Risk Management Department

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Posted: November 1, 2007

IISD Injectible Prescription Process

When a member needs to obtain an injectible medication, he or she can choose between

    (a)  Tel-Drug Specialty Pharmacy
    (b)  Retail Pharmacy
    (c)  Physician’s Office

If the patient needs/wants to obtain an injectible drug outside of the physician's office, the member can;

1. Use the Tel-Drug Specialty Pharmacy to dispense the medication. Tel Drug will file the claim under the medical plan and the member will pay the medical copay. Tel Drug will dispense the injectible drug as ordered by the physician (either directly to the patient or directly to the physician's office).

2. Obtain a prescription from his or her physician and use a local retail pharmacy to dispense the medication. The member will pay l00% of the cost out of pocket and submit a claim to the medical plan for reimbursement. The member will be reimbursed subject to U&C expenses and the appropriate medical copay will be applied.

3. Use a physician who offers to supply the medicine from their office and administer the injectible drug during an office visit. The PCP or Specialist office visit copay will be charged each visit.

As of October 18, 2007*, the following list of injectible drugs** can be obtained through Tel-Drug Mail Order or a local retail pharmacy with a prescription from their physician.  They are injectible drugs used to treat ''acute" conditions and often needed in emergency or urgent situations and they are not paid under the medical plan.

This list of drugs will provide pharmacy benefits as follows:

     •  Generic = 30% coinsurance up to $300 max per script

     •  Preferred Brand = 40% coinsurance up to $400 max per script

     •  Non-Preferred Brand = 50% coinsurance up to $500 max per script

 *   The list of injectible drugs shown below may change at any time.  It is the member’s responsibility to check with the Administrator when use is planned.

 **  All other Injectible drugs are paid under the medical plan and subject to the medical copay.

Quantity Limits Applied