Central PA Teamsters

Central Pennsylvania Teamsters Health & Welfare and Pension Funds News

Check back frequently for new information and updates. The "What's New?" section on the front page provides up-to-date news on your Health & Welfare and Pension benefits.

Central Pennsylvania Teamsters Health & Welfare Fund News

Effective January 1, 2017, the Health and Welfare Fund's Medical Mental Health/Substance Abuse and network provider will change to Aetna. There will be minimal change in providers from the current HealthAmerica/Aetna and MHNet networks. Participants will receive new ID cards in November.


IMPORTANT CHANGES

TO YOUR PRESCRIPTION BENEFITS EFFECTIVE MARCH 8, 2016

SUMMARY OF MATERIAL MODIFICATION (“SMM”)

The information contained in this SMM reflects changes to the Rheumatoid Arthritis Step Therapy and changes to the Limits on FDA “CLASS II” Pain Medications information set forth  in the SMM mailed to all participants on October 30, 2015, and in the December 2015 Guardian Newsletter. 

At the March 8, 2016 meeting, the Trustees of the Central Pennsylvania Teamsters Health & Welfare Fund (“Fund”) adopted the following changes:

Rheumatoid Arthritis Step Therapy

The following generic drugs are now added to the Step I Rheumatoid Arthritis Step Therapy category:

High dose ibuprofen and naproxen (i.e. requiring an RX), celecoxib, nabumetone, piroxicam, diclofenac, diflunisal, indomethacin, ketoprofen, etodolac, prednisone, cyclophosphamide, cyclosporine, azathioprine and methotrexate.

Limits on FDA “Class II” Pain Medications

The following changes apply to the Limits on FDA “Class II” Pain Medications:

In cases where patients are taking one or more Class II Pain Medications on an extended basis (i.e. more than 15 days) as part of a physician-monitored pain management program, the Fund Office will require a letter from the treating physician that:

1.  Explains the condition for which the patient is being treated; and

2. Addresses the length of time that the patient has been under their care for said condition; and

3. Lists the Class II Pain Medications which are being prescribed to the patient on an on-going basis; and

4.  Includes a certification by the physician that the treatment plan for the patient is being monitored on a regular basis.

If these four conditions are documented by the treating physician in writing, the Fund can relax the 15 day script requirement and allow the patient to go to a regular 30 day script co-pay schedule for their Class II Pain Medications.


Important changes to your PRESCRIPTION BENEFITS

Effective JANUARY 1, 2016

 

*IMPORTANT*

PLEASE READ EACH ITEM BELOW CAREFULLY TO SEE

HOW YOUR PRESCRIPTION BENEFITS WILL BE AFFECTED

The information in this SMM is different from the information you received in the Summary of Benefits and Coverage (SBC) which was mailed in September, 2015.

 

            At the September 2015 meeting, the Trustees of the Central Pennsylvania Teamsters Health & Welfare Fund (“Fund”) adopted the following changes to the Fund’s Prescription Benefits.  The changes below will be effective January 1, 2016.

 

1.  GPP FORMULARY ADOPTED:  As of January 1, 2016, your copayments for preferred and non-preferred brand name drugs and specialty drugs will be determined by the GPP Formulary. The new copayment description is included in the newsletter.  We will no longer use a negative formulary.  “GPP” is the Funds prescription drug pharmacy benefit manager, General Prescription Programs, Inc. 

 

The Fund will provide benefits for ALL medically necessary Generic drugs, not just those Generic medications listed on the Formulary.  Unless subject to a specific exclusion or limitation, the Fund will provide benefits for medically necessary Brand Name drugs, even those not appearing on the Formulary.  However, you will be responsible for the Non-Preferred Brand copayment.

 

Your copayment will depend on whether you receive a Generic or Brand Preferred or Non-Preferred or Specialty medication.  Please see the Copayment Chart on Page XX.  These copayments differ between Plans and depend on the level of benefit selected.  Provided that other restrictions are not applicable, the Fund will provide benefits for Brand Name medications not appearing on the Formulary at the “Non-Preferred” or “Specialty” copayment level.

