1.  Federal Legend Drugs

Any FDA approved medicinal substance which bears the legend “Caution: Federal Law prohibits dispensing without a prescription.”

 

2.  State Restricted Drugs

Any medicinal substance which may be dispense by prescription only, according to State Law.

New Jersey State Law requires available generic drugs to be dispensed by the pharmacist unless a prescribing physician specifically indicates that only a brand name be dispensed or a patient insists on a brand name.  Consequently, unless a brand name prescription drug is stipulated as medically necessary by the prescribing physician, participating providers may require cardholders under this contract who decline a generic alternative to pay any drug costs in excess of the reimbursable generic price. The dispensing pharmacist will be reimbursed based upon the appropriate generic price. 

3.  Compounded Medications
A compounded medical prescription is an extemporaneously prepared dosage form.  The compound must contain at least one federal legend drug in a therapeutic amount; or a combination of ingredients which require a prescription by law when compounded into a specific dosage form for an individual patient at the direction of a prescriber, and which is also in a therapeutic amount.

4. Diabetic Supplies
Insulin; disposable insulin needles/syringes; disposable blood/urine glucose/acetone testing agents (e.g. Clinitest tables, Chemstrips. Diastix Strips and test-tape); blood glucose monitors; and lancets.

5. Contraceptive Devices
Any drug or device used for contraception by a female which is approved by the FDA for that purpose.

Exclusions, Limitations & Disclaimer

NEW Express Scripts  Information

Members can provide their pharmacy the following information in absence of an ID card:   

• RXBIN #: 003858
• RXPCN: A4
• RXGRP #: 0804 0364
• Member Social Security #       

Members can also contact Customer Service at 800-467-2006 with any questions or concerns regarding ID cards & claims, etc. 

 

Notice of Creditable Coverage

Beginning January 1, 2006, Medicare beneficiaries have the opportunity to receive subsidized prescription drug coverage through the new Medicare Part D program. Beneficiaries who choose not to sign up at the first opportunity may have to pay more if they wait to enter the program later after the open enrollment period. Beneficiaries who have other sources of drug coverage - through a current or former employer or union, for example - may stay in that plan and choose not to enroll in the Medicare drug plan. If their other coverage is at least as good as the new Medicare drug benefit (and therefore considered "creditable coverage" ), then the beneficiary can continue to get the high quality care they have now as well as avoid higher payments if they sign up later for the Medicare drug benefit.  

 

The Medicare Modernization Act (MMA) requires entities (whose policies include prescription drug coverage) to notify Medicare eligible policyholders whether their prescription drug coverage is creditable coverage, which means that the coverage is expected to pay on average as much as the standard Medicare prescription drug coverage.  Accordingly, this information is essential to an individual's decision whether to enroll in a Medicare.   

 

 For Medicare-eligible members, please visit the Medicare website at: www.medicare.gov.

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Important Note: Your insurance benefits are limited to the terms, conditions, exclusions and limitations of the insurance carrier's policy.  Nothing contained on this website shall be deemed to have altered, waived, or extended the coverage provided by the policy.  This overview contains a general description of your benefits program for your use as a convenient reference. Complete details of your program appear in the policy, which govern the benefits and operation of your program. The policy supersedes if there should be any inconsistency or difference between its provisions and the information in this overview.