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Important Health & Welfare Benefit Changes Effective October 1, 2013
Prescription Drug Plan Changes
Continually rising prescription drugs costs have made it necessary to institute a few changes in the Fund’s CVS CAREMARK prescription drug plan.
Sleep Aids
Did you know that Lunesta and Ambien, two heavily advertised sleeping aids, cost the Fund between $150 and $200 for a 30 day supply while generic alternatives can cost as little as $7.00 a month? It’s true and by most accounts, there is no good reason for the cost difference other than to cover the cost of advertising. Besides, many feel that over-the-counter products like Tylenol PM are perfectly good substitutes for these very expensive prescription drugs.
To protect the Fund from these high costs, effective October 1, 2013 the maximