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PRESCRIPTION DRUG SERVICES Plan Details
Benefits are only available at Educators Mutual Insurance Association retail network pharmacies and the mail-order pharmacy, Medco By Mail (under emergency circumstances, benefits may be obtained out -of-network).
For more information on the mail-order pharmacy, visit www.educatorsmutual.com, call 1-800-572-8734 (TTY/TDD users should call 1-800-716-3231) Pharmacy Customer Service hours are 7:00 a.m. to 7:00 p.m. (EST) 7 days a week, except Thanksgiving and Christmas or write Medco at, P.O. Box 2016, Pine Brook, NJ 07058.
For more information on retail network pharmacies (including LTC, I/T/U, and Home Infusion pharmacies), visit www.educatorsmutual.com, call 1-800-572-8734 (TTY/TDD users should call 1-800-716-3231) Pharmacy Customer Service Hours are 7:00 a.m. to 7:00 p.m. (EST) 7 days a week, except Thanksgiving and Christmas or write Medco at, P.O. Box 2016, Pine Brook, NJ 07058.
To price medications and locate pharmacies you can go online to:
PHARMACY NETWORK INFORMATION
To obtain the names and addresses of Educators Mutual Insurance Association’s network pharmacies contact Pharmacy Customer Service at 1-800-572-8734 (TTY/TDD users should call 1-800-716-3231) Customer Service hours are 7:00 a.m. to 7:00 p.m. (EST) 7 days a week, except Thanksgiving and Christmas or visit www.educatorsmutual.com.
Transition Prolicy
Can the Formulary change?
Generally, if you are taking a drug on our 2008 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2008 coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing amount for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or improve the safety of your drugs.
If we remove drugs from our formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug, or move a drug to a higher cost-sharing tier, we must notify affected members of the change at least 60 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug.s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug. The enclosed formulary is current as of January 01, 2008. To get updated information about the drugs covered by Educators Basic, please visit our website at www.educatorsmutual.com or call Customer Service at 1-800-572-8734, 24 hours a day, 7 days a week (except Thanksgiving and Christmas). TTY/TDD users should call 1-800-716-3231.
MEDICATION THERAPY MANAGEMENT
A Medication Therapy Management (MTM) Program is a free service we may offer. You may be invited to participate in a program designed for your specific health and pharmacy needs if you meet limited eligibility criteria. An MTM is not considered a benefit. You may decide not to participate but it is recommended that you take full advantage of this covered service if you are selected.
An MTM program may be available for a combination of the following conditions: Hypertension, High Cholesterol, Heart Failure, Diabetes, and Chronic Obstructive Pulmonary Disease (COPD).
Please contact Pharmacy Customer Service for more details about the MTM program:
Toll free: | 1-800-820-9731 |
TTY: | 1-800-716-3231 |
24 Hours a day, 7 days a week, except Thanksgiving and Christmas
MAIL-ORDER PRESCRIPTION DRUG SERVICES
With Educators Mutual Insurance Association there are two easy ways to fill your prescriptions:
- By Mail: If you are looking for additional savings, you can order through Medco By Mail for prescription medications you take on a regular basis.
- At a Retail Pharmacy: You have access to over 40,000 retail network pharmacies nationwide, so you'll be sure to have a pharmacy near you. Just show your card each time you get your prescriptions filled.
In order to receive prescription drug coverage through Educators Mutual Insurance Association, the prescription must be filled through either Medco By Mail or a retail network pharmacy. Please note there are some medications that cannot be filled through Medco By Mail.
If you use a pharmacy outside the network, the plan may not provide reimbursement, unless it is an emergency situation.
Medco By Mail is part of Educators Mutual Insurance Association, so once you join the plan, there's no extra cost to you! You can compare the retail pharmacy and Medco By Mail costs in your Summary of Benefits. Enrollees are not required to use mail-order prescription drug services to obtain their extended supplies of maintenance medications; if a retail pharmacy does agree to accept the mail-order reimbursement rate for an extended supply of medications, the enrollee should have no out-of-pocket payment differences; if a retail pharmacy does not agree to accept the mail-order reimbursement rate but has accepted an alternative retail-mail-order pharmacy rate for an extended supply of medications, the enrollee will be liable for any difference in charge.
Educators Mutual Insurance Association members will usually receive medication they order through our Medco By Mail pharmacy within 3 to 5 days after we receive the order. If you do not have enough medication, you may need to ask your doctor for another prescription for a 14-day supply that you can fill at a retail network pharmacy.
Questions concerning orders can be directed to 1-800-572-8734, (TTY/TDD users should call 1-800-716-3231) Pharmacy Customer Service hours are 7:00 a.m. to 7:00 p.m. (EST) 7 days a week, except Thanksgiving and Christmas.
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