This describes benefits for eligible participants who have elected the Indemnity Plan and Medicare eligible members who have selected supplemental benefits only.

Please note: retail is limited to a 30 days supply, but members may obtain maintenance prescriptions for up to a 90 day supply at Longs Drug Stores.

Federal Legend Drugs (Drugs approved by the FDA requiring a written prescription), Azelex (through age 22), Bee Sting Kits, Depo Provera, Diabetic Test Strips, Lancets and Tablets, Diaphragms, Glucogan, Immunosuppressants, Insulin/Insulin syringes (written prescription), Immunization Drugs, Oral Contraceptives, Injectable drugs (self-administered only), Retin-A (through age 22), Viagra (limit 8 tablets/month), Vitamins (prescription only).

Refer to the exclusions and limitations, Section VII for list of medications that are not covered. The Insured Indemnity program continues to cover blood and blood plasma, drugs administered at the doctor's office, and injectibles that are not self-administered.

OTC antihistamines and OTC Priolosec are now covered by the Plan for a $0.00 copay.

Generic drugs are just as effective as brand name medications, but are considerably less expensive. Members are, therefore, encouraged to purchase generic prescriptions, when available, as a cost savings to themselves and the Plan.

Blood glucose monitoring for participants diagnosed with Diabetes.

3 months with a zero copay for certain generic drugs, for participants being treated for high cholesterol, depression, or arthritis.

For participants being treated with biotech or injectable drugs for chronic medical conditions.

The program is administered by RX America who will issue you an ID card when you become eligible.

Most pharmacies participate in the program which provides you and the Plan with discounted prices on most drugs and which determines your payment electronically at the time of purchase.

The Plan pays 80% of the discounted price of covered pharmaceuticals

You must pay 20% of the discounted price of covered pharmaceuticals at the time of purchase.

If you are taking "maintenance" medications on a long-term basis, your costs will be lower if you use the Mail Order service. For 90 day prescriptions your cost is 20% for generics. More details are found in the SPD.

Drug Card Phone Number: 800-770-8014
Website: www.rxamerica.com

Mail Order Phone Number: 877-889-3402
Website: www.adprx.com