drug or specialty drug. Please see the Schedule of Benefits for the applicable amounts, and for applicable limitations on number of days supply.
The Plan, on behalf of the Employer, retains the right at its discretion to determine coverage for dosage formulations in terms of covered dosage administration methods (for example by mouth, injections, topical or inhaled) and may cover one form of administration and exclude or place other forms of administration on other Tiers.
The amounts for which you are responsible are shown in the Schedule of Benefits. No payment will be made by the Plan for any Covered Service unless the negotiated rate exceeds any applicable deductible and/or copayment/coinsurance for which you are responsible.
Your copayment(s), coinsurance and/or deductible amounts will not be reduced by any discounts, rebates or other funds received by Medco and/or the Plan from drug manufacturers or similar vendors. For Covered Services provided by a retail pharmacy, retail specialty pharmacy, Accredo mail order specialty pharmacy or through the Medco Mail Service Pharmacy, you are responsible for all deductibles and/or copayment/coinsurance amounts.
For Covered Services provided by a non-network retail pharmacy, you will be responsible for the amount(s) shown in the Schedule of Benefits. This is based on the Maximum Allowable Amount.
How to Obtain Prescription Drug Benefits How you obtain your benefits depends upon whether you go to a network or a non-network pharmacy.
Network Retail Pharmacy – The retail pharmacy network includes the following chains: Walgreens, CVS, Wal- Mart, Meijer, Target, Kroger, Marsh and more. For the names of participating pharmacies, call 877-841-5241 or visit www.medco.com. Present your written prescription from your physician and your ID card to the pharmacist at a network retail pharmacy. Alternatively, some physicians send prescriptions to pharmacies electronically. The Pharmacy will submit your claim for you. You will be charged at the point of purchase for applicable deductible and/or copayment/coinsurance amounts. If you do not present your ID card, you will have to pay the full retail price of the prescription. If you do pay the full charge, ask your pharmacist for an itemized receipt and submit it to Medco using a direct claim reimbursement form, which you can request from Medco customer service.
Specialty Drugs – Specialty medications are used to treat complex conditions, such as cancer, growth hormone deficiency, hemophilia, hepatitis C, immune deficiency, multiple sclerosis, and rheumatoid arthritis.
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