Prescription through a Pharmacy
AdvancePCS is a nationwide organization of pharmacies with more than
50,000 participating member pharmacists in all states. Each eligible Employee and spouse is issued a
personalized plastic Prescription Drug Card, which is presented to a
participating pharmacy at time of claim (prescription drug purchase or refill).
You pay the druggist the appropriate Copay amount selected
for generic equivalent prescription drugs or brand-name prescriptions and
sign the form. Everything else is taken care of. YOUR GREAT LAKES EMPLOYERS ASSOCIATION
PRESCRIPTION DRUG CARD PROGRAM is designed for your convenience so that you
can easily fill a prescription.
Brand-Name vs. Generic Equivalent Drugs: Many drugs are available in generic equivalent
(non-brand-name) form today. Although your doctor may prescribe a brand-name
drug, you should ask if it is available in generic equivalent form and if the
generic equivalent form can be substituted.
If you purchase a brand name or generic equivalent drug, there is a
specific selected Copay.
Your prescription drug purchases at a non-participating pharmacy are
also covered (except Copay). In some instances,
however, the prescription drug card program may not cover the entire cost of a
drug purchased at a non-participating pharmacy. This is also true if you do not
present a PCS card at a participating pharmacy.
DISPENSING LIMITATIONS
For each prescription and each refill through a pharmacy the amount
normally prescribed by your Physician, but not to exceed a 34-day supply or 100
unit dose, whichever is lesser. If you
need a supply greater then 100 unit dose refer to the mail order procedures
below.
If your personalized plastic Prescription Drug Card is not
presented to the participating pharmacy at time of claim (prescription drug
purchase or refill) of you fill a prescription at a non-participating pharmacy,
you must pay full price for the prescription and request direct reimbursement
through the Great Lakes Employers Association.
For direct reimbursement Prescription Claim Reimbursement Form #010007
Rev. 10-99 must be completed in it entirety and submitted to:
AdvancePCS
PO BOX 961066
Fort Worth, TX 76161-9854
Prescription through AdvanceRX
Mail Order Service
AdvanceRX Mail Order Prescription Drug
Service is available for prescribed, maintenance prescriptions. Maintenance prescriptions are those
medication/drugs taken regularly to treat a continuing health condition. Some examples would be conditions of high
blood pressure, hormone replacement and similar long term situations. Oral contraceptives are available through the
Mail Order Service.
Using the Mail Order Service
for maintenance drugs is convenient and reduces your required Copay, saving you money.
Your maintenance drugs can be delivered directly to you. You receive up to a 90 day supply, without a
maximum on quantity. Currently the
maximum allowed at the retail pharmacy is a thirty-four day supply or 100 unit doses,
whichever is lesser.
AdvanceRX Mail Order Prescription Drug
Service offers a toll free number for ordering (800) 966 - 5772 or complete Prescription
Mail Order Application #11968, overnight delivery, and 24 hour pharmacy
consultation.
If you have any questions or
would like help in getting your Mail Order Service started, please contact us
at (269) 343 – 2611 ext 109.
The Copay for mail order is based on the table
below:
*Prescription Drug Copays
Available:
(see Certificate Booklet, pg.1 for Selected Copay):
Retail: $10
brand-name/$ 5 generic equivalent Mail Order: $15 brand-name/$
8 generic equivalent
Retail: $15
brand-name/$10 generic equivalent Mail Order: $30 brand-name/$20 generic
equivalent
Retail: $25
brand-name/$15 generic equivalent Mail Order: $35 brand-name/$20 generic
equivalent
Retail: $25
brand-name/$10 generic equivalent Mail Order: $30 brand-name/$15 generic
equivalent
Retail: $30
brand-name/$15 generic equivalent Mail Order: $50 brand-name/$25 generic
equivalent
Retail: $40
brand-name/$20 generic equivalent Mail Order: $60 brand-name/$40 generic
equivalent
