PHARMACY
New West offers several
different pharmacy endorsements.
Do I have prescription drug ?
Call customer Service at 800-290-3657 or if you are insured through an employer, check with your Human Resources Department.
What
types of pharmacy endorsements are available through New West?
New West offers several different pharmacy options. Please see the Products tab for more information.
Which
pharmacies can I use?
To get the best prices, members should use a participating New West pharmacy in order for prescriptions
to be covered. A listing of participating pharmacies is included in
your New West Provider Directory.
What
is a drug formulary (Also known as a Prescribing Guide)?
A formulary is a list of preferred drugs. These drugs have been proven
to be more effective based on safety, efficacy and clinical outcomes.
The New West three-tier pharmacy benefit riders include a drug formulary.
Members pay the lowest copayment (tier 1) for generic drugs, a higher
copayment (tier 2) for brand name drugs without generic equivalents
and the highest copayment (tier 3) for brand name drugs not included
on the formulary and for those formulary drugs that have a generic available
(indicated in bold text ).
Are
Formulary drugs the best therapy available?
Yes. Formulary drugs are chosen because of their quality, efficacy and
safety. A drug that is not on the formulary has no clinical advantage
over a formulary drug that is.
How
Does the Three-Tier Drug Endorsements Work?
The three-tier
drug endorsements apply a copayment depending on the status of the drug dispensed.
All prescription generic drugs charge the lowest copayment followed
by brand name prescription drugs on the formulary listing and then by
brand name prescription drugs not on the formulary listing. The following
chart helps to further explain this benefit:
| |
Is the Drug Generic? |
Is the drug a Formulary Drug WITHOUT a Generic Available?
(Indicated in the formulary listing WITHOUT bold text) |
Is the drug a Formulary Drug WITH Generic
Available?
(Identified in the formulary listing in BOLDED text) |
Is the drug a NON Formulary Drug? (Not
listed on the formulary or a formulary drug with a generic available) |
|
Tier
|
Tier 1
|
Tier 2
|
Tier 3
|
Tier 3
|
| |
|
|
|
|
|
Copayment
|
Lowest Copayment
|
Middle Copayment
|
Highest Copayment
|
Highest Copayment
|
| |
|
|
|
|
How
do I obtain my prescriptions through the mail-order program?
If your benefit includes a prescription drug endorsement, you may have a mail-order
benefit. (Some plans do not have mail order. Check your pharmacy endorsement for more information.) If your Pharmacy Rider lists a mail order benefit, you may receive maintenance medications through the mail.
A mail-order form is provided to you in your New West member material
or can be obtained by contacting Member Services at 1-800-290-3657.
Mail-order prescriptions allow members to receive a 90-day supply of
medication provided your PCP indicates this on your prescription. You
will be charged two copayments for each 90-day supply.
Do
I have to pay a deductible?
Members covered under a prescription drug rider may have a separate pharmacy
deductible to meet. Refer to the pharmacy endorsement for information regarding any applicable deductible.
Am
I required to submit a new prescription for mail-order prescriptions?
If your benefit includes a prescription drug endorsement and the accompanying
mail-order benefit, submission of a new prescription is the best way
to begin your mail order benefit. Once you've begun, you may reorder
your prescriptions on the Caremark web site at http://www.caremark.com/, through
the mail, or over the phone.
What
should I do if I will be out of town and not able to refill my prescription
when it is due?
You may request an early refill by contacting Caremark Member Services
at 1-800-552-8159. An early refill will ensure that you have an adequate
supply of medication while you are out of town. Two vacation supplies
are allowed per contract/calendar year.
I
just got a prescription, which I must start taking right away. What
should I do?
Prescriptions needed immediately should be obtained locally. If you
will be taking the medication on an ongoing basis, obtain two prescriptions
from your doctor. One prescription should be for a 2-3 week supply of
medication and the other, which you can mail to Caremark, should be
for a three-month supply.
Do
some medications require prior authorization?
Yes, See Chapter 4 in your benefit booklet or your Prescription drug rider for more information. Your PCP needs to write a prescription
and provide documentation before the medication is approved.
What
drugs are not covered by the plan?
Examples of
classes of drugs that are not covered include: Non-FDA-approved drugs,
experimental drugs, over-the-counter drugs except insulin, and cosmetic
drugs.
What
if my prescription cost is less than my copayment?
You will pay the lower amount.
Please refer to your pharmacy endorsement for full details. The above information is only a summary.
