Rx AMENDMENTS: 2019
Out of Pocket (OOP) Rx limit shall be increased to $2,550, Effective 1/1/2019.
Erectile Dysfunction (ED): The maximum annual benefit for any prescriptive ED drug shall be increased to $2,000, Effective 4/1/2019.
Prescriptive (Rx) Co-Pays: All co-pays, retail and mail order, generic and brand (except for CanaRx which has no co-pay),
shall be increased by $5, Effective 4/1/2019.
Retail Generic-$15, Brand (Medicare) $25, Brand $40.
Mail Order Generic-$20, Brand $60.
Any time the price of the drug is less than the co-pay, the drug will not be dispensed through the plan.
The Pharmacy Benefit Manager is ProAct.
To enroll in Mail Order, as per the Welcome letter from ProAct, members can go online to ProActRx.com and fill out the Patient Profile. Those with limited computer access can call the Trust Office (845-338-5422) and a Patient Profile form will be mailed to you, or you can download a copy here. The Profile is necessary for monitoring drug interactions.
We've received several questions with regard to the process of registering an online profile through the ProAct website. If you have experienced any challenges with the process, we ask that you please try these quick steps:
1) Add your first name followed by a space and your middle initial.
2) Ensure that you are entering the 5 digit zip code associated with the home address ProAct would have on file for you.
If neither of these steps resolves your registration challenges, please contact the ProAct Helpdesk at: 1-877-635-9545.
Thanks for your patience.
MAINTENANCE DRUGS: Any drug taken for more than 3 consecutive months is determined to be a Maintenance Drug. Therefore, members may refill Rx at a local pharmacy for 3 months, but must switch to mail order Rx for any refills after 3 months. The penalty for continued use of a local pharmacy after 3 consecutive refills is a double co-pay for generic and brand name drugs and $200 for specialty drugs.
CanaRx: CanaRx is a voluntary prescription service for Brand Name maintenance drugs (90 day supply) where there is no-copay. It does not offer generic drugs. As with all maintenance drugs, after three monthly local retail refills, members must use mail order for the drug or will be penalized. The penalty is a double copay for generic and brand name drugs and $200 for specialty drugs.
If a Brand Name maintenance drug is available through CanaRx and the member does not use CanaRx and refills through ProAct or another pharmacy, the penalty will be assessed. Members are responsible for checking to see if their Brand Name maintenance drug is available from CanaRx. For a list of available CanaRx Brand Name drugs, go to:www.KTFMeds.com; The website includes an informational video.
Proof of previous successful use of the drug is mandated for CanaRx, either by a 30 day purchase from a retail pharmacy or verification from your provider who can fax the request to CanaRx.
Members can enroll in CanaRx at any time as the need arises. An enrollment form is available on this website under "Forms."