The Prescription Drug Card Program for Participants who are covered under the Self Funded PPO Plan is administered by Catamaran. The following information is provided to help you best utilize the pharmacy program. Click here for a more detailed summary of the Catamaran Prescription Drug Card program.
You must present the enclosed identification card at a network pharmacy each time you purchase a prescription. To order additional cards, call Catamaran at 1-888-354-0090.
Most major chains and independent pharmacies are in the Catamaran pharmacy network, including, but not limited to, the following: Lucky, Costco, K-Mart, CVS, Raley's, Safeway, Save Mart, Save-on, Shopko, RiteAid, Target, Von's Food & Drug, Walgreen's, and Wal-Mart.
To locate a participating pharmacy closest to your home or workplace, call the Catamaran Help Desk at 1-888-354-0090 and request a zip code search.
Supply: 30-day supply maximum allowed with each prescription.
NOTE: If you have other prescription drug coverage through another group provider that is primary, the Plan, as secondary carrier, will coordinate benefits by reimbursing you for the primary plan's out-of-pocket copayment. This can be done at the retail pharmacy by using your prescription card for your primary carrier and then your San Francisco Eectrical Workers card as secondary carrier. If you do not have your SFEW prescription coverage card when the pharmacist fills your prescription, you may also seek reimbursement by submitting a Direct Member Reimbursement Form to Catamaran with your receipt showing the amount you paid and the amount your primary insurance paid.
Pay by Check, Credit/Debit Card or, with online or phone pre-registration by Electronic Payment or "Bill Me Later"
Supply: 90-day supply maximum allowed with each prescription with up to three refills, if appropriate.
Click here for brochure that explains how the program works in more detail.
Federal Legend Drugs (Drugs approved by the FDA requiring a written prescription), Bee Sting Kits, Depo Provera, Diabetic Test Strips, Lancets, Diaphragms, Glucogan, Immunosuppressants, Insulin/Syringes (must be on a written prescription), One Glucose Meter per year, Acne/Dermatological products (through age 40 with Prior Authorization), Viagra (limit 8 tablets/months), Vitamins (prescription only).
Appetite Suppressants/weight loss agent, Blood and Blood Plasma*, Cosmetic Drugs, Drugs and devices administered at the doctor's office, rest home or hospital, Fertility Drugs, Growth Hormones, Immunization* and Vaccinations*, Injectables not self administered or otherwise available through the Specialty Rx Program described below*, Medical Supplies and Appliances*, Over the Counter products (with the exception of PPIs and NSAs w/written prescription- see below), and Over the Counter Vitamins and Nutritional Products.
*Items with an asterisk are covered under the Self Funded Medical Program.
The Plan will cover the full cost of prescription strength PPIs (OTC Prilosec, Omeprazole, Prevacid, and Zegerid) and NSAs (OTC Claritin, Alaver, Claritin D, Allegra, Allegra-D, Zyrtec, and Zyrtec-D) over the counter ("OTC") for no copayment, provided you have a prescription.
This program provides one-on-one service and active management of Biopharmaceuticals. This program provides a more cost effective solution for specialty medications. A Member care specialist will be assigned to contact individuals who have been prescribed certain medications to make sure that they are taking them, as prescribed, and understand how to deal with any side effects that may occur. These medications are sent directly to the members' homes and clinical pharmacists that are dedicated to the specialty pharmacy are available on a 24 hour basis to answer questions or concerns.
Copayments: 20%, up to a maximum of $150 per script.
New Members may submit claims for prescriptions not billed through Catamaran during the first 60 days of their participation the pharmacy program. A Direct Member reimbursement form must be filled out and submitted with your receipt to the fund administration office. Reimbursement will be at 80% of the retail price paid. Claims for prescriptions filled outside of the Catamaran program after 60-day grace period will be reimbursed at the contract rate minus copayment.
The prescription drug plan includes a "step therapy" program for select drugs prescribed after July 31, 2011, under the self-funded PPO plan to retirees and their dependents. Generic and higher cost drugs that were prescribed to retirees and their dependents before August 1, 2011, are not be affected by this change.
Step therapy is an automated program that a pharmacist uses to review a patient's medication history, often resulting in an alternative (sometimes generic) medication to replace a more costly medication. The program requires a patient to try a clinically appropriate, lower cost medication first, unless a physician provides medical documentation that a patient has tried and failed an alternative (generic) medication in the recent past.
If a covered individual chooses not to participate in the step therapy program by purchasing the brand drug before trying the alternative, that individual will be required to pay the applicable copay plus the total cost difference between the brand and the alternative, unless clinical documentation from the prescribing physician indicates the lower cost medication is not a suitable substitute. Click here to access a listing of the traditional generic step therapy classes with drugs that are currently subject to step therapy. This list is for informational purposes ONLY since there will be changes as new drugs are introduced and patents expire.Program for Retirees only.