against the $500 deductible?

The entire cost of the brand name prescription paid by the MILA participant is applied against the $500 deductible until the $500 deductible has been satisfied.

17. When is a MILA participant responsible for paying the co-pay for a brand name medication which has a generic substitute?

After a MILA participant has paid the $500 deductible, the MILA participant will be responsible for paying the co-pays on each brand name prescription which has a generic substitute. The MILA participant is always required to pay the co-pay on any brand name medication which does not have a generic substitute.

18. If a MILA participant fills a prescription for a brand name medication which has a generic substitute at a pharmacy which is not part of the CAREMARK network, how does the participant get credit for the amount he or she paid against the $500 deductible?

The MILA participant must send CAREMARK the receipt he/she received when the prescription was filled along with a copy of the CAREMARK claim form. The receipt must contain the prescription number, the name of the medication, the quantity dispensed, the date the prescription was filled and the cost of each prescription. After CAREMARK receives the receipt, the participant will receive a credit against the deductible which will be equal to the cost of the prescription that would have been paid if the prescription had been filled at a CAREMARK participating pharmacy. This amount will usually be less than your cost for the medication because of the substantial discount that MILA has negotiated with CAREMARK for our participants. The CAREMARK address is:

Caremark
P.O. Box 52136
Phoenix, AZ 85072-2136
19. How do I pay for my mail order prescriptions?

You can pay for your mail order prescriptions with a credit card, a debit card, a check or money order. Please click here to read more details on your payment options.