When you and your dependents are eligible for the medical and hospital benefits provided by the Operating Engineers Health and Welfare Fund, you are also eligible for the benefits of the Prescription Drug Plan, except for Retirees enrolled in Plan 'M' and Active & Retiree HMO plan enrollees.   

Three options are available for the payment of prescription drug claims and you have the free choice of any of the three options.

The Fund will pay 80% of the reasonable and customary charge as long as your Calendar Year Deductible has been met ($500.00 per person, $1,500.00 maximum per family).  However, you may only obtain a maximum of 60 days of any one individual drug.  Once you've obtained 60 days, you must use the contracting pharmacy for additional refills.  Continued purchases at non-contract pharmacies will be denied.

GENERIC DRUG POLICY

Many of the most-prescribed drugs are available under their generic names and many are manufactured by the same company that produces the brand-name drug.  Ask your doctor if the medication he is prescribing for you has a generic counterpart. 

A generic drug is identified by its official chemical name rather than a brand name.  Because of existing patent laws, some medications are supplied only under their trademarked brand names.  For example: St. Joseph's and Bayer are brand names for "aspirin" which is the generic name.  They have the same active ingredients.  They have the same effect on the body, and they meet the same Federal Government standards as their brand name equivalents.  

You don't have to know the generic name of your prescription or how to pronounce it.  Your doctor or pharmacist will know.  All you have to do is ask your doctor if a generic drug is available and if so, to prescribe it instead of a higher priced brand name drug.  

Many doctors just don't realize how much money you can save if they prescribe generic drugs.  Most doctors are not opposed to generics, and your doctor would probably like to help you save money.  If so, the next time he prescribes medicine for you, ask him to prescribe generically,  if possible.  

If your doctor is unsure of a drug's generic name (this is common), ask him to add the phrase "or generic equivalent" to your prescription.  This will help your pharmacist provide you with a more reasonably priced product.

EXAMPLE # 1 (Generic Drug):

EXAMPLE #2 (Name-Brand Drug):

NOTE:   The Fee-for-Service Plan has a $500.00 per person, $1,500 per family maximum Calendar Year Deductible which applies to prescriptions.

The Plan requires that your prescription be filled with the generic equivalent, if one exists.  Therefore, you are encouraged to use generic medications when appropriate.  You will be required to pay the difference in price between a brand-name drug and its generic equivalent (plus your required co-payment) when you request a brand-name drug for which a generic is available.

DIABETIC SUPPLIES

1. The Fund will pay for the purchase of insulin, needles, syringes and most over-the-counter diabetic supplies for diabetic patients.  The Fee-for-Service Plan will pay 80% after satisfaction of the Calendar Year Deductible.  You may also purchase insulin, needles, syringes and supplies through the Caremark Retail Program and Caremark Mail Order Program by paying a co-payment for each prescription. This would be the least expensive option.

2. Insulin injectors are a covered expense for diabetics who require multiple daily injections of insulin.  The Fund will reimburse 100% up to a maximum payment of $500.00. You are entitled to benefits for a new insulin injector once every four years.

3. If you use a home glucose monitor and you are covered by Medicare, Medicare may provide benefits for the monitor and for the supplies used with the device; however, there are limitations.  Therefore, you must submit your claims to Medicare before the Fund will provide payment.

4. The Fund will pay a one-time allowance of $200.00 for diabetic training and educational materials subject to satisfaction of the Calendar Year Deductible for an eligible individual.

OVER-THE-COUNTER DRUGS

Doctors may instruct you to take aspirin, Vitamin C, Maalox™ and similar types of medication which can be purchased "over-the-counter," without a prescription.  The Fund will not pay for "over-the-counter" medications.

Some examples of "over-the-counter" drugs that are not covered by the Fund  are:

The Fund will provide benefits for the following non-prescription drug:

If your doctor prescribes a vitamin which cannot be purchased "over-the-counter," you may obtain the prescription vitamins through the Caremark Prescription Program, or the Fund's fee-for-service prescription drug plan.

1. Drugs or medications not requiring a physician's or dentist's prescription.  (This would include any medication which can be purchased "over the counter.")

2. "Over the counter" vitamins.

3. Bandages, heat lamps, splints, non-drug items (over-the-counter items).

4. Weight control medications, and liquid or powered food supplements.

5. Drugs or drug treatments not approved by the Food and Drug Administration (FDA), including, but not limited to, compounded medications, or experimental drugs.

6. Retin-A™, unless used in the treatment of acne and skin cancer.

7. Minoxidil™, Rogaine™, and any other hair growth treatments.

8. Drugs used in the treatment of infertility.

9. Homeopathic or holistic medications and herbal remedies.  (Homeopathic treatment is covered by the Fund only in the State of Nevada).

10. Smoking deterrents.

11. Viagra™ is limited to 8 pills per month if determined to be medically necessary.  This means that the dysfunction must be caused by a physiological condition, as certified by the physician.