ZZ23 11/29/01 10:48 AM Page 1. Your Prescription Drug Benefit Plan

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1 ZZ23 11/29/01 10:48 AM Page 1 Your Prescription Drug Benefit Plan

2 ZZ23 11/29/01 10:48 AM 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. Whether you get your medications through the Merck-Medco network of participating retail pharmacies or through the Merck-MedcoHome Delivery Pharmacy Service Home Delivery Pharmacy Service (mail order service), you can confidently rely upon Merck-Medco s clinical expertise and state-of-the-art technology. Table of contents Your prescription drug benefits The Merck-MedcoHome Delivery Pharmacy Service (mail order service) 2-5 Your retail network pharmacy service The Merck-Medco website Your privacy and safety The generic drug advantage Information anytime by telephone Answers to your questions How to reach us Back cover

3 ZZ23 11/29/01 10:48 AM 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 ZZ23 11/29/01 10:48 AM Page 4 The Merck-Medco Home Delivery Pharmacy Service The Merck-Medco Home Delivery Pharmacy Service (mail order service) The Merck-Medco Home Delivery Pharmacy Service offers you convenience and potential cost savings. For your chronic maintenance prescription needs If you need medication on an ongoing basis, such as you might need to treat asthma or diabetes, you can ask your doctor to prescribe up to a 90-day supply for home delivery, plus refills for up to 1 year. You will pay the applicable copayment(s) for each prescription or refill, based upon your plan design. Please refer to your Summary of Benefits and Certificate of Coverage for more information. Oxford offers members the ability to obtain certain medications within fourteen therapeutic categories of medications through the Merck-Medco Home Delivery Pharmacy Service. Maintenance prescriptions to treat the following medical conditions will be dispensed through Merck-Medco s Home Delivery Pharmacy Service : Benign Prostate Hypertrophy Chronic Cardiovascular Disorders Chronic Hyperlipidemia Chronic Obstructive Pulmonary Disease Clotting Disorders Colitis Diabetes Estrogen Therapy Glaucoma Gout Hypertension Osteoporosis Seizure Disorders Thyroid Disease With the Home Delivery Pharmacy Service : Your medications are dispensed by a home delivery pharmacy and delivered to your home. Medications are shipped by standard delivery at no additional cost to you. (Express shipping is available for an added charge.) You can order and track your prescriptions online at or you can call in your order through our toll-free number. Registered pharmacists are available around the clock for consultations. 2

5 ZZ23 11/29/01 10:48 AM Page 5 Using the Home Delivery Pharmacy Service for the first time Requesting a new prescription for home delivery is simple whether you re ordering by mail or online. Just follow these steps: By mail: Step 1: Ask your doctor to write a new prescription for up to a 90-day supply, plus refills (if appropriate) for up to 1 year. Step 2: Mail the new prescription(s), along with the enclosed "Ordering Medications" form and the appropriate copayment, to Merck-Medco in the return envelope. For more information, see "Paying for your medication" at the end of this section. Online: You can request new prescriptions online by visiting us at Step 1: If you haven t already done so, take a few moments to register with us, making sure you let us know that you are a Merck-Medco plan member when prompted. Once you are registered, all you need to do when you return is log in using the address and password you created. Step 2: Once you are registered and logged in, select the "My Benefits" tab at the top of the page. Then choose the "Order new prescriptions" link and follow the online instructions. Your medication will be delivered to your home within 7 to 11 business days after Merck-Medco s receipt of your prescription order. Orders placed via the Internet or telephone may be received even faster. Standard shipping is free. The Merck-Medco Home Delivery Pharmacy Service Since your medication can take 7 to 11 business days to be delivered, you should have at least a 3-week supply of that medication on hand to hold you over. You can request additional Home Delivery Pharmacy Service order forms and envelopes through our website, or by calling hours a day, 7 days a week except Thanksgiving and Christmas. 3

6 ZZ23 11/29/01 10:48 AM Page 6 The Merck-Medco Home Delivery Pharmacy Service Refilling your prescription To make sure that you don t run out of your medication, remember to reorder 3 weeks before your medication runs out. You can find the refill date on the refill slip that comes with every order or on our website at or call Merck-Medco Member Services at When it s time to refill your prescription, you have three options. Choose the one that s easiest for you: Online: Log on to our website at If you are a first-time visitor, you will need to register online and create a password. The next time you visit, you will only need to enter your address and password. Have your Oxford Rx Member ID number (which is on your Oxford Member ID card) and your prescription number for the medication you would like to refill handy. Follow the online instructions to complete your registration. Each time you log in, available prescription refills will be displayed in your personalized "My Page," as well as within your "My Prescriptions" center. By telephone: Call REFILL ( ) and use the automated refill system. Please have your Oxford Rx Member ID number (which is on your Oxford Member ID card), the prescription number, and your credit card number handy. By mail: Use the refill and order forms that will accompany your initial prescription. Mail them with your copayment to Merck-Medco in the return envelope. 4