 

NOTE:  This Formulary may change in the future without advance notice to you upon the advice of the Fund’s pharmacy benefit manager.  Please call the Fund Office or check the Fund’s website: www.centralpateamsters.com to verify whether the prescription medication your doctor prescribes is on the GPP Formulary.  You will periodically receive a copy of the updated Formulary.

 

2.  STEP THERAPY:  The Trustees have expanded the Fund’s “Step Therapy” Program.  Effective January 1, 2016, under the “Step Therapy” Program, the Fund will not pay benefits for certain generic and brand name medications until you have first tried and failed a medication listed in Step I.  After you have tried and failed on a medication in Step I, the Fund will ONLY provide benefits for the medications listed in Step II if the Fund’s records (or documentation that you supply) show that you tried and failed on a Step I medication and your physician provides documentation demonstrating that the Step II medication is “medically necessary”. 

 

IMPORTANT!  Please review the attached Step Therapy Chart carefully.  You may need to change medications effective January 1, 2016.  If your medication is not “grandfathered,” the Fund will not provide benefits for the Step II medication after January 1, 2016 until you have documented that you have tried and failed on a Step I medication and your physician has demonstrated that it is “medically necessary” for you to have the Step II medication.

 

3.              INSULIN DRUGS:  Effective January 1, 2016, the Fund will not provide benefits for any new prescriptions for insulin medications except NovolinR, Novolog, Levemir and Victoza.  If you are currently taking another insulin medication, you will be “grandfathered,” that is, the Fund will continue to provide benefits for this medication.

 

4.  ADVAIR and BREO EXCLUDED FROM COVERAGE:  Effective January 1, 2016, the Fund will not provide any benefits for ADVAIR or BREO. The Fund will provide benefits for the Asthma medications listed on the attached Formulary or other medically necessary asthma medications to which Fund restrictions or prohibitions do not apply.  Copayments will vary depending on the medication.  No patients will be “grandfathered” for these medications.  Therefore, if you currently use ADVAIR or BREO, it is essential that you speak with your physician now about moving to an alternative medication before January 1, 2016.

 

5.  SPECIALTY DRUGS DEFINED:  Effective January 1, 2016, any drug that costs $3,000 or more per script will be classified as “Specialty Drugs.”

 

6.  NEW COPAYMENT ADDED FOR SPECIALTY DRUGS:  Effective January 1, 2016, there will be a $150 copayment for any “Specialty Drug,” that is, for any drug that costs $3,000 or more per script. 

 

7.  LIMITED COVERAGE OF NEW BRAND MEDICATIONS:  Effective January 1, 2016, the Fund will provide no benefits for new brand-name prescription drugs for the first 6 months after their initial public release.  After the initial six month period, these medications will be subject to any applicable plan rule (for example, copayment, pre-authorization, quantity limits, etc.).

 

8.  COMPOUND DRUGS EXCLUDED: Effective January 1, 2016, the Fund will provide no benefits for any compound drugs.

 

9.  NEW RESTRICTIONS ON ZOHYDRO:  Effective January 1, 2016, the Fund will provide no benefits for Zohydro unless it has been submitted to GPP and approved pursuant to the Fund’s pre-authorization criteria.  The pre-authorization criteria include trying certain other medications listed in Step I under Narcotic Analgesics in the attached “Step Therapy” protocol.  In addition, the copayment for all Zohydro prescriptions will be $150 per script.

 

10.  PREAUTHORIZATION REQUIRED FOR PCSK9 (proprotein convertase subtilisin/kexin 9)  MEDICATIONS:  Effective January 1, 2016, the Fund will ONLY provide benefits for PCSK9 medication where that medication has been pre-authorized under the Fund’s criteria.  The medications will be considered for patients with diagnosed and documented homozygous familial hypercholesterolemia (HoFH),  who have no labeled contraindications to this therapy, where the therapy is prescribed by or in consultation with a cardiologist or lipid specialist, and who submit required documentation.

