You will pay a 20% coinsurance per prescription toward the cost of Your prescription drugs if generic drugs are prescribed. If non-generic drugs are prescribed, You will pay the 20% coinsurance plus the difference between the cost of the non-generic drug and a generic drug if a generic drug is available. The Fund will pay the balance, no matter what the charge, providing the prescription is filled by a Participating Pharmacy. If a Non-Participating Pharmacy is used, reimbursement of the charges will be made in accordance with a specific schedule of allowances. When a Non-Participating Pharmacy is used, there is no assurance that the charges will not exceed the amount that the Fund allows. In such instances, payment by You may exceed the benefit provided by the Fund. The drug benefits are provided when prescribed by a licensed doctor, dentist or podiatrist and dispensed by a licensed pharmacy or the out-patient department of a hospital.

Only the following prescriptions will be accepted for payment:

1. Prescriptions which require compounding.
2. Prescriptions for legend drugs.
3. Prescriptions for Federal Legend and OTC Diabetic Medications and Supplies.

* The maximum amount of the out-of-pocket expenses per person per calendar year for those prescription expenses payable at 80% is $2,000.

HOW ARE BENEFITS OBTAINED?

Each covered Participant is issued an Identification Card authorizing any Participating Pharmacy to fill prescriptions which come within the scope of the Plan as outlined above. The Identification Card certifies the Participant’s eligibility to the Participating Pharmacy.

Failure to Notify the Fund Office of a new dependent will result in disallowance of Your claim. You will sign for each prescription thus filled or refilled and pay the charges as set forth above, as applicable for each such prescription.

If a prescription is filled at a Non-Participating Pharmacy, Express Scripts, who administers the Prescription Plan for the Fund, requires a receipted bill indicating name and date of birth of patient, name of medication, NDC number (drug number), strength and quantity dispensed and the signature of a registered pharmacist. Such receipted bills must then be submitted to Express Scripts, Attention: Commerical Claims, P.O. Box 2872, Clinton, IA 52733-2872 for payment. Reimbursement will be made in accordance with a specific schedule of allowances as established by Express Scripts. Reimbursement is determined by the price the Fund would have paid for the same drug if it had been purchased at one of the Participating Pharmacies. Such direct reimbursements will be made as soon as possible after receipt of claim.

SPECIALTY PHARMACY PRESCRIPTION DRUGS

All infusible drugs and self-injectables, except those administered in a hospital, must be obtained from Express Scripts, the Funds’ prescription drug benefit manager.

Important Information for those who use Specialty Medications

As part of your prescription drug benefit, IBEW Local 25 Health & Benefit Fund has arranged for you to have access to the enhanced services of Accredo, Express Scripts’ specialty pharmacy, for your specialty medication needs. Accredo is a mail-order pharmacy dedicated to providing specialty medications and delivering the high level of care and service you deserve.

Specialty medications are typically injectable medications administered either by you or a healthcare professional, and they often require special handling. These medications treat complex conditions, such as anemia, hepatitis C, multiple sclerosis, asthma, growth hormone deficiency and rheumatoid arthritis.

The IBEW Local 25 Health & Benefit Fund prescription drug plan REQUIRES that certain specialty medications be accessed through Accredo. If you are currently using a  retail pharmacy to obtain your specialty medications, you may be required to transfer those prescriptions to Accredo. If you continue to purchase your medications from a pharmacy other than Accredo or thru your physicians office, you may be responsible for their full cost.

If you use specialty medications, you’ll appreciate the extra services offered by Accredo, including:

• Toll-free access to specially trained pharmacists 24 hours a day, 7 days a week
• Personalized counseling from our dedicated team of registered nurses and pharmacists
• Expedited, scheduled delivery of your medications at no extra charge
• Refill reminder calls
• Free supplies to administer your medication, such as needles and syringes

For more information about specialty medications and services or to confirm whether a medication you take is part of the specialty program, call the number on the back of your prescription drug ID card or visit www.accredohealthgroup.com