The Seafarers Health and Benefits Plan’s new agreement with Prescription Solutions took effect as scheduled Jan. 1. According to Plan officials, the transfer of all pertinent data from the Plan to the pharmacy management company went smoothly.Individual identification cards already have been mailed to all eligible participants, while informational packages were sent to all ports. Initial reaction to the cards was very positive, according to port officials.
As reported earlier in the Seafarers LOG, the Seafarers Health and Benefits Plan in December entered into the agreement with Prescription Solutions to provide pharmacy benefits to all eligible participants. Under the agreement, the cost of prescribed drugs will be greatly reduced, resulting in a savings to the Plan and to participants.
Eligible members and dependents participating at Plan Level G will pay only small co-payments for certain prescribed name-brand drugs. In addition, maintenance drugs will be available through a mail order arrangement.
The program provides coverage for new as well as refill prescriptions filled at participating retail pharmacies and through the Prescription Solutions Mail Services Pharmacy. To use the program, members need only present their Prescription Solutions ID cards at any participating pharmacy.
When participants fill or refill prescriptions at participating pharmacies, pharmacy workers will enter members’ ID numbers and other pertinent information into their computer system. This information automatically will be sent to Prescription Solutions, which will verify coverage and instruct the pharmacy to collect applicable co-payments from those having prescriptions filled. No additional claim forms or paperwork will be required.
Maintenance medications (required for prolonged or indefinite periods) are available through the Mail Service Pharmacy. Members’ out-of-pocket costs will be less and/or the supply of medication will be greater if they choose to receive their covered medications through Prescription Solutions’ Mail Service Pharmacy. Also, medications—generally up to a 90-day supply with lower co-pay—will be sent directly to participants’ homes.
Additional information on using the mail service pharmacy is available by calling Prescription Solutions’ Mail Service Customer Service at 1-800-562-6223.
Utilization of the network will eliminate any out-of-pocket costs for participants unless a name-brand drug is requested when a generic is available. If a participant chooses a name-brand drug over the generic equivalent, then a co-payment of $20 is required at a retail outlet and a co-payment of $10 monthly, or $30 for a 90-day supply, will be required from the mail-order service.
If a participant continues to use a retail outlet for a maintenance type drug—a drug that will be taken for an indefinite period of time as in the case of blood pressure medication and blood thinners—then, beginning with the fourth month of retail, the co-payment will be $30 for name brand drugs, and $15 for generic drugs and for name-brand drugs when a generic is not available.
Although the new program is operating, the Plan will continue to honor pharmacy claims submitted for reimbursement from non-participating pharmacies for a three-month grace period.
During this grace period, Prescription Solutions will attempt to enroll the non-participating pharmacy in their network. Should they be unsuccessful, however, reimbursements would be made in accordance with the network payment schedule if participants continue to use non-participating pharmacies after the grace period expires.
Prescription Solutions has more than 55,000 participating pharmacies in their network. Included in this list are: Carr’s, CVS, Eckerd, Rite-Aid, Safeway, Kroger, Publix, Giant and Walgreen’s. Those with questions about this new prescription drug plan, or needing assistance in locating a participating pharmacy, may call Prescription Solutions Customer Service at 1-800-797-9791, Monday through Friday, from 6 a.m. to 9 p.m., and from 7 a.m. to 7 p.m., Saturday and Sunday, Pacific Standard Time.
For a chart that shows the co-pay rates that will apply to all eligible members and dependents when using participating pharmacies, please see the printed version of the February LOG or download the PDF version from this web site.
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