Prescription Drug Coverage

Kaiser Prescription Drug Coverage

Prescriptions: can only be obtained from a Kaiser facility. This includes Dental prescriptions.

Self-funded Medical Prescription Drug Coverage

Prescriptions are filled at your participant pharmacy through Caremark.
An important part of your medical insurance program is the Caremark Retail prescription drug plan. Your prescription benefit is managed by Caremark. Under this plan, The Self Funded Medical Plan pays for a large part of the cost of medically necessary drugs and medicines. You and your dependents can buy the prescriptions you need to preserve your health.

You may fill your prescription at any of more than 50,000 pharmacies in the United States who transmit claim information via the Caremark Electronic System. Because of this technology, you will receive fast, accurate pharmacy service. Also, you will rarely need to submit a written claim form.

Getting Started is Easy! Fill your prescriptions in three simple steps:

  1. Select a pharmacy
  2. Present your benefit card to your pharmacist
  3. Pay your portion of the medication cost

If you or your family member do not have the Caremark card when you go to the pharmacy, you may have the prescription filled if you give the pharmacy the carrier’s name (CVS Caremark), group number (RX6644), RXBIN number (004336), RXPCN number (ADV), the subscriber’s social security number and the birth date of the family member the prescription is for. If there is any problem filling the prescription, you or the pharmacist can call our office at 408/288-4456 or 408/288-4457 during business hours for immediate help.

Over 90% of all pharmacies are Caremark members. To find out if a certain pharmacy accepts your card, call the pharmacy directly or log on to www.caremark.com to find a nearby pharmacy. However, there may be a rare occasion when you might not utilize a member pharmacy. Under these circumstances, you will have to submit a claim form for reimbursement. These forms can be obtained from UAS at 408-288-4457.

Your out-of-pocket cost at the retail pharmacy is $15 for a generic Drug, $30 for a preferred brand drug, and $50 for a non-preferred brand drug for a 30-day supply. If a generic is available and you are prescribed a brand drug, you will be required to pay the difference between the cost of the generic and the brand prescription. There is now a deductible of $100 per year for name brand drugs only – this does not apply to generic drugs.

You are now able to fill your 90-day maintenance prescriptions at a participating pharmacy of your choice for the same co-payments as regular 30-day prescriptions. This program is known as CVS-90.  Bay Area Roofers negotiated this 90-day offering at many of the 7,000 plus CVS pharmacies nationwide to enhance your prescription benefit and provide more options for receiving your long-term medications.

Mail Service Pharmacy – Caremark.com

Members may save time and money by obtaining their prescription medication through the Mail Service Pharmacy. For the same co-payments as retail, you may obtain up to a 90-day supply of medication. The medication is mailed directly to your home. The Mail Service Pharmacy is designed mainly for maintenance type medication for treatment of chronic or long-term conditions such as diabetes, arthritis, heart conditions, and high blood pressure, but may be used for any prescription medication, including oral contraceptives.

The Mail Service Pharmacy is through Caremark.com, a home RX delivery from Caremark. Order envelopes which contain complete information about this service may be obtained from UAS at 408-288-4457.

To get started with the Mail Service Pharmacy, have you doctor write two prescriptions. One prescription for a short-term supply (e.g., 30 days) to be filled immediately at a participating retail pharmacy. A second prescription for the maximum days’ supply allowed (90 days) with as many as three refills (if appropriate) to mail to Caremark. Complete the mail service order form. Mail your order form, along with your original prescription, and payment, in the Caremark envelope. They accept VISA, MasterCard, Discover or American Express. You also can pay by check or money order.

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