 

11.  HEPATITIS-C MEDICATIONS – PRE-AUTHORIZATION REQUIRED:  Effective January 1, 2016, the Fund will ONLY provide benefits where the medication has been pre-authorized under the Fund’s criteria, which include the patient’s Metavir score, as well as documentation of patient specific information related to their condition provided by the patient’s physician.

 

12. LIMITS ON FDA “CLASS II” PAIN MEDICATIONS:  Effective January 1, 2016, the Fund will provide benefits for a maximum of  fifteen days (15) per script for medications classified as CLASS II medications by the U.S. Food and Drug Administration.

 

13.  NO BENEFITS FOR “REFORMULATED” MEDICATIONS:  Effective January 1, 2016, the Fund will not provide any benefits for the medications in Column A.  The Fund will provide benefits for the medications in Column B.  This list is subject to modification.

 

COLUMN A

COLUMN B

ATIVAN 0.5 MG TABLET

LORAZEPAM 0.5 MG TABLET

ATIVAN 1 MG TABLET

LORAZEPAM 1 MG TABLET

ATIVAN 2 MG TABLET

LORAZEPAM 2 MG TABLET

COLAZAL 750 MG CAPSULE

BALSALAZIDE DISODIUM 750 MG CAPSULE

DEXPAK 10 DAY 1.5 MG TABLET

DEXAMETHASONE 1.5 MG TABLET

FORTAMET ER 1,000 MG TABLET

METFORMIN ER 1,000 MG TABLET

GLUMETZA ER 1,000 MG TABLET

METFORMIN ER 1,000 MG TABLET

NORITATE 1% CREAM

METRONIZADOLE 1% GEL

VASOTEC 2.5 MG TABLET

ENALAPRIL MALEATE 2.5 MG TABLET

VASOTEC 5 MG TABLET

ENALAPRIL MALEATE 5 MG TABLET

VASOTEC 10 MG TABLET

ENALAPRIL MALEATE 10 MG TABLET

VASOTEC 20 MG TABLET

ENALAPRIL MALEATE 20 MG

 

STEP THERAPY

NOTE:  The medications in each category are subject to change.  Please make sure to check with the Fund (Phone:  Toll Free in PA: 1-800-422-8330; Toll Free in USA: 1-800-331-0420) or on the Fund’s website (www.centralpateamsters.com) for updates to this chart before beginning a course of medication.

 

STEP THERAPY CATEGORIES NOT SUBJECT TO GRANDFATHERING:

Effective January 1, 2016, the Fund will NOT provide benefits for medications in Step II unless you have documented that you have tried and failed on a Step I medication and your physician has submitted documentation demonstrating that the Step II medications are “medically necessary” under the Fund’s criteria.

 

CATEGORY

STEP I

STEP II

ALZHEIMER’S DISEASE

DONEPEZIL

GALANTAMINE

RIVASTIGMINE

 

ARICEPT

EXELON

NAMENDA

RAZADYNE

ANGIOTENSIN RECEPTOR BLOCKERS (ANTIHYPERTENSIVES)

