Eligible Management/Support/Production employees - 2012 Prescription Drug Network FAQs
Eligible Health Alliance HMO Participants - 2012 Prescription Drug Network FAQs
(All other) Eligible Production Hourly employees - 2012 Prescription Drug Network FAQs
How is the Pharmacy Network changing in 2012?
Who determines what drugs are put on the Caterpillar Drug Formulary and the Preferred Drug List?
What if I need more than a 30-day supply of my medication?
What is our policy on drugs from Canada?
What is the logic behind quantity limits?
Has mail order been expanded or is it only with Walgreens?
Why does Caterpillar recommend generic prescription drugs when a brand is prescribed by a physician?
If a Caterpillar spouse has prescription drug coverage through another provider, can they submit out-of-pocket expenses to Cat for additional coverage if the spouse has Cat as secondary?
What is a Legend Drug?
What is Step Therapy and why is it used for some classes of drugs?
Is there a place where step therapy explanations are available for participants, pharmacies and physicians?
If I pay for a prescription in full, how do I get reimbursed?
Who do I contact for prescription drug questions?
On the cost share tier, does the $1,000 refer to per fill or per month?
Does the cost share only apply to prescriptions purchased at a pharmacy?
Does the cost share apply to medications administered by a physician in their office? (e.g., Tysabri for Multiple Sclerosis when administered by the treating physician)
Does Caterpillar cover the smoking cessation drug called Chantix?
What is a drug formulary?
What does a drug tier mean?
Where can the Formulary List be found?
Will my doctor know what I'm talking about when I ask for a drug that is on a different tier?
What can I do to keep the cost of my medications down?
Where can the Preferred Drug List be found?
Will my doctor know what I’m talking about when I ask for a drug that is on the Preferred Drug List?
What determines whether or not a specific drug costs $35, especially if there is no generic form?
What can I do to keep the cost of my medications down?
How is the Pharmacy Network changing in 2012?
(Applies to certain Management/Salaried/Non-bargained hourly participants, Health Alliance HMO participants and participants covered by the Central Labor Agreement.)
Effective January 1, 2012, in addition to Walmart and Walgreens, we have added Kroger (and its affiliates Dillons, Fry's, Ralphs, Fred Meyer, King Soopers, City Market, Gerbes, Baker's, QFC and JayC) and Community Pharmacy Prescription Network (CPRxN) (which currently includes Alwan pharmacies, Doc's Drugs and Sartoris Drugs) to the list of Participating Providers.
Who determines what drugs are put on the Caterpillar Drug Formulary and the Preferred Drug List?
The Caterpillar Drug Formulary and Preferred Drug List are developed using recommendations by a Pharmacy and Therapeutics Committee. This group is made up of physicians and pharmacists. They look at the drugs available in a given class, and make their recommendations as to which provide better efficacy, less drug interactions and less side effects based on the published literature, package inserts, manufacturers’ verifiable information (clinical data) and any external medical opinion as needed. The Pharmacy and Therapeutics Committee meet to evaluate and review new drugs and new data on drugs that are already on the market. Their determinations are published quarterly and made available to Pharmacy Benefit Managers like RESTAT to incorporate into formularies and preferred drug lists for their clients.
If there are several drugs in the same class that provide the same efficacy, less drug interactions and less side effects, then the most cost effective drug is selected for the Preferred Drug List and/or the Formulary List. The decision as to which drug the patient takes should be determined by the patient and their doctor based on which drug works best for the patient. The Caterpillar Drug Formulary List, Preferred Drug List and the CatHealthBenefits.com web site are updated quarterly.
TOP
What if I need more than a 30-day supply of my medication?
Members are encouraged to use the mail service when greater than a 30-day supply is needed. For a vacation override on a 30-day prescription, the patient must have already used 15 days (i.e., 50%) of the medication. The pharmacist must contact RESTAT to request the vacation override. The vacation override will not exceed 30 days of additional medication, and one co-pay will be applied. For extended travel-related requests the member should contact RESTAT at 877-228-7909.
