Summary Plan Description

Preferred Prescriptions Incentive Formulary

The prescription drug programs include an incentive formulary. A formulary is a list of commonly prescribed medications that are preferred based on their clinical effectiveness and affordability. Use of a formulary drug is encouraged through lower copayments.

Sometimes your physician may prescribe a medication when a formulary preferred brand or generic alternative drug is available, including in some cases, a prescription to be dispensed as written. As part of the prescription drug programs, the pharmacist may discuss with your physician whether an alternative drug listed on the formulary might be appropriate for you. If your physician agrees, the prescription will be filled with the alternative drug. Confirmation will be sent to your physician explaining the change. You should let your physician know if you have any questions about a change in prescription. Your physician always makes the final decision on all medications and you can always choose to keep the original prescription drug. However, you save money if a generic or brand-name formulary drug is prescribed, and if the home delivery pharmacy service is used.

Key Point

Benefits are provided for prescription drugs and medicines that are required by federal or state law to be prescribed in writing by a physician or dentist, are in full compliance with Federal Food and Drug Administration (FDA) regulations, bear a label indicating dose, warnings and an assigned prescription number, and are dispensed by a licensed pharmacist. Certain drugs require preauthorization with the Trust Office prior to purchase. Preauthorization is currently required for injectable medications (except insulin), amphetamines (e.g., Dexedrine and Adderall), Ritalin, Retin-A, Renova, Lamisil, and Sporanox, and immunosuppressives (e.g., CellCept, Neoral, Sandimmune, and Prograf). This list is subject to change based on FDA guidelines for new and existing drugs.