Northwest laborers-employers health & security trust

NORTHWEST LABORERS-EMPLOYERS HEALTH & SECURITY TRUST
201 Queen Anne Avenue N., Suite 100
Seattle, WA 98109
(206) 282-3600 or (800) 826-2102
SUMMARY OF MATERIAL MODIFICATION
Effective with pharmacy prescriptions filled on or after January 1, 2013, the Trust is implementing changes to the Prescription Drug Benefit. The changes include: (1) step therapy; (2) dispense as written rules; (3) quantity level limits & quantity duration management; and (4) the specialty oral oncology half fill program. 1. Step Therapy is a “step” approach to providing drug coverage. It is designed to encourage the use of appropriate and cost-effective prescription drugs. This means that you may first need to try an alternative, typically a generic drug, before the Plan will cover certain medications prescribed by your physician. If necessary, you may then progress to more costly therapy. You may request that the Trust waive step therapy if your healthcare provider clinically documents why you cannot take the alternative drug. Step therapy programs were developed using FDA Guidelines, clinical evidence and research. Effective with prescriptions purchased on and after January 1, 2013, Step Therapy will be applied to all new prescriptions for the following therapeutic classes of drugs: High cholesterol. Medications used to treat high blood pressure, specifically angiotensin II receptor blockers (ARBs). Medications that prevent the loss of bone mass, to treat osteoporosis, specifically bisphosphonates. Nasal spray medications used to treat allergies, specifically intranasal steroids. Medicines used to prevent asthma, specifically leukotrienes (leukotriene modifiers or antagonists). Medicines used to treat allergy, specifically non-sedating antihistamines (NSAs). Proton pump inhibitors (PPIs), which are medications used to prevent and treat ulcers, gastroesophageal reflux disease (GERD), and conditions in which the stomach produces too much acid. Sedative hypnotics, which are medications used to promote sleep. 2. Dispense as written rules. Participating Pharmacies and the Mail Order facility will dispense prescriptions as written by the healthcare provider. If a participant chooses to select a brand named drug in place of a generic drug (equivalent agent), the participant must pay the ingredient cost difference between the brand drug and the generic equivalent drug, plus the applicable brand copayment. 3. Quantity level limits and quantity duration management for specific classes of drugs, such as migraine products and Tramadol/Ultram products (for certain types of severe pain). Participating Pharmacies and the Mail Order facility will dispense these prescriptions using the Federal Drug Administration (FDA) dosing guidelines. 4. The Specialty Oral Oncology half fill program limits the first two dispensing prescriptions to a 15-day supply. Subsequent refills are limited to a 30-day supply. This program is designed to provide for early identification and management of adverse effects of medication. If serious adverse effects are identified in the first half of the cycle, the medication can be discontinued and it avoids potential waste associated with early therapy discontinuation. All specialty oral oncology medication must continue to be filled by the Plan’s specialty pharmacy. Please keep this notice with your 2010 Summary Plan Description booklet for easy reference to all Plan provisions. If you have questions regarding this notice or other benefit provisions, please contact the Trust Administration Office at the address or phone number indicated above.

Source: http://www.local348.com/images/Linked%20Docs/Summary%20of%20Material%20Modification%20Drug%20Benefit%20Change%201-1-12.pdf