Local 237 Welfare Fund Prescription Drug Benefit For
New York City Retiree Welfare Fund Participants

Effective January 1, 2019

Medicare Eligible Retirees Enrolled in the GHI Plan
The maximum annual family cap for Medicare eligible retirees has been raised from $8,500 to $20,500 for those enrolled in the full-time GHI plan.

The Fund has adopted Aetna’s Maintenance Choice Program, which allows 2 choices for prescriptions that are for 90 day fills. The first choice is Aetna’s mail order and the second choice is to make your purchase at any CVS retail store.

A second program, Mandatory Generics, calls for the use of generic drugs when one is available in lieu of a Brand name drug.  Additionally, Step Therapy requires your doctor to prescribe less costly and risky drugs. When beginning drug therapy for a medical condition, the most cost-effective and safest drug therapy will be prescribed before progressing to more costly or risky therapy, when necessary. The goal is to control costs and minimize risks.

Since many retirees have already followed some of these cost control strategies, the changes will only affect a small percentage of the our retiree population.

HIP Medicare Enrollees
Those members who are enrolled in the HIP Medicare Plan (which includes the enhanced Rx rider) who had NOT been eligible for the union’s drug plan may want to consider a change at this time to the GHI Medical Plan. While the new $20,500 maximum increase is significant, it may not meet the needs of all. Carefully consider making any switch in medical plans, which should be based on your individual situation.

If you experience any issue with your pharmacy benefit or need further explanation, please call the Fund office at (212) 924-7220 from 8:30 A.M. until 5:00 P.M, Monday thru Friday. The Teamsters Local 237 Retiree Division staff is also available to help and may be reached by calling (212) 807-0555.

Aetna Prescription Benefit
Aetna is the Prescription Benefit Manager for the Fund. When filling a prescription at a retail pharmacy you will need to provide your Aetna ID card. For those members who choose the cost saving mail order program,  complete an Aetna Mail Order Delivery form. Forms may be obtained by contacting Aetna customer service, Teamsters Local 237 Welfare Fund or print a form from the Aetna Navigator at www.Aetna.com

Contact Aetna’s customer service number (specifically for Local 237 members) for questions regarding prescriptions benefits at:

1 (855) 352-1599

Standard Operating Hours for Aetna’s customer service

Monday – Friday: 7:00am to 11:00pm Eastern
Saturday: 7:00am to 9:30pm Eastern
Sunday: 8:00am to 6:00pm Eastern

Summary of the Fund’s prescription benefit:

  • For all retirees, there is a cap – or maximum annual drug benefit, for you and your eligible dependents. As of January 1, 2019 the cap for Medicare eligible retirees was increased from $8,500 to $20,500 per year. For retirees who are not Medicare eligible the annual cap is $2500 and for the part time category it is $1100
  • For Medicare eligible and part time retirees the co-pay for a 34 day supply or less of a generic drug purchased at a local retail pharmacy is $5.00 and the co-pay for a name-brand drug is $15.00.
  • For Medicare eligible and part time retirees 90-day supply ordered through the Aetna mail order program or purchased at a CVS Pharmacy is available to members for a single co-pay. The cost is $5.00 for generic and $15.00 for name-brand for a full 90-day supply, the same price as a 34-day supply purchased at a local retail pharmacy.
  • For non Medicare eligible retirees the co-pay for a 34 day supply or less of a generic drug purchased at a local retail pharmacy is $15.00 and the co-pay for a name-brand drug is $25.00. If the prescription is for more than a 34-day supply, the co-pay at a local retail pharmacy doubles to $30.00 for generic drugs and $50.00 for brand-name drugs.
  • For non Medicare eligible retirees the Maintenance Choice Program applies, a 90-day supply ordered through Aetna mail order program or purchased at a CVS Pharmacy is available to members for a single co-pay. The cost is $15.00 for generic and $25.00 for name-brand for a full 90-day supply, the same price as a 34-day supply purchased at a local retail pharmacy.

While the mail order program is voluntary, all members using “maintenance drugs” are encouraged to take advantage of the savings and convenience available through Aetna. Aetna has set up a dedicated customer service line for Local 237 members, you can reach them by calling 1 (855) 352-1599.

Click here for active full time Welfare Fund participant information.

 

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