Active Member Prescription Benefit
The Superior Officers Council Health and Welfare Fund prescription plan is administered by Prescription Solutions. Prescription Solutions Customer Service is available 24/7. You can find a pharmacy, view and print forms for claim reimbursements, register for the mail order pharmacy, and more by visiting www.PrescriptionSolutions.com
or by calling 877-559-2955.
Benefit Summary
The Superior Officers Council Health and Welfare Fund pays up to $10,000 per calendar year for you and your family's prescription drug expenses. The SOC'S plan is a mandatory generic plan. Mandatory generic means the plan eliminates coverage for all brand name medications that have a direct generic available. Should you or your doctor insist on receiving a brand name medication where there is a generic equivalent available, you will be responsible for the FULL COST of the medication.
The SOC Prescription plan is based on a co-payment schedule. The member is responsible for 30% of the total cost of covered brand name medications and 5% of generic medications.
Coverage of Adult Children Up to Age 26
Effective January 1, 2011, Federal Health Care Legislation requires essential health benefits (includes only the prescription drug coverage provided by the Fund) coverage be extended for current active members' qualified adult child(ren) up to age 26 regardless of their financial dependency on the active member, residency with the active member, martial status, student status, or employment status.
Coverage will not be extended for adult children up to age 26 who are eligible for other coverage through another employer sponsored plan, whether it is the adult child's employer or his/her spouse's employer. When a child of an active member turns 26, their coverage will end the day prior to their birth date. (For example, child turns 26 on July 17, 2011, the last day the plan must cover the child is July 16, 2011.)
If your adult child(ren) previously lost Fund prescription drug plan coverage because he/she "aged out", and he/she is not yet 26 years old, you will have an opportunity to enroll your child(ren) during the period of January 1, 2011 through February 28, 2011 with an effective date of January 1, 2011.
To enroll your adult child(ren) up to age 26, you must complete the form (click here ->) "Request for Coverage of Adult Children to Age 26" and submit to the Superior Officers Council Health and Welfare Fund Office.
If you have any questions regarding enrollment for adult dependents to age 26, please contact the Fund Office at 212 964-7500.
Rx In-Step Programs
Rx In-Step Programs (Step-Therapy) programs employ "smart edits" requiring patients to use clinically effective products that have the most economic value within specific therapeutic categories. These programs are created for categories where there are a number of products that deliver similar safety and effectiveness but have significant differences in cost. The categories covered and Step-Therapy Programs required are available by contacting Prescription Solutions at 877.559.2955.
Combination Drugs
Certain drugs combine two or more existing individual drugs into a single pill. This process may increase the cost factor of the pill by a factor of ten. The SOC does not cover combination drugs such as Caduet, Simcor, or Advicor. The SOC does cover the individual medications contained in these drug combinations.
Prior Authorizations
Prior authorization (PA) review is needed to determine coverage for products involved in the Step-Therapy Program. For further information call Prescription Solutions Customer Service or the SOC Health and Welfare Fund Office.
Pharmacy Network
It's easy to find a participating pharmacy in your local area. With over 60,000 pharmacies in the Prescription Solutions network you're sure to find one that's close to home or work. If you need assistance locating the pharmacy closest to you, call the Customer Service number on back of your ID card or visit www.PrescriptionSolutions.com
Using Your ID Card
Every covered member is issued a prescription drug card that will certify the member and the dependents eligibility for Prescription Solutions Prescription Drug Plan. All you have to do is present your card to the pharmacy and your claim will be processed electronically.
Replacement Cards
If you lose or misplace your prescription benefit card you can call the Fund Office during regular business hours. You will receive two replacement cards within 5 to 7 business days.
Prescription Solutions Mail Order Pharmacy
The Superior Officers Council prescription plan offers a program that allows you to order prescription products through the mail. Using Prescription Solutions Mail Order Pharmacy is an easy way to have your prescriptions delivered right to your home. People on maintenance medications (medications that are taken on an ongoing basis) will especially enjoy the convenience of not having to go to the pharmacy as often. You can download the application by clicking here -> Prescription Mail-in Form, contact Prescription Solutions at 877.559.2955, or visit their website at www.PrescriptionSolutions.com.
Saving Money
To save money on your prescriptions, try requesting generic products. Not all brand name products have equivalent generic alternatives, but it is a good idea to ask your doctor if your brand-name medication can be substituted with a similar generic product before you request them from the pharmacist.
Quantity Limits
On some prescriptions you will find quantity limitations. Quantity limits are based upon FDA guidelines published clinical recommendations, such as the Journal of the American Medical Association (JAMA), as well as manufacturer packaging and labeling instructions. Limits are intended to encourage appropriate dosing. Exceptions are generally limited to chronic conditions that necessitate a quantity greater than "normal". These limits are not intended to restrict access to quantities of medications where limits would not be considered functional or appropriate.
