ZZ25 11/29/01 12:17 PM Page 1. Your Prescription Drug Benefit Plan

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1 ZZ25 11/29/01 12:17 PM Page 1 Your Prescription Drug Benefit Plan

2 ZZ25 11/29/01 12:17 PM Page 2 Welcome! Oxford Health Plans has chosen Merck-Medco to manage your prescription drug benefits. Merck-Medco is one of the nation s leading pharmacy benefit managers, helping to serve the prescription needs of over 65 million Americans. We have developed this brochure to make your prescription drug benefits easy to use and understand. When you get your medications through the Merck-Medco network of participating retail pharmacies, you can confidently rely upon Merck-Medco s clinical expertise and state-of-the-art technology. Table of contents Your prescription drug benefits Your retail network pharmacy service The Merck-Medco website Your privacy and safety The generic drug advantage Answers to your questions How to reach us Back cover

3 ZZ25 11/29/01 12:17 PM Page 3 Your prescription drug benefits * Merck-Medco has a comprehensive retail pharmacy network of nearly 50,000 locations nationwide, including approximately 6,000 in the tri-state area. Major chains include CVS, Eckerd, Genovese, Medicine Shoppe, Stop & Shop and Wal-Mart. *Please refer to your Summary of Benefits and Certificate of Coverage for detailed information regarding your pharmacy coverage. Your Prescription Drug Formulary Your prescription drug benefit plan includes a Prescription Drug Formulary. The formulary includes a wide selection of drugs, which offers you choice and helps keep the cost of your pharmacy benefit affordable. Each drug is approved by the Food and Drug Administration and reviewed by an independent group of doctors and pharmacists. Your prescription drug benefits *This information is an overview of your plan sponsor s prescription drug benefit program. Please note that benefits and co-payments are subject to change by your plan sponsor. 1

4 ZZ25 11/29/01 12:17 PM Page 4 Your retail network pharmacy service Your retail network pharmacy service For your prescription needs Filling prescriptions can be fast and easy when you use one of our retail network pharmacies. These pharmacies will accept your Oxford Rx Member ID card and charge you the appropriate copayment when you fill a prescription covered by your plan. To find out whether a pharmacy participates in our program: Ask your retail pharmacist. Visit our website at and use our online pharmacy locator. Call and use our automated pharmacy locator. Follow these steps to order new prescriptions or refills at participating pharmacies Step 1: Show your Oxford Rx Member ID card at the pharmacy. Step 2: Pay the applicable copayment(s)* {which a representative at the pharmacy will tell you} when you pick up your prescription. Note: Copayment requirements vary by plan design. Please refer to your Certificate of Coverage for more information. 2

5 ZZ25 11/29/01 12:17 PM Page 5 When you fill a prescription at a participating network pharmacy, you will be told if your plan does not cover your medication. To find coverage and pricing details online, visit our website at and choose our "Prescription Coverage & Pricing" feature, located within the "My Prescriptions" area. If it is your first visit to the site, you will need to register with us. Find a participating retail network pharmacy by telephone Our interactive telephone service gives you a convenient way to find a participating pharmacy at any time of the day or night. And with our voiceactivated feature, you don t even have to press numbers on the telephone. Before you call, you should have your Oxford Rx Member ID number (which is on your Oxford Member ID card) ready. Then dial Your retail network pharmacy service For security purposes, you may be asked to enter or speak your 10-digit home telephone number or your Oxford Rx Member ID number. (This information is confidential and will not be shared). You can respond either by speaking the appropriate number or by pressing numbers on the telephone. To locate a participating pharmacy, at the prompt say or press 1. 3

6 ZZ25 11/29/01 12:17 PM Page 6 The Merck-Medco website The Merck-Medco website To learn how to get the most from your prescription drug benefit plan, visit us online at where you ll find convenient, timesaving features. For example, through our website, you can: Compare pricing and coverage for brand-name and generic drugs. Keep track of your prescription history and related expenses. Request claim forms for prescription reimbursement. Locate and get directions to a participating retail network pharmacy. Choose to receive notices so that you can stay informed about your prescription orders and new website features. Get the necessary information about your prescription medications and your plan s benefits before you visit your doctor. Take charge of your health with our health and wellness information, tools, and resources. To help get the most from our website, click on the "Register now" link and have your Oxford Rx Member ID number (which is on your Oxford Member ID card) handy. Simply follow the instructions to complete the registration. The next time you visit, you will only need to enter your address and password. 4

7 ZZ25 11/29/01 12:17 PM Page 7 Your privacy and safety Your privacy is important to us. Merck-Medco uses the health and prescription information about you and your dependents to administer your benefit program. This process generally involves reporting the information to your plan administrator/healthcare plan. We also use information and prescription data from claims submitted nationwide for reporting and analysis without identifying individual patients. Merck-Medco may contact your doctors to discuss certain clinical factors and benefit management matters. We may also provide your retail pharmacy with health and prescription information we have on file for you to consider many important clinical factors, including drug selection, dosing, interactions, duration of therapy and allergies, at the time of dispensing. Your privacy and safety By visiting our website, you can access educational and safety information on important topics as well as other health-related facts and resources. Click on "Health & Wellness" to browse a wide range of articles, news, tips, health alerts, and drug information. To take advantage of personalized health alerts, news, and information, be certain to register with us. 5

8 ZZ25 11/29/01 12:17 PM Page 8 The generic drug advantage The generic drug advantage Be assured that generic drugs and their brand-name counterparts: Have the same active ingredients Are manufactured according to the same strict federal regulations Generic drugs may differ in color, size, or shape, but the FDA requires that they have the same strength, purity, and quality as the brand-name alternatives. Prescriptions filled with generic drugs often have lower copayments. Therefore, you may be able to get the same health benefits at a lower cost. You should ask your doctor or pharmacist whether a generic version of your medication is available and whether it would be right for you. You can find out more information about generic drugs and their costs based on your prescription plan s guidelines by visiting Remember to register if you are a first time visitor so that you can easily log in when you return your address and the password that you create. 6

9 ZZ25 11/29/01 12:17 PM Page 9 Answers to your questions Q: How do I know if my medication is covered? A: To determine if a medication is covered, call Merck-Medco Member Services at hours a day, 7 days a week (except for Thanksgiving and Christmas). To find coverage and pricing details online, visit our website anytime at register with us, and choose our "Prescription Coverage & Pricing" feature, located within the "My Prescriptions" area of our site. Answers to your questions Q: Are generic drugs as effective as their brand name counterparts? A: Yes. Generic drugs have the same active ingredients and are manufactured according to the same strict federal regulations. While they may differ in color, size or shape, the FDA requires that generic drugs have the same strength, purity and quality as their brand name counterparts. 7

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12 ZZ25 11/29/01 12:17 PM Page 12 How to reach us via web site You can reach us at Visit our website anytime to: Check prescription coverage and pricing. Locate a participating retail network pharmacy. Request claim forms for prescription reimbursement. Discover a world of health information and much more (see page 7). How to reach us via phone You can reach us at the number below. Most services listed are available 24 hours a day, 7 days a week (except for Thanksgiving and Christmas). To contact Merck-Medco to: Find a participating retail network pharmacy. Request claim forms for prescription reimbursement. Speak with a Member Services representative. Speak with a registered pharmacist at any time. Call Merck-Medco Managed Care, L.L.C., is a subsidiary of Merck & Co., Inc Merck-Medco. All rights reserved. FORM #ZZ25 (11/01) * ZZ25!!!!* * ZZ25 *