Drug Card Program

Some features of the Plan described on this page have been affected by the December 2010 Summary of Material Modifications (SMM), effective January 1, 2011. Click here to access the SMM.

You can buy your short-term or acute prescription drugs at discounted prices through the Drug Card Program (administered by Express Scripts). You should use this program ONLY for short-term (acute) prescription drugs such as antibiotics—your out-of-pocket costs will be lower if you use the Mail Service Program for your long-term prescription drug needs.

Packets containing two Express Scripts I.D. cards plus some additional information about how to use the program have previously been sent to all eligible participants whose addresses are on file at the Fund Office.

How to Use the Express Scripts Drug Card Program

  1. When purchasing prescription drugs at a participating pharmacy, present your Express Scripts I.D. card and pay the pharmacist the contracted price and the service fee. Each time you have your prescription filled, you can get up to a 30-day supply, or, if less, the amount prescribed by your doctor.
  2. Submit your itemized prescription drug receipts to Lineco for reimbursement in the usual way.
  3. After your calendar year deductible has been satisfied, Lineco will reimburse you 80% of the contracted price of your covered prescription drugs.

Note that the Drug Card Program (unlike the Mail Service Program) is part of the Comprehensive Medical Benefit. In addition to the $300 calendar year deductible, the 80% Plan payment percentage and the out-of- pocket maximum and the maximum benefit provisions apply.

Covered Drugs - Covered drugs and medications under the Drug Card Program are the same as those covered under the Comprehensive Benefit (see No. 19-a on page 48). The Plan exclusions (starting on page 72) also apply to the Drug Card Program. For example, the Plan does not cover over-the-counter (non-prescription) or experimental/investigative drugs, vitamins or nutritional supplements, or drugs for birth control, infertility, obesity, sexual dysfunction or smoking cessation, even if you have a doctor's prescription. Some prescriptions may require Prior Authorization (PA) which is a verification from the prescribing physician to ensure that the medication is being used for a medically approved indication. Prior Authorization promotes clinically appropriate and cost effective therapy.

Any amount that is determined to be in excess of the reasonable and customary price is not covered. For example, the Fund's arrangement with CuraScriptTM Pharmacy (see page 55) includes discounted prices for expensive medications, and you are required to obtain your specialty drugs through CuraScript. In addition, the Fund Office may be able to secure more favorable terms for other pharmaceuticals. If so, the Fund Office will contact you. If you do not purchase your medications through the recommended source, the Plan will not cover any charges in excess of the price the recommended provider would have charged.

Specialty Drugs - CuraScriptTM Pharmacy, a mail-service pharmacy that provides specialized medications, is Lineco's exclusive provider for specialty pharmacy medications. CuraScript, which is a subsidiary of Express Scripts, Inc., is one of the nation's largest specialty pharmacy providers.

Specialty drugs are high-cost injectable, infusion, intravenous (IV) drugs and certain oral medications that are prescribed for diseases such as multiple sclerosis, rheumatoid arthritis, hepatitis C and asthma. These medications are not only very expensive, they require special storage and handling, frequent dosage changes, and periodic laboratory testing. They are not usually stocked in retail pharmacies. Some common specialty drugs are:

(This is NOT a complete list of all the specialty drugs available through CuraScript.)

Patients MUST go through CuraScript for all specialty drugs. This applies regardless of where the drug will be administered (including drugs administered in a doctor's office).

CuraScript will dispense up to a 30-day supply of your specialty medication at one time for a co-pay amount of 1/3 of the normal mail-service co-pay. For more information, call CuraScript's toll-free telephone number shown on the inside front cover of this booklet. You can also find information about CuraScript Pharmacy online at www.curascript.com .

Prescription Drug Program for Medicare-Eligible Individuals - Instead of paying full price and filing a claim for prescription drug benefits, Medicare-eligible employees, retirees and dependents pay a 20% co-pay when they purchase their covered prescription drugs from a participating pharmacy. When a Medicare-eligible individual's 20% retail co-pays and his mail-service co-pays combined total $1,000 during a calendar year, his retail and mail-service co-pays during the remainder of that year will be $0. Use of participating pharmacies is mandatory—no benefits will be provided for out-of-network pharmacy purchases. In addition, use of the mail-service pharmacy is mandatory for maintenance drugs after the original supply plus one refill.

Note - Don't send your 20% co-pay receipts to the Fund Office—these are your responsibility.

Step Therapy for Medicare-Eligibles - A step therapy program applies to prescription drugs purchased by Medicare-eligible individuals. "Step therapy" is used to guide a patient with a chronic condition to a less costly medication (called a "step one" drug), if appropriate, before he tries a more expensive drug (called a "step two" drug). Step one drugs are often the generic equivalents of step two drugs.

If you present a new prescription to your pharmacist for a drug included in this program, and you haven't tried a step one drug first, you may have to pay full price for your prescription. In such case, you can talk to your doctor about prescribing a covered step one drug instead.

Some common step two drugs are Nexium, Lipitor, Zocor, Prevacid and Diovan. The step therapy procedures apply to these (and other) maintenance medications.

The goal is to ensure that the patient receives an appropriate medication for his condition. Since an appropriate drug is not always the most costly, and in many cases, the most appropriate drug will save you money, step therapy can also help reduce costs. Step therapy applies to drugs purchased at retail pharmacies or through the mail-service pharmacy.

Medicare Part D Prescription Drug Plans - Covered individuals who are also entitled to Medicare (whether or not they are retired), have the option of dropping their prescription drug coverage through the Line Construction Benefit Fund and switching to a Medicare Part D plan. However, most participants will NOT benefit by doing so, and Lineco is not encouraging anyone to switch to a Part D plan. You cannot choose dual prescription drug coverage. Lineco cannot coordinate its benefits with a Part D plan's benefits. If you choose a Part D plan, your Lineco prescription drug coverage will terminate.