CANDESARTAN

EPROSARTAN

IRBESARTAN

LOSARTAN

TELMISARTAN

VALSARTAN

ATACAND

AVAPRO

BENICAR

COZAAR

DIOVAN

EDARBI

MICARDIS

TEVETEN

ANTI-DEPRESSANTS

BUPROPION HCL DESVENLAFAXINE

DULOXETINE

ESCITALOPRAM

FLUOXETINE

NEFAZODONE

SERTRALINE

TRAZODONE

VENLAFAXINE

APLENZIN

BRINTELLIX

CYMBALTA

EFFEXOR

FETZIMA

FORFIVO XL

KHEDEZLA

LEXAPRO

OLEPTRO

PRISTIQ

PROZAC

VllBRYD

WELLBUTRIN

ZOLOFT

ANTI-GLAUCOMA EYE PREPARATIONS

APRACLONIDINE HCL

BETAXOLOL

BRIMONIDINE

CARTEOLOL

DORZOLAMIDE

LATANOPROST

LEVOBUNOLOL

METIPRANOLOL

PILOCARPINE

TIMOLOL

TRAVOPROST

ALPHAGAN

AZOPT

BETIMOL

BETOPTIC

COMBIGAN

COSOPT

IOPIDINE

ISTALOL

LUMIGAN

PHOSPHOLINE

RESCULA

SIMBRINZA

TIMOPTIC

TRAVATAN

TRUSOPT

XALATAN

ZIOPTAN

ANTIPSYCHOTICS

CLOZAPINE

OLANZAPINE

QUETIAPINE

RISPERIDONE

ZIPRASIDONE

ABILIFY  - Evidence of “medical necessity” must include documentation of failure of all other therapies, including non-drug intervention

BETA-ADRENERGIC BLOCKERS (ANTIHYPERTENSIVES)

ACEBUTOLOL

ATENOLOL

BETAXOLOL

BISOPROLOL

METOPROLOL

NADOLOL

PINDOLOL

PROPRANONOL

SOTALOL

TIMOLOL

BYSTOLIC

CALCIUM CHANNEL BLOCKERS (ANTIHYPERTENSIVES)

AMLODIPINE ATORVASTATIN AMLODIPINE BESYLATE

AMLODIPINE VALSARTAN DILTIAZEM

FELODIPINE

ISRADIPINE

NICARDIPINE

NIFEDIPINE

NISOLDIPINE

VERPAMIL

ADALAT

CADUET

CALAN

CARDENE

CARDIZEM

CARTIA XT

EFIDITAB

EXFORGE

NORVASC

PROCARDIA XL

SULAR

TIAZAC ER

VERELAN

CONTRACEPTIVES

All Generic Contraceptives

BEYAZ

CYCLESSA

DESOGEN

MODICON

NATAZIA

ORTHO MICRONOR

ORTHO TRl-CYCLEN

ORTHO-CEPT

ORTHO-CYCLEN

ORTHO-NOVUM

SAFYRAL

YASMIN

YAZ

DIABETES

ACARBOSE

GLIMEPIRIDE

GLIPIZIDE

GLYBURIDE

JANUMET

JANUVIA

METFORMIN

PIOGLITAZONE

REPAGLINIDE

INVOKANA

JARDIANCE

JENTADUETO

KAZANO

TRADJENTA

NARCOTIC ANALGESICS

 

NOTE:  BENEFITS WILL BE PROVIDED ONLY FOR NARCOTIC ANALGESICS PRESCRIBED AT THE MANUFACTURERS RECOMMENDED SCRIPT LEVEL.

 

 

 

 

 

NARCOTIC ANALGESICS CONTINUED….

ACETAM INOPHEN-CODEINE HYDROCODONE-ACETAMINOPHEN HYDROMORPHONE

MEPERIDINE

METHADONE

MORPHINE  SULFATE

OXYCODONE

OXYCODONE-ACETAMINOPHEN OXYCODONE-ASPIRIN OXYMORPHONE

TRAMADOL

DEMEROL

DOLOPHINE

LORTAB

NORCO

NUCYNTA

OPANA

OXYCONTIN

PERCOCET

PERCODAN

TYLENOL WITH CODEINE ULTRACET

ULTRAM

VICODIN

VICOPROFEN

 

OSTEOPOROSIS

ALENDRONATE

CALCITONIN-SALMON BANDRONATE

RALOXIFENE

RISEDRONATE

ACTONEL

ATELVIA

BINOSTO

BONIVA

EVISTA

FORTICAL

FOSAMAX

MIACALCIN

PROLIA

RHEUMATOID ARTHRITIS

XELJANZ

ACTEMRA

CIMZIA

ENBREL

HUMIRA

KINERET

ORENCIA

SIMPONI

STELARA

URINARY AGENTS

TOVIAZ

FLAVOXATE

OXYBUTYNIN

TOLTERODINE

TROSPIUM

ENABLEX

GELNIQUE

MYRBETRIQ

OXYTROL

VESICARE

 

 

 

 

GRANDFATHERED DRUGS:  Effective January 1, 2016, any NEW prescriptions for the medications in the chart below are subject to the Step Therapy requirements set forth above.  If, however, you are currently taking a medication in one of these categories, the Fund will continue to provide benefits for your medication.