7 ZZ23 11/29/01 10:48 AM Page 7 Paying for your medication You may pay by Visa, MasterCard, Discover /NOVUS, American Express, or Diners Club, or by check or money order. If you prefer to pay for all of your orders by credit card, you may want to join our automatic payment program by calling or by enrolling online at Please note: By law, Merck-Medco must fill your prescription for the exact quantity of medicine prescribed by your doctor subject to your plan s limitations. Federal law prohibits the return of dispensed prescription medications. The Merck-Medco Home Delivery Pharmacy Service 5

8 ZZ23 11/29/01 10:48 AM Page 8 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. 6

9 ZZ23 11/29/01 10:48 AM Page 9 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: Refill, renew, or request new Home Delivery Pharmacy Service (mail order service) prescriptions. Track the status of Home Delivery Pharmacy Service orders. Compare pricing and coverage for brand-name and generic drugs for both home delivery and retail. Keep track of your prescription history and related expenses. Review your account summary; check and pay balances. Print Home Delivery Pharmacy Service order forms. Request that Home Delivery Pharmacy Service order forms be mailed to you. 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. The Merck-Medco website 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. 7

10 ZZ23 11/29/01 10:48 AM Page 10 Your privacy and safety 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. When your prescriptions are filled at one of the Merck-Medco home delivery pharmacies, our pharmacists use the 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. They also have information received from your retail network pharmacy when you have used your benefit with Merck-Medco. Similar information is provided to your retail pharmacy at the time a prescription is filled. Merck-Medco may contact your doctors to discuss certain clinical factors and benefit management matters. Use of medications Prescriptions filled through our Home Delivery Pharmacy Service will be checked for potential problems, such as potential interactions with other medications you may be taking. If a potential problem is identified, an experienced, registered pharmacist may contact your doctor. If you have any questions about your prescriptions, you can call Merck-Medco Member Services at and talk to one of our pharmacists 24 hours a day, 7 days a week. We include educational and safety information with every new prescription ordered through the Home Delivery Pharmacy Service. By visiting our website, you can access this same information as well as other health-related facts and resources. To take advantage of personalized health alerts, news, and information, be certain to register with us. 8

11 ZZ23 11/29/01 10:48 AM Page 11 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. The generic drug advantage 9

12 ZZ23 11/29/01 10:48 AM Page 12 Information anytime by telephone Information anytime by telephone Our interactive telephone service gives you a convenient way to get information or materials at any time of the day or night. And with our voice-activated 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) and any other numbers you might need, such as your credit card number or your prescription number. Then dial Quick reference 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 then will have several options: To locate a participating retail network pharmacy, say or press 1. To refill a prescription, say or press 2. To check the status of an order, say or press 3. To request a Home Delivery Pharmacy Service order form/envelope, brochure, or retail claim form, say or press 4. You will hear additional choices. You can respond either by speaking the appropriate number or by pressing numbers on the telephone. If you are ordering a refill and paying by credit card, please have your card information available. Be sure to write down your confirmation number after the telephone order is completed in case any questions about your prescription come up later. 10

13 ZZ23 11/29/01 10:48 AM Page 13 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: How can I start using the Merck-Medco Home Delivery Pharmacy Service (mail service)? A: When your doctor is writing a prescription, let him or her know that your prescription drug plan permits you to receive up to a 90-day supply of certain chronic maintenance medications, plus refills for up to 1 year, through the Home Delivery Pharmacy Service. Then mail your prescription(s) along with the enclosed "Ordering Medications" form and required copayment in the envelope provided. You can also use our website, to get started. Simply visit us online, register with us, and visit the "My Benefits" section of the site to learn more about how to get started. Q: What are chronic maintenance prescription medications? A: Chronic maintenance prescription medications are drugs used to treat certain chronic medical conditions such as diabetes, high blood pressure, epilepsy, thyroid condition or other conditions that require long-term medication use. 11

14 ZZ23 11/29/01 10:48 AM Page 14 Answers to your questions Q: How long will it take to receive my medications? A: Your medication will be delivered to your home within 7 to 11 business days of Merck-Medco s receipt of your prescription order. Since your medication can take 7 to 11 business days to be delivered, you should have at least a 3- week supply of your medication on hand when you place your order. 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. 12

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16 ZZ23 11/29/01 10:48 AM Page 16 How to reach us online You can reach us at Visit our website anytime to: Order and track the status of your home delivery prescriptions. Check prescription coverage and pricing. Request Home Delivery Pharmacy Service order forms. 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 numbers below. Most services listed are available 24 hours a day, 7 days a week (except for Thanksgiving and Christmas). To contact Merck-Medco to: Request Home Delivery Pharmacy Service order forms. 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 To refill a Home Delivery Pharmacy Service prescription using our automated system: Call REFILL ( ). Home Delivery Pharmacy Service To arrange credit card payment for all your Home Delivery Pharmacy Service orders: Call To access TTY service for hearing-impaired members: Call To request Braille labels for Home Delivery Pharmacy Service prescriptions: Call Merck-Medco Managed Care, L.L.C., is a subsidiary of Merck & Co., Inc. Preferred Prescriptions, Rx Selections, and Merck-Medco Home Delivery Pharmacy Service are trademarks of Merck-Medco Managed Care, L.L.C Merck-Medco. All rights reserved. FORM #ZZ23 (11/01) * ZZ23!!!!* * ZZ23 *