Express Scripts Announces New National Preferred Formulary 2013 News_248.pdf · CH ICAG O, L ®...

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Winter 2013 From the Trustees Happy holidays to everyone! We hope this edition of on the LEVEL finds you and your families enjoying good health and prosperity and looking forward to the promise of 2014! Chicago Regional Council of Carpenters Welfare and Pension Funds Union Trustees Frank T. Libby Jeffrey Isaacson Gary Perinar, Jr. Keith Jutkins Bruce Werning Joseph Pastorino Employer Trustees J. David Pepper Benjamin A. Johnston Paul R. Hellermann Gerald W. Thiel, Jr. Todd H. Harris Mike Forest Express Scripts Announces New National Preferred Formulary The Chicago Regional Council of Carpenters Welfare Fund covers prescription drugs on the Express Scripts National Preferred Formulary — a list of preferred generic and brand-name medications approved by the Food and Drug Administration (FDA). Express Scripts has recently announced that effective April 1, 2014, it will exclude certain drugs from its Formulary. On or before this date, Plan participants will have to switch to an alternate medication or pay the full retail price to receive an excluded drug. A list of the prescription drugs that will be excluded from the Formulary appears below. DRUG TREATMENT FOR DRUG TREATMENT FOR DRUG TREATMENT FOR ADVAIR DISKUS ASTHMA KADIAN PAIN PEG-INTRON HEPATITIS ADVAIR HFA ASTHMA KAZANO DIABETES PEG-INTRON REDIPEN HEPATITIS ALVESCO ASTHMA MAXAIR AUTOHALER ASTHMA PROVENTIL HFA ASTHMA APIDRA DIABETES MICARDIS HIGH BLOOD PRESS/ HEART DISEASE RHINOCORT AQUA ALLERGIES APIDRA SOLOSTAR DIABETES MICARDIS HCT HIGH BLOOD PRESS/ HEART DISEASE SAIZEN GROWTH DEFICIENCY AUVI-Q ANAPHYLAXIS NESINA DIABETES SIMPONI INFLAMMATORY CONDITIONS AVINZA PAIN NOVOLIN 70-30 DIABETES STAXYN IMPOTENCE BECONASE AQ ALLERGIES NOVOLIN 70-30 INNOLET DIABETES STELARA SKIN CONDITIONS BETASERON MULTIPLE SCLEROSIS NOVOLIN N DIABETES TESTIM HORMONAL SUPPLEMENTATION BRAVELLE INFERTILITY NOVOLIN N INNOLET DIABETES TEVETEN HCT HIGH BLOOD PRESS/ HEART DISEASE BREO ELLIPTA ASTHMA NOVOLIN R DIABETES TEV-TROPIN GROWTH DEFICIENCY CIMZIA INFLAMMATORY CONDITIONS NOVOLIN R INNOLET DIABETES TRADJENTA DIABETES EDARBI HIGH BLOOD PRESS/ HEART DISEASE NOVOLOG DIABETES VERAMYST ALLERGIES EDARBYCLOR HIGH BLOOD PRESS/ HEART DISEASE NOVOLOG FLEXPEN DIABETES VICTOZA DIABETES EXALGO PAIN NOVOLOG MIX 70-30 DIABETES XELJANZ PAIN AND INFLAMMATION FLOVENT DISKUS ASTHMA NUTROPIN GROWTH DEFICIENCY XOPENEX HFA ASTHMA FLOVENT HFA ASTHMA NUTROPIN AQ GROWTH DEFICIENCY ZETONNA ALLERGIES FOLLISTIM AQ INFERTILITY NUTROPIN AQ NUSPIN GROWTH DEFICIENCY ZIOPTAN GLAUCOMA FORTESTA HORMONAL SUPPLEMENTATION OMNARIS ALLERGIES JENTADUETO DIABETES OMNITROPE GROWTH DEFICIENCY

Transcript of Express Scripts Announces New National Preferred Formulary 2013 News_248.pdf · CH ICAG O, L ®...