 

 

CATEGORY

STEP I

STEP II

ADD & ADHD

AMPHETAMINE SALTS

D-AMPHETAMINE ER

DEXMETHYLPHENIDATE  DEXTROAMPHETAMINE METHAMPHETAMINE METHYLPHENIDATE

ADDERALL

CONCERTA

DAYTRANA

DESOXYN

DEXEDRINE

EVEKEO

FOCALIN

METADATE

METHYLIN

PROCENTRA

QUILLIVANT

RITALIN

VYVANSE

ZENZEDI

ANTI-MIGRAINE

 

 

 

 

 

 

 

 

 

 

ANTI-MIGRAINE CONTINUED….

DIHYDROERGOTAMINE ERGOTAMINE-CAFFEINE TABLET

ISOMETHEPT-CAFF- ACETAMINOPHEN

ISOMETHEPT-DICHLORALP-ACETAMIN

NARATRIPTAN

RIZATRIPTAN

SUMATRIPTAN

ZOLMITRIPTAN

ALSUMA

AMERGE

AXERT

CAFERGOT

D.H.E.45

ERGOMAR

FROVA

IMITREX

MAXALT

MIGERGOT

MIGRANAL

RELPAX

SUMAVEL

TREXIMET

ZOMIG

ANTI-CONVULSANTS

CARBAMAZEPINE

CLONAZEPAM

DIVALPROEX

ETHOSUXIMIDE

FELBAMATE

FOSPHENYTOIN

GABAPENTIN

LAMOTRIGINE

LEVETIRACETAM OXCARBAZEPINE

PHENYTOIN

PRIMIDONE

TIAGABINE

TOPIRAMATE

VALPROATE

VALPROIC ACID

ZONISAMIDE

APTIOM

BANZEL

CARBATROL

CELONTIN

CEREBYX

DEPACON

DEPAKENE

DEPAKOTE

DILANTIN

FANATREX

FELBATOL

FYCOMPA

GABITRIL

KEPPRA

KLONOPIN

LAMICTAL

MYSOLINE

NEURONTIN

ONFI

OXTELLAR

PEGANONE

PHENYTEK

POTIGA

QUDEXY

TEGRETOL

TOPAMAX

TRILEPTAL

TROKENDI

VIMPAT

ZARONTIN

ZONEGRAN

 

PROTON PUMP INHIBITORS

OVER THE COUNTER (“OTC”):

LANSOPRAZOLE DR OTC

NEXIUM OTC

OMEPRAZOLE OTC

OMEPRAZOLE-BICARB OTC

PREVACID OTC

PRILOSEC OTC

ZEGERID OTC

ACIPHEX

DEXILANT

ESOMEPRAZOLE

LANSOPRAZOLE

OMEPRAZOLE

LANSOPRAZOLE

NEXIUM

OMEPRAZOLE

OMEPRAZOLE-BICARB

PANTOPRAZOLE

PREVACID

PRILOSEC

PROTONIX

ZEGERID

ULCERATIVE COLITIS

AZULFIDINE

BALSALAZIDE

SULFASALAZINE

SULFAZINE

APRISO

ASACOL

COLAZAL

DELZICOL

DIPENTUM

GIAZO

LIALDA

PENTASA



Central Pennsylvania Teamsters Pension Fund
P.O. Box 15223
Reading, PA 19612-5223
Toll Free in PA:
1-800-343-0136
Toll Free in USA:
1-800-331-0420

 

Central Pennsylvania Teamsters Health & Welfare Fund
P.O. Box 15224
Reading, PA 19612-5224
Toll Free in PA:
1-800-422-8330
Toll Free in USA:
1-800-331-0420

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