General

• The Plans cannot reimburse or dispense prescriptions that are refilled too soon. Have your prescription refilled when at least 75% of the medication has been used. If you refill your prescription when more than 25% of the total days supply of medication is still remaining, your prescription cannot be processed for payment.

Coordination of Benefits
WTWT will pay as the primary payer for prescription drug benefits. Benefits will not be coordinated with other plans. If benefits are paid, or are payable, under any other plan, this Plan will not pay.

Generic Prescription Drugs
You can take advantage of the availability of lower cost generic drugs. The steps to take:

• Discuss this matter with your doctor and ask your doctor to request that the pharmacist use a generic drug equivalent, if available.
• Present the prescription to your pharmacist and request the generic equivalent.

The use of generic medication has become prevalent in the last few years. The generic name of a medication is simply its chemical name. By law, brand name medications and generic medications must be the same chemically and also have the same therapeutic effect. Generic medications meet strict requirements under the Food and Drug Administration (FDA) and are as safe, efficient and effective as brand name medications, but are considerably less expensive.

If your prescription is filled with a brand name drug when a generic is available, additional copayments may apply.

Drug Utilization Review (DUR)
An essential feature of your managed prescription drug program is “Drug Utilization Review” (DUR). The Western Teamsters Welfare Trust has authorized this structured system for the analysis and improvement of prescription prescribing and use patterns. The DUR committee consists of professors, pharmacists and physicians with experience in drug benefit management, clinical pharmacy, and drug interactions. The committee confidentially reviews and evaluates drug therapy using predetermined medical and pharmaceutical standards. Individual prescription profiles that are flagged for review may include:

• Profiles with an unusual number of prescriptions in a given time period.
• Profiles with a high number of controlled substances.
• Numerous prescribing physicians and dispensing pharmacies.
• Possibility of clinically significant drug interactions.
• Physician prescribing patterns or pharmacy dispensing patterns which result in excessive cost drugs.

Whenever DUR studies disclose possible inappropriate use of prescription drugs or possible drug interactions, the DUR committee is authorized to contact the prescribing physicians or dispensing pharmacies in an effort to resolve the matter. Unresolved cases of inappropriate prescription drug use will be referred to the Plan Administrator with a recommendation for denial or curtailment of benefits.

Formulary Services
Your prescription drug benefit program also includes a list of preferred prescription drugs called the “Preferred Prescriptions Formulary”. These have been selected by a panel of physicians and pharmacists based on their combination of therapeutic effectiveness and favorable pricing arrangements including volume rebates. A copy of the list can be obtained from your Area Administrative Office. Your participation is voluntary and your compliance will not affect the amount of your co-payment or benefit reimbursement. Please share this list with your physician during your next visit.

NBN/Rx Network Pharmacy Quality Control
All NBN/Rx network pharmacies are electronically linked to a central computer system, which contains certain information regarding WTWT participants (employees and dependents). This information system is updated frequently based on your most current eligibility status. Occasionally, you may attempt to purchase a prescription from a participating NBN/Rx network pharmacy, but the pharmacy will be unable to confirm your entitlement to the discounted retail purchase. This could occur because pertinent information regarding the patient (employee or dependent) has not been added to the system or has been deleted from the system. Examples of situations when employee or dependent information may not be in the system include:

• You are a new participant and have not been entered into the WTWT data files.
• You have not been eligible under WTWT for an extended period (usually three or more months).
• Your dependent child attains “non-qualifying” age (i.e., age 19).
• Your newly acquired dependents (due to marriage or re-marriage, newborn children, stepchildren, etc.), have not been entered into the WTWT data files.
• Your contributions are late.

On other occasions, the network pharmacy may not be familiar with the NBN/Rx program, and will not release discounted prescriptions at the time of your attempted purchase. This is not an uncommon situation for pharmacies that have just been recently added to the NBN/Rx network.