If you have a chronic condition, which may necessitate a quantity greater than "normal", you can contact the Fund office for further assistance.
Wise Choice Rx - Save Money - One Prescription at a Time
Wise Choice Rx by Prescription Solutions is a service to help you identify and use money saving options within your prescription benefits plan. When you contact Prescription Solutions, a pharmacy benefit representative will schedule an appointment for a personalized benefit consultation. Prior to your appointment, the Prescription Solutions representative will review your medications and search for ways for you to reduce costs using your prescription plan. The Prescription Solutions representative shares this information with you during your consultation and can help you start using options that are right for you.
Save Plan Expenses
Contacting Wise Choice Rx is also good for our prescription benefits plan. The options reviewed during your personalized benefit consultation will usually save costs for both you and the Fund. By using the plan's money saving features, you can help manage the cost of your prescription coverage.
Get Started With Wise Choice Rx
To schedule a personalized benefit consultation, contact Wise Choice Rx by calling Prescription Solutions at 877.809.6996. They are available Monday through Friday 7 a.m. to 6 p.m. CT. If you have other questions or need more information, please call Prescription Solutions Customer Service Department at 877.559.2955. They are available to answer your calls 24 hours a day, seven days a week.
FREQUENTLY ASKED QUESTION'S
Q: What will I need to do for mail order prescriptions?
A: In order to be eligible to enroll in Prescription Solutions Mail Order Pharmacy you must fill your prescription 2X at the retail level. Once you have enrolled in Prescription Solutions Mail Order Pharmacy, you will need a new prescription from your physician for up to a 90-day supply and mail it, along with the completed enrollment forms and correct co-payment to the mail order facility.
Q: How long will it take for my medication to reach me through mail order?
A: Prescriptions mailed to the mail order facility should be received 10-14 days from the date the prescriptions are mailed.
Q: Who should I call with questions or concerns about the program?
A: Please call the Prescription Solutions Customer Service Center with questions about your benefits, mail order programs or email Prescription Solutions at INN-RxRFP@PrescriptionSolutions.com.
Q: How do I obtain a prior authorization?
A: The Prescription Solutions Prior Authorization Program can be initiated by either the pharmacist or the member contacting Prescription Solutions Customer Service Center. Prescription Solutions representatives will work with your doctor's office and pharmacy to obtain the information required.
Q: What if the drug that I need requires prior authorization and I can't wait for the prior authorization to be reviewed?
A: You may ask your physician if a drug sample is available or your pharmacy may provide you with a short-term supply (i.e., five days). You will be responsible for the full co-payment at this time. If the prior authorization is approved, your pharmacist can dispense the remainder of the prescription.
Q: What if my prior authorization is denied?
A: The Superior Officers Council prescription plan design includes medications that effectively treat most medical conditions. Most likely, there is an alternative product that may be prescribed by your doctor that will not require prior authorization. If no other options are available and the prescribed treatment is medically necessary, you have the option of appealing the denial.
Q: How come I used to be able to receive my medication but am not able to now?
A: From time to time, there may be changes to Superior Officers Council prescription plan design. If you have trouble getting your prescription filled, a representative at the Prescription Solutions Customer Service center may be able to offer advice.
PICA BENEFIT OVERVIEW
The PICA Program is a prescription drug benefit that is provided to all NYC employees, non-Medicare retirees and their eligible dependents that are enrolled in a health plan offered by the City's Health Benefits Program. It is made available through the joint efforts of the City of New York Office of Labor Relations and the Municipal Labor Committee.
The Superior Officers Council Prescription Plan does not cover medications covered by the City of New York Office of Labor Relations PICA Program.
Medications Covered by the PICA Program
PICA covers medications in two specific drug categories:
* INJECTABLE - Most injectable medications not requiring administration by a health care professional (self-administered).
* CHEMOTHERAPY - Medications used to treat cancer or medications used to treat the side effects of chemotherapy.
For further information on the PICA Program call 800.467.2006 or visit The Office of Labor Relations website at www.nyc.gov.
NOTE: Psychotropic and Asthma medications are no longer available through the PICA program. These medications can be obtained through Superior Officers Council prescription plan and are subject to the Fund's plan design.
DIABETIC MEDICATIONS
The Superior Officers Council Health and Welfare Fund do not cover diabetes medication, management equipment, syringes, oral agents, diabetes testing and monitoring equipment or supplies for controlling blood sugar for non-Medicare members. Under mandated law your Health Plan is responsible for this basic benefit. Diabetes medications must be obtained through the members Health Plan (GHI, HIP, Aetna, etc.). When filling prescriptions for diabetic medications and supplies present the pharmacist with your health carrier's identification card.