coverage.
What does my prescription benefit plan cover? What is not covered?
Your plan covers charges for eligible drugs prescribed by a physician and dispensed by a pharmacist. Please view the Summary Plan Descrip�on for covered expenses and limita�ons.
Commonly Asked Ques�ons
Do I need my Benefit ID card to get a prescription filled?
Yes, we suggest carrying your insurance ID card at all �mes. Please note that you and each par�cipa�ng member of your family will be receiving new ID cards with the TrueScripts informa�on on the back. It is extremely important that youunder use this ID card on forbenefi all prescrip�on and medical services, beginning 1/1/2021. If you do Who is covered mynew prescripti ts? not have your card with you and need to fill a prescrip�on, your pharmacy may contact at (844) 257-1955 This benefit plan covers you, your eligible spouse, and eligible children through age 26. us Permanently disabledfor all of the informa�on they will need to process your prescrip�on. To request addi�onal ID cards, please contact children may be eligible for some benefits a�er the age of 26, if they meet the requirements for con�nued your health insurance agency. coverage.
Whatdodoes prescriptionclaim benefiift Iplan cover? What is notatcovered? How I filemy a prescription didn’t use my ID card the pharmacy?
Yourwill plan covers charges for eligible drugs by a physician dispensed a pharmacist. Please view You need to submit a Prescrip�on Drugprescribed Reimbursement form on and our website at by truescripts.com/members. the Summary Descrip� forpharmacy covered expenses andreimbursement. limita�ons. Please be sure Plan to keep all of on your receipts for
Do I need myifBenefi t ID card to getme a prescripti on filled? What do I do the pharmacy tells a prescription has been rejected or is not covered?
Yes, we carryingayour your insurance IDcard card all��mes. Please notethat that you andeach each par� cipa� member carrying insurance ID atatall note you and par� cipa� ngng member There aresuggest many reasons prescrip�on may be rejected -mes. suchPlease as a problem with eligibility, step therapy of will be receiving new ID cards with the TrueScripts informa� on on the back. It is extremely your family will be receiving new ID cards with the TrueScripts informa� on on the back. It is extremely requirement, or trying to get a non-covered drug. Ask the pharmacy why the prescrip�on was rejected and important thatour you useyou thisuse new IDnew card all for prescrip� on andonmedical services, a�er beginning going live with TrueScripts. If you important that this IDfor card all prescrip� and medical services, 1/1/2021. If you do contact Member Care team for assistance. do have a prescrip� on, your pharmacy contact at (844) 257-1955 notnot have youryour cardcard withwith youyou andand needneed to fito ll afill prescrip� on, your pharmacy may may contact us atus (844) 257-1955 for for allthe theinforma� informa�on onthey theywill willneed needtotoprocess processyour your prescrip� request addi� onal cards, please contact all of prescrip� on.on. ToTo request addi� onal ID ID cards, please contact I’ve filled my agency. medications at a 90 day supply. Will I be able to continue getting a 90 day supply? youralways insurance agency. health insurance Yes - you can conveniently fill your 90 day supply medica�ons at any retail pharmacy of your choice. You may also u�lize theI mail pharmacies Truepill or Elixiruse formy 90-day supplies. Simply contact your prescriber and ask that How do file aorder prescripti on claim if I didn’t ID card at the pharmacy? aYou new prescrip�on(s) be called in to your pharmacy any �me a�er 12/21/2020. will con�nue to receive a 90 will need to submit a Prescrip�on Drug Reimbursement form on our websiteYou at truescripts.com/members. day supply with no interrup�ons. *Note: A new prescrip�on is not necessary for 30-day supply medica�ons. Please be sure to keep all of your pharmacy receipts for reimbursement.
I’ve never a medication a me 90 day supply -on how I start? What do I filled do if the pharmacyfor tells a prescripti hasdobeen rejected or is not covered?
To start, prescriber specifically write your prescrip�on(s) for a 90 with day supply withstep the therapy appropriate There areyour many reasons amust prescrip� on may be rejected - such as a problem eligibility, amount of refills. Since your provider should be able to call this into your pharmacy, an office visit is typically requirement, or trying to get a non-covered drug. Ask the pharmacy why the prescrip�on was rejected and not required. contact our Member Care team for assistance.
How do I know if amy medicati on is considered specialty drug? I’ve always filled medications at a 90 dayasupply. Will I be able to continue getting a 90 day supply? AYes Specialty Drug is a drug that targets treats specific complex condi� or illnesses suchchoice. as cancer, - you can conveniently fill your 90 and day supply medica�ons at any retailons pharmacy of your You may also rheumatoid arthri� s, hepa� � s C, and HIV/AIDS. Specialty drugs require pa� ent-specifi c dosing, carefuland clinical u�lize the mail order pharmacies Truepill or Elixir for 90-day supplies. Simply contact your prescriber ask that management, and are typically higher-cost than normal drugs. If you feel your new prescrip� on may be for aa 90 a new prescrip�on(s) be called in to your pharmacy any �me a�er 12/21/2020. You will con�nue to receive specialty drug, contact our *Note: Member Careprescrip�on team for assistance. day supply withplease no interrup�ons. A new is not necessary for 30-day supply medica�ons.
What is Step Therapy and howfor doaI90 know it affects me? I’ve never filled a medication dayifsupply - how do I start?
The Step Therapy Program encourages members to use medica�ons that are recognized as safe and effec�ve, To start, your prescriber must specifically write your prescrip�on(s) for a 90 day supply with the appropriate but are lower-cost. To receive coverage under this program, you may need to first try a proven, cost-effec�ve amount of refills. Since your provider should be able to call this into your pharmacy, an office visit is typically not medica�on before progressing to a more costly treatment. Please see the Step Therapy Program Drug List for a required. full list of affected brand drugs. If you have any ques�ons, please contact our Member Care team.
How are do Ithere knowquanti if a medication is certain considered a specialty Why ty limits on medicati ons? drug?
A Specialty is a drug and treats complexsuggested condi�onsquan� or illnesses such Medica� onsDrug for condi� onsthat suchtargets as migraines havespecific manufacturer ty limits dueastocancer, the therapeu�c rheumatoid arthri�s, hepa��s C, and HIV/AIDS. Specialty drugs require pa�ent-specific dosing, effect of the medica�on on your body. Please contact our Member Care team for more details careful on howclinical quan�ty management, andyou. are typically higher-cost than normal drugs. If you feel your new prescrip�on may be for a limits may impact specialty drug, please contact our Member Care team for assistance.
What is Step Therapy and how do I know if it affects me?
The Step Therapy Program encourages members to use medica�ons that are recognized as safe and effec�ve, but are lower-cost. To receive coverage under this program, you may need to first try a proven, cost-effec�ve medica�on before progressing to a more costly treatment. Please see the Step Therapy Program Drug List for a full list of affected brand drugs. If you have any ques�ons, please contact our Member Care team.
Why are there quantity limits on certain medications?
We Are Experts in Prescrip�on Benefits.
Medica�ons for condi�ons such as migraines have manufacturerQues� suggested quan�ty limits duetotoathe ons? Please call and speak caretherapeu�c specialist effect of the medica�on on your body. Please contact our Member Care team for more details on how quan�ty who will answer your ques�ons. 844-257-1955 limits may impact you.