Page 1: Express Scripts Announces New National Preferred Formulary 2013 News_248.pdf · CH ICAG O, L ® UNION LABEL New ... their original certified marriage certificate issued by a state

Winter 2013

From the TrusteesHappy holidays to everyone! We hope this edition of on the LEVEL finds you and your families enjoying good health and prosperity and looking forward to the promise of 2014!

Chicago Regional Council of Carpenters Welfare and Pension Funds

Union Trustees Frank T. Libby Jeffrey Isaacson Gary Perinar, Jr. Keith Jutkins Bruce Werning Joseph PastorinoEmployer Trustees J. David Pepper Benjamin A. Johnston Paul R. Hellermann Gerald W. Thiel, Jr. Todd H. Harris Mike Forest

Express Scripts Announces New National Preferred FormularyThe Chicago Regional Council of Carpenters Welfare Fund covers prescription drugs on the Express Scripts National Preferred Formulary — a list of preferred generic and brand-name medications approved by the Food and Drug Administration (FDA). Express Scripts has recently announced that effective April 1, 2014, it will exclude certain drugs from its Formulary. On or before this date, Plan participants will have to switch to an alternate medication or pay the full retail price to receive an excluded drug. A list of the prescription drugs that will be excluded from the Formulary appears below.

DRUG TREATMENT FOR DRUG TREATMENT FOR DRUG TREATMENT FOR

ADVAIR DISKUS ASTHMA KADIAN PAIN PEG-INTRON HEPATITIS

ADVAIR HFA ASTHMA KAZANO DIABETES PEG-INTRON REDIPEN HEPATITIS

ALVESCO ASTHMA MAXAIR AUTOHALER ASTHMA PROVENTIL HFA ASTHMA

APIDRA DIABETES MICARDIS HIGH BLOOD PRESS/ HEART DISEASE RHINOCORT AQUA ALLERGIES

APIDRA SOLOSTAR DIABETES MICARDIS HCT HIGH BLOOD PRESS/ HEART DISEASE SAIZEN GROWTH DEFICIENCY

AUVI-Q ANAPHYLAXIS NESINA DIABETES SIMPONI INFLAMMATORY CONDITIONS

AVINZA PAIN NOVOLIN 70-30 DIABETES STAXYN IMPOTENCE

BECONASE AQ ALLERGIES NOVOLIN 70-30 INNOLET DIABETES STELARA SKIN CONDITIONS

BETASERON MULTIPLE SCLEROSIS NOVOLIN N DIABETES TESTIM HORMONAL SUPPLEMENTATION

BRAVELLE INFERTILITY NOVOLIN N INNOLET DIABETES TEVETEN HCT HIGH BLOOD PRESS/ HEART DISEASE

BREO ELLIPTA ASTHMA NOVOLIN R DIABETES TEV-TROPIN GROWTH DEFICIENCY

CIMZIA INFLAMMATORY CONDITIONS NOVOLIN R INNOLET DIABETES TRADJENTA DIABETES

EDARBI HIGH BLOOD PRESS/ HEART DISEASE NOVOLOG DIABETES VERAMYST ALLERGIES

EDARBYCLOR HIGH BLOOD PRESS/ HEART DISEASE NOVOLOG FLEXPEN DIABETES VICTOZA DIABETES

EXALGO PAIN NOVOLOG MIX 70-30 DIABETES XELJANZ PAIN AND INFLAMMATION

FLOVENT DISKUS ASTHMA NUTROPIN GROWTH DEFICIENCY XOPENEX HFA ASTHMA

FLOVENT HFA ASTHMA NUTROPIN AQ GROWTH DEFICIENCY ZETONNA ALLERGIES

FOLLISTIM AQ INFERTILITY NUTROPIN AQ NUSPIN GROWTH DEFICIENCY ZIOPTAN GLAUCOMA

FORTESTA HORMONAL SUPPLEMENTATION OMNARIS ALLERGIES

JENTADUETO DIABETES OMNITROPE GROWTH DEFICIENCY

Page 2: Express Scripts Announces New National Preferred Formulary 2013 News_248.pdf · CH ICAG O, L ® UNION LABEL New ... their original certified marriage certificate issued by a state

The information provided in on the LEVEL is of a general nature only and does not replace or alter the official rules and policies contained in the official plan documents that legally govern the terms and operation of the Welfare Fund. If this newsletter differs in any way from the official plan documents, the official plan documents always govern. Receipt of this newsletter does not guarantee eligibility for benefits. The Trustees have the right to modify benefits at any time.

