Medical/ Dental/ Prescription

How to request a prescription coverage review

If special circumstances require you to take a multi-source brand name drug instead of its generic equivalent, you or your doctor can request approval of the multi-source drug through a coverage review using the following instructions:

The review can begin in one of two ways:

1. You call Express Scripts. If you call Member Services 1-877-877-1878 and ask for a coverage review, they will contact your doctor and ask that he or she send in the necessary information.

2.  Your doctor calls Express Scripts. If your doctor calls the special physician number 1-800-946-3979, they will discuss the situation and request the necessary information.

Once the coverage review is complete, they will notify you and your doctor of the decision.

ATTENTION Medicare eligible dependents and retirees

You will receive a letter from Medco (see attached) explaining the process for obtaining diabetic supplies.

You have two choices- mail order through Medco or your local retail pharmacy.

When using mail order, your supplies will automatically be processed at the highest level of benefits.

When using a retail pharmacy, to get the highest level of benefits, you must:

1)      Instruct pharmacy to process your claim using your Medicare ID card (red, white and blue ID card) FIRST

2)      Then, process the remaining balance of the claim under the Vz/Medco ID card

If this process is not followed, you will incur a higher out of pocket expense than necessary.

If the claim wasn’t processed correctly, you have 14 days to return to the retail pharmacy for an adjustment.

If you incur any problems with this process, please contact Paula Small, IBEW Local 827 Health Care Benefits Coordinator at 888-855-0364