Prescription Drug Benefits

Benefits are payable according to the stipulations below for covered prescription drug purchases while the member and dependent(s) - if any - remain eligible to receive them.

Who Is Covered

Prescription drug benefits are available for most medications prescribed by a physician for the member and any eligible dependent(s).

What Charges Are Covered

Most medications prescribed by a physician are covered under this section. However, the Plan encourages the member to consider the use of generic drugs rather than name-brand medications since the former afford the best return on the dollar. (When the doctor prescribes a medication, ask whether there is a generic drug alternative, and, if there is, have the prescription written accordingly.)

The following conditions apply as of September 1, 2022

There is a maximum, annual prescription drug benefit of $2,500 per family; Any claims above $2,500, the Welfare fund will pay 1% of the claim.

NOTE: Affordable Care Act does not allow Welfare Funds to have a cap on drug prescription claims. The Fund cannot afford to pay an unlimited amount for drug reimbursement. The only way we are able to keep this benefit is to reimburse the members 1 percent of all prescription claims above $2,500 which will eliminate our drug cap.

The prescription drug benefit is subject to the provisions described in the "Non-duplication of Benefits" section, found in the "General Information" portion of this booklet;
The following items are excluded under the prescription drug program:

Medications obtained without a prescription;
Non-legend medications;
Medications for which a hospital makes a change;
Medications provided through or received from the pharmacy of the member's employer that would normally have been available without cost to the member;
Medications which are covered under any governmental program or law for which no charge is made or there is no legal obligation to pay

-OR-

Which are dispensed in a hospital (contracted for or operated by the United States Government) for the treatment of members or ex-members of the Armed Forces

-OR-

Which are dispensed by a rest home, sanitarium, sanatorium, drug or alcohol rehabilitation center or other similar institution;

Any contraceptive materials or any therapeutic device (e.g. hypodermic needles, syringes, support garments or other non-medical items or substances) regardless of the intended use.