TOP
What is our policy on drugs from Canada?
Caterpillar covers certain drugs that have been reviewed and approved by the Food & Drug Administration. Since drugs from Canada are not reviewed and approved by the Food & Drug Administration, they are not covered.
TOP
What is the logic behind quantity limits?
Quantity limits are implemented on certain prescription drugs based on recommended FDA dosing guidelines. If your doctor prescribes a higher quantity of a drug that has a quantity limit implemented, the patient will be responsible for paying 100 percent of any quantity that exceeds the plan’s coverage.
TOP
Has mail order been expanded or is it only with Walgreens?
Walgreens Mail Service is Caterpillar's only preferred prescription mail provider.
TOP
Why does Caterpillar promote generic prescription drugs when a brand is prescribed by a physician?
The main issue raised is the quality of generic medications vs. their branded counterparts. As stated, Caterpillar touts the quality of our genuine parts against those of our competitors. Caterpillar makes parts using proprietary methods and mix of compounds and metals we do not share with our competitors. Whereas, once a prescription medication loses its patent protection and generic manufacturers can begin selling generic versions of the branded drug the FDA mandates that these medications are copies of the original versions. The branded manufacturers are required under the Hatch-Waxman Act to disclose the exact molecular structure to create the medication. These generic versions are required by the FDA to fall within 5% efficacy and safety of the branded drug. These drugs are tested and approved by the FDA and their manufacturing process is periodically evaluated by the FDA unlike engine and tractor parts where there is no regulating body to ensure equivalent performance standards.
Caterpillar promotes the use of generic medications because they are an effective and safe alternative to their branded counterparts. At the same time, Caterpillar still covers most branded medications so members and their physicians still have that option. Caterpillar has not raised co-pays on prescription drugs since 2002, and in January 2007 we introduced a $0 Select Tier in which six of our top nine prescribed medications are now free to certain salaried / management / non-bargained hourly participants, Health Alliance HMO participants and participants covered by the Central Labor Agreement. Since January 2006 the average price of a branded drug has increased 46 percent while the average co-pay for our members has decreased 10 percent. Generic medications are one way our members can decrease their out-of-pocket expenditures and still get a high quality and safe treatment.
TOP
If a Caterpillar spouse has prescription drug coverage through another provider, can they submit out-of-pocket expenses to Cat for additional coverage if the spouse has Cat as secondary?
Yes, the employee can submit a request to Restat for secondary coverage. Applicable co-pays will apply. Prescription Drug Claim Forms can be found on cathealthbenefits.com > Drug Benefits Tab > Restat Prescription Drug Claim Form on the right side or by calling Restat at 1-877-228-7909.
What is a Legend Drug?
Legend Drugs - Any medical substance the label of which, under the Federal Food, Drug and Cosmetic Act, is required to bear the legend: “Caution: Federal law prohibits dispensing without prescription”.
What is Step Therapy and why is it used for some classes of drugs?
When there are several drugs in a given class that are considered equally effective and safe, the most cost-effective drug may be required as a first step. This is referred to as Step Therapy. Step Therapy may be required for coverage through the Prior Authorization process.
TOP
Is there a place where step therapy explanations are available for participants, pharmacies and physicians?
Information and examples of step therapy are available on CatHealthBenefits.com
TOP
If I pay for a prescription in full, how do I get reimbursed?
The plan participant is required to complete the form below making sure to include a copy of the prescription receipt (not the cash register receipt) and send to RESTAT at the address below. You may want to keep a copy for your records.
Mail form to:
RESTAT Claims Department
11900 W. Lake Park Drive
Milwaukee, WI 53224
OR Fax form to RESTAT at:
414-359-1319
TOP
Who do I contact for prescription drug questions?
Contact RESTAT Customer Service Center at 877-228-7909.
TOP
On the cost share tier, does the $1,000 refer to per fill or per month?
The cost share is applicable per prescription and per each refill of that prescription. If the cost of the medication is over $1,000 per prescription or per each refill of that prescription, it requires one $100.00 co-pay.
