(For Eligible Employees and Dependents)

The Fund provides Prescription Drug Benefits for you and your Dependents for drugs and/or medicines that are prescribed by your Physician. The Plan will pay the cost of the prescription, less any copayment after you have paid your calendar year deductible. The copayments and deductible are listed in the Schedule of Benefits.

The prescription drug program provides coverage for both acute medications (immediate treatment) and maintenance medications (long-term treatment).

Retail Pharmacy Network
Mail Order Prescription Drug Service
Prescription Drug Exclusions and Limitations

14.1 Retail Pharmacy Network

Acute medications should be filled at a participating network pharmacy. The retail pharmacy network is offered through CVS Caremark Prescription Service. To find out whether a particular pharmacy is a participating network pharmacy, call a CVS Caremark customer service representative at
1-800-776-1465 or visit the CVS Caremark website at www.caremark.com.

Acute medications are usually prescribed to treat acute conditions of a short-term or temporary nature such as an infection or the flu. They are limited to a 34-day supply.

To fill this type of prescription simply:

1. Obtain a newly written prescription for each acute medication,
   
2. Take the prescription to a participating CVS Caremark network pharmacy,
   
3. Identify yourself as an eligible Local 73 Welfare Fund Participant (for instance, by showing your prescription drug plan CVS Caremark ID card), and
   
4. Pay the required copayment and any deductible as shown in the Schedule of Benefits and you will then receive the prescription drug with no additional paperwork or charge.

If you use a non-participating network pharmacy, you must pay for the entire cost of the medication when the prescription is filled. You must then complete a CVS Caremark Claim Form and submit it along with the original prescription receipt to the CVS Caremark Claims Department . You will be reimbursed at the negotiated pharmacy rate less the appropriate copayment.

You may obtain a CVS Caremark Claim Form by calling CVS Caremark at 1-800-776-1465, visiting their website at www.caremark.com or contacting the Fund Office.

14.2 Mail Order Prescription Drug Service

If your Physician has prescribed a maintenance medication (long-term treatment), you should have your prescription filled by the mail order program. The mail order prescription drug service is administered by CVS Caremark.

To fill a maintenance prescription through CVS Caremark, simply:

1. Obtain a new written prescription for each covered medication. CVS Caremark can only dispense the amount of medication your Physician has prescribed up to a 90-day supply. Show your Physician the material attached to the Prescription Drug Benefit brochure to help him or her write a prescription for this program.
   
2. Complete the Mail Service Order Form/Patient Profile.
   
3. Mail the written prescription, the profile, the order form and your copayment to CVS Caremark in the pre-addressed envelope. The copayment for each prescription order is shown in the Schedule of Benefits. If you need assistance determining the copayment amount, call CVS Caremark at 1-800-776-1465 or visit their website at www.caremark.com.
   

You will receive refill labels (if refills remain) and a new order form in your prescription package. To obtain a refill order, simply affix the refill label to the back of the order form and send it to CVS Caremark. If you have no refills remaining or if your prescription has expired, contact your Physician for a new written prescription to send to CVS Caremark.

If you have a question about your prescription, call CVS Caremark at 1-800-776-1465. Customer Service Representatives will be available to answer questions weekdays from 7:30 a.m. - 9:00 p.m. and Saturdays from 8:00 a.m. - 12:00 p.m. Central Standard Time.

14.3 Prescription Drug Exclusions and Limitations

Benefits are not payable under this Prescription Drug Benefit for:

1. Medicines or drugs obtainable without a Physician’s prescription, except insulin,
   
2. All forms of contraceptives, including medicines and devices, unless they are Medically Necessary,
   
3. Medications used for cosmetic purposes, including Vitamin A derivatives (retinoids) for dermatological use (i.e. Retin A, Renova),
   
4. Vitamins and nutritional supplements,
   
5. Smoking deterrents (except as provided under the Wellness Benefit),
   
6. Fertility drugs (except as provided under the Infertility Benefit),
   
7. Viagra and other erectile dysfunction drugs. However, Prescription Drugs prescribed by the treating Physician to treat erectile dysfunction will be covered if:

a) You have or had one of the following: Prostate and testicular cancer, disorders of the prostate (including prostatic enlargement and hyperplasia), low testosterone level, Diabetes, Crohn’s disease, Peripheral neuropathy, Hypertension and other vascular conditions, or erectile dysfunction as a side effect from another prescription medication or combination of medications that can be verified as a side effect, which is listed in the Physician’s Desk Reference; and

b) You provide the following information: A letter of Medical Necessity from your attending Physician, complete diagnosis, and name and dosage of medication prescribed.

Re-verification from the Physician is required every twelve-month period.

8. Anabolic steroids
   
9. Antiviral drugs used for influenza (flu) treatment or prevention,
   
10. Weight control or drugs or anorexiants, except those used for treatment of Children with attention deficit disorder (ADD) or attention deficity hyperactivity disorder (ADHD) or individuals with narcolepsy.
    
11. Serum allergy antigen solutions; and
    
12. Existing and new drugs that are not uniformly and professionally endorsed by the general medical community for prescription in the course of standard medical care, including existing and new drugs that are experimental in nature.

Prescription Drug Benefits Coordination with Medicare Part D

If you or your Eligible Dependents are eligible for and enroll in Medicare Part D, the Plan will continue to provide you with the Prescription Drug Benefits and will not coordinate benefits with Medicare Part D benefits.

If you or your Eligible Dependent are eligible for but do not enroll in Medicare Part D, the Plan will continue to provide your Prescription Drug Benefits.