Medco Health Solutions, Inc. is the pharmacy benefit manager for members of the active and COBRA WELS VEBA health plan. Medco has provided the administration of the WELS VEBA prescription drug plan since January 1, 2006. Medco customer service is available at: 1-800-818-6634.
Prescription drug benefits for members of the Anthem SmartValue Medicare Advantage plan are now administered by Anthem's pharmacy benefit manager, NextRx. Co-pays and other details on this plan can be found on this page.
Schedule of Benefits
A prescription drug ID card is provided to all WELS VEBA active and COBRA plan members. This card is now combined with the WELS VEBA medical ID card.
Retail Pharmacy
A Member may use their card to purchase up to a 34-day supply of prescribed drugs. The pharmacist will collect the Member's Co-Pay portion of the cost for a prescription. The Member does not submit a claim to WELS VEBA.
Mail Service Pharmacy
A Member may use the Medco Mail Service Pharmacy when the Member's Physician writes a prescription which exceeds a 34-day supply. The prescription may include up to a 90-day supply.
The Member submits the order to the Mail Service Pharmacy and pays the Member's Co-Pay portion of the cost to the pharmacy. The Member does not submit a claim to WELS VEBA.
Member Payment Amounts
The table below shows a Member's payment amount for Retail Pharmacy and Mail Service Pharmacy coverage:
| 2009 WELS VEBA Active Plan Prescription Drug Co-Pays |
| Drug Status |
Retail Co-Pay
(34-day supply) |
Mail Co-Pay
(90-day supply) |
| Generic |
$10 |
$25 |
| Formulary (Preferred) brand name drugs |
$30 |
$75 |
| Non-Formulary (Non-preferred) & other brands |
$60 |
$150 |
| 2008 WELS VEBA Active Plan Prescription Drug Co-Pays |
| Drug Status |
Retail Co-Pay
(34-day supply) |
Mail Co-Pay
(90-day supply) |
| Generic |
$10 |
$25 |
| Formulary (Preferred) brand name drugs |
$25 |
$62.50 |
| Non-Formulary (Non-preferred) & other brands |
$40 |
$100 |
Important! Members enrolled in the HSA-compliant Plan Option 3 ($2200 individual/$4000 family deductible) for 2007 should understand that they will be required to pay for the full discounted cost of their prescription drugs until their deductible has been met. The co-pay amounts listed below will go into effect only after the deductible has been met. This change was made effective January 1, 2006 per IRS regulations, and applies only to WELS VEBA Plan Option 3. |
Under the Prescription Drug Plan, whenever a brand-name drug is dispensed when a generic substitute is available and allowable, the Member will be responsible for the appropriate co-payment plus the difference between the brand and the generic price for each drug.
The Retail Pharmacy and Mail Service Pharmacy also include the following programs:
Clinical Prior Authorization Program
Certain prescriptions require this type of authorization or approval before they will be covered. The categories/medications that require clinical prior authorization may include but are not limited to: Anabolic Steroids, Acne (topical), Biological Response Modifier and Migraine. To confirm whether or not you need clinical approval, call Medco at 1-800-818-6634.
Specialty Pharmacy
Certain medications for treating complex health conditions must be obtained through this program. The following conditions may require drugs that fall under Specialty Pharmacy which include but are not limited to: Cerezyme & Ceredase, Cystic Fibrosis, Growth Hormone Deficiency, Multiple Sclerosis, Rheumatoid Arthritis and Viral Hepatitis. Please call the Medco Special Care Pharmacy at 1-800-803-2523 for more information about this program.
Step Care Therapy
This program encourages appropriate utilization by applying on-line edits requiring the use of prerequisite drugs that meet specific conditions prior to coverage of other drugs.
Arthritis - COX-2 Inhibitors, which are anti-arthritic medications such as Vioxx®, Celebrex® or Bextra®. The program may deny the brand drug to promote the generic pain killer as the first line agent before a COX-2 inhibitor is used.
Acid Reducers - Proton Pump Inhibitor (PPI) program. The use of PPIs (e.g. Prilosec®, Prevacid®, Nexium®, Protonix® and Aciphex®) lowers the acid level in the stomach and intestines so ulcers may heal and acid reflux disease may be controlled. The program may require you to first use Prilosec OTC® and generic omeprazole that are now over the counter products.
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