TOP
Does the cost share only apply to prescriptions purchased at a pharmacy?
The cost share for prescriptions costing over $1,000 per fill pertains to any covered prescription purchased at a participating or network pharmacy.
TOP
Does the cost share apply to medications administered by a physician in their office?(e.g.,Tysabri for Multiple Sclerosis when administered by the treating physician)
A prescription drug administered in the physician’s office will be subject to the appropriate coinsurance and deductibles under the member’s medical plan.
TOP
Does Caterpillar cover the smoking cessation drug called Chantix?
Caterpillar's insurance benefit plans do not cover any tobacco cessation products. However, as part of our tobacco cessation program, (Quit for Life) through Healthy Balance, Caterpillar will pay for nicotine replacement therapy in the form of nicotine patch or gum. We do not cover Chantix for 2 reasons: 1. In the relatively few studies to date, (and they were done by the drug manufacturer), the one year quit rate with Chantix was about 25%, the same result as independently run studies of Zyban. Chantix does not appear to improve the outcomes. 2. Chantix is an entirely new class of medication and there is no long- term safety data.
TOP
What is a drug formulary?
(Applies to certain Salaried/Management/Non-Bargained Hourly Participants, Health Alliance HMO participants and particpants covered by the Central Labor Agreement) A prescription drug formulary lists all medications that are covered by the prescription drug benefit.
TOP
What does a drug tier mean?
(Applies to certain Salaried/Management/Non-Bargained Hourly Participants, Health Alliance HMO participants and participants covered by the Central Labor Agreement)
The tier designates the co-pay amount that the member is responsible to pay at the pharmacy.
TOP
Where can the Formulary List be found?
(Applies to certain Salaried/Management/Non-Bargained Hourly Participants, Health Alliance HMO participants and participants covered by the Central Labor Agreement) The Formulary List is available on CatHealthBenefits.com under the Drug Benefits tab – Salaried/Management/Non-Bargained Hourly Participants section. For a printed list, call RESTAT at 877-228-7909.
TOP
Will my doctor know what I'm talking about when I ask for a drug that is on a different tier?
(Applies to certain Salaried/Management/Non-Bargained Hourly Participants, Health Alliance HMO participants and participants covered by the Central Labor Agreement) Physicians are not required to know what is covered under the Caterpillar health or prescription drug benefit. Employees are encouraged to print a copy of their Formulary List to take with them to doctor’s appointments. Physicians who have internet access can go to the CatHealthBenefits.com web site and view or print the Formulary List.
What can I do to keep the cost of my medications down?
1) Ask your physician to prescribe a generic drug, when appropriate.
2) If a generic is not available, ask your physician to prescribe a Tier 2 (preferred) drug rather than a Tier 3 (non-preferred) drug.
Where can the Preferred Drug List be found?
(Applies to certain Production Hourly Participants)
The Preferred Drug List is available on CatHealthBenefits.com under the Drug Benefits tab in the Production Hourly Participants section. For a printed list, call RESTAT at 877-228-7909.
Will my doctor know what I’m talking about when I ask for a drug that is on the Preferred Drug List?
(Applies to certain Production Hourly Participants)
Physicians are not required to know what is covered under the Caterpillar health or prescription drug benefit. Employees are encouraged to print a copy of the Preferred Drug List to take with them to doctor’s appointments. Physicians who have internet access can go to the CatHealthBenefits.com web site and view or print the Preferred Drug List.
What determines whether or not a specific drug costs $35, especially if there is no generic form?
(Applies to certain Production Hourly Participants)
Drugs in the $35 co-pay can be brand name drugs that have a generic drug available. These non-preferred medications may have a lower cost generic or branded drug that treats the same condition.
TOP
What can I do to keep the cost of my medications down?
(Applies to certain Production Hourly Participants)
1) Ask your physician to prescribe a generic drug, when appropriate.
2) If a generic is not available, ask your physician to prescribe a 'preferred' brand drug rather than a 'non-preferred' brand drug.
TOP
Eligible Management/Support/Production employees - 2012 Prescription Drug Network FAQs