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Prescription Highlights
The
prescription drug program provides two convenient ways to
get your covered prescriptions filled, either through a
retail pharmacy or by mail order. The chart below provides
highlights of the prescription drug coverage for the Trooper Chapter, Airport Police
and Fire Officers Chapter, Fairbanks Police Department, and
Juneau Police Department members, as of July 1, 2005. Refer to your
Benefit Booklet for details, limitations and exclusions.
|
Service |
Retail
Pharmacy Benefits |
|
Supply
|
Up to
a 34- or 90-day supply per prescription or refill
|
|
Coverage |
100%,
after your copayment |
|
Participating pharmacy |
Show
your coverage identification card and pay the
required copayment |
|
Nonparticipating pharmacy |
You
pay the full cost for prescriptions or refills. You
will be reimbursed for the cost of the prescription
that a participating pharmacy would have charged,
less your copayment |
|
Submitting a claim |
If you
show your coverage identification card, you will not
have to submit a claim, the pharmacy will bill to
the plan directly. If you don’t show your card, you
will have to submit a claim. Contact Premera Blue
Cross Blue Shield to get a prescription drug claim
form and send your claim and receipt to the address
shown on the form. |
|
Contact information |
Pharmacy Benefit Customer Service: 1-800-626-6080
www.medco.com |
|
Mail
Order Service |
|
Supply
|
Up to
a 90-day supply per prescription or refill
|
|
Coverage |
100%,
after your copayment; use this service for
prescription drugs you take on a regular basis
|
|
Contact information |
Pharmacy Benefit Customer Service: 1-800-626-6080
www.medco.com
|
|
Prescription Type |
Retail
Pharmacy Drug Benefit copayment
(34-day supply) |
Delivery by Mail copayment
(Up to a 90-day supply) |
|
Generic
Drugs
for which the manufacturer’s patent has expired.
These are interchangeable with brand name drugs for
all approved uses |
$10 |
$10 |
|
Brand
name*
Drugs
that are on the Preferred Drug List – the list of
brand name drugs available to the plan at discounted
prices |
$20
|
$20
|
* If you
request a brand name drug over a generic equivalent you will
be required to pay the difference in cost between the brand
name drug and the generic equivalent in addition to your
copayment.
Contact Information
Premera Blue
Cross Blue Shield of Alaska
Customer Assessment Manager
P.O. Box 91059
Seattle, WA 98111-9159
Seattle Area:
425-670-5900
Outside Seattle Area: 1-800-508-4722
Hearing-impaired TTY:1-800-842-5357
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