Participant ServicesHealth Benefits: Phone: 312-787-9455/Option 3 Fax: 312-951-1515

Pension Benefits: Phone: 312-787-9455/Option 4 Fax: 312-951-3986

Contributions & Collections: Phone: 312-787-9455/Option 5 Fax: 312-787-3212

Administration: Phone: 312-787-9455/Option 7 Fax: 312-951-2996

Website: www.crccbenefits.org TRADES COUNCILALLI

ED PRINTING

212CHICAGO, IL

® UNIONLABEL

New National Preferred Formulary continued

Although this change in Formulary will affect some of our Plan participants, all of the excluded drugs have a recommended replacement — either generic or brand name — that is included in the revised Formulary. Any of the recommended replacement medications are considered to be clinically appropriate and are designed to meet your needs as well as the drug(s) they are replacing. And, this change in the Formulary will have a huge impact on the significantly higher costs associated with these brand-name medications. It will mean cost savings for you, your families and the Plan in 2014.

If you are not using one of the drugs that will be excluded, you do not have to take any action.

If you do take one of the excluded drugs, you will receive or may already have received a letter from Express Scripts about the change in Formulary and the drugs being recommended as alternatives. Contact your doctor as soon as possible to discuss which of the covered alternatives may be appropriate for you. If your doctor believes there will be no negative effect on your treatment by switching to a covered alternative drug, he will provide you with a new prescription.

In some situations, your doctor may feel it is medically necessary for you to remain on a medication that is on the excluded list. If this is the case, on or after April 1, 2014, your physician should contact Express Scripts to request a Formulary Exception. If the request is approved, your doctor will be notified that you may continue to obtain the excluded drug by paying the appropriate co-pay.

Your physician may request a clinical exception from Express Scripts for certain conditions.

This exception process is not available until April 1, 2014.

Legally Married Same-Sex Spouses Eligible for Plan Coverage in 2014Starting June 1, 2014, the Welfare Fund will allow legally married same-sex spouses to participate in the Plan. We will be hosting a special enrollment period in the spring to allow legally married same-sex couples the opportunity to enroll in the Plan.

The enrollment period will take place from April 1 through May 15, 2014. The appropriate documents will need to be provided to the Fund by May 15 for a June 1 effective date. To be eligible, same-sex couples will need to provide their original certified marriage certificate issued by a state that legally recognizes same-sex marriage.

For those same sex couples who marry after June 1, 2014, enrollments will begin the first of the month following the receipt of the appropriate documents. For example, if you submit the original certified marriage certificate on June 8th, the effective date of coverage will be July 1st.

If you have questions, please contact the Health Benefits Department at 312-787-9455, Menu Option 3.

If you have any questions about these changes, please contact Express Scripts at 800-939-2089 for more information.

Generic Cymbalta Coming Soon!Cymbalta is making its generic debut in December. If you use Cymbalta, you may want to talk to your doctor about switching to the generic version. This simple change could save you big bucks—if you decide to continue taking Cymbalta once the generic is released, your copay will increase to 35% of the cost. Switch to generic and you’ll pay just a $5 copay.

FREE Physical for You and Your Spouse

As an eligible participant, you and your spouse can receive a FREE physical exam with a health evaluation each year! See the current provider listing at www.crccbenefits.org under News and Announcements, click on “Health Dynamics Provider Listing.” To schedule your free physical, simply call the provider directly to make an appointment. Don’t forget to mention that you are with the Chicago Carpenters Welfare Fund and you are calling for a “Health Dynamics” physical. If you have questions about the program, call Health Dynamics at 414-443-0200.

FREE Counseling SessionsHoliday blues? Life getting you down? Through your Member Assistance Program (MAP), you and your dependents are eligible for five FREE counseling sessions per person, per issue, per year. Call ComPsych at 888-860-1566 or visit www.guidanceresources.com. First time users, use the password “CRCC.”