Get The Best Value Out Of Your Drug Coverage 

Find the lowest dispensing fee

Did you know that pharmacies charge “dispensing fees” to fill your prescription? Different pharmacies charge different amounts—from about $4 per prescription to as much as $16 per prescription.

Dispensing fees are not covered under Core Health, and coverage is limited to $7 per prescription for Health Plus and Health Premium, with a maximum of 5 dispensing fees covered per prescription per year.

To reduce your dispensing fee costs you should do two things:

• Shop for the pharmacy that charges the lowest dispensing fees. You can ask the pharmacist what the dispensing fee is or, in some cases, it will appear on your receipt.
• If you take a drug regularly, ask your doctor to write prescriptions for a 90-day (three-month) supply; that reduces the number of dispensing fees you pay per year.

Verify if your drug is covered

Not all drugs are covered. You can confirm your drug is covered by accessing the prescription drug coverage tool on GroupNet for Plan Members.

Get prior approval if you need a brand-name drug

In rare cases, your doctor may believe that it is medically necessary to prescribe a brand-name drug even when a generic is available. To be covered for the full price of the brand-name drug, you will need to ask your doctor to fill out a “Request for brand-name drug coverage” form. This form is available on the GroupNet for Plan Members site.

Pre-authorized specialty drugs

Certain drugs will only be covered if you have prior authorization to purchase them. To see a list of specialty drugs that require prior authorization—and to download the Prior authorization form—visit the Prior authorization section of GroupNet for Plan Members.

Some of the most commonly used specialty drugs that require pre-authorization include:

REMICADE     HARVONI     HUMIRA     SIMPONI     ENBREL     HOLKIRA     GILENYA

Generic drugs instead of brand-name drugs

Generic drugs have the same active ingredients as their brand-name equivalents—but are usually much less expensive. If a generic drug is available, TimCare Flex covers the cost of the generic only. If you purchase the brand-name drug instead of the generic, any cost beyond the cost of the generic will not be covered.

Because of this, anytime your doctor prescribes a drug, be sure to ask the doctor if it is a generic. If not, ask if there’s a generic option that the doctor can prescribe instead.

If there is no generic equivalent for a brand-name drug, the brand-name drug may be covered at its full cost. You can confirm your brand-name drug is covered by accessing the prescription drug coverage tool on GroupNet for Plan Members.

The following commonly-used brand-name drugs all have generic equivalents. If you receive a prescription for one of these drugs, be sure to ask your doctor for the generic substitute:

CIPRALEX     CRESTOR    NEXIUM    CONCERTA     LIPITOR
CELEBREX    EFFEXOR    ATACAND    MICARDIS    WELLBUTRIN
MARVELON    DIOVAN    CELLCEPT    TEGRETOL    PREVACID
NORVASC    LOSEC    SINGULAIR    PROGRAF    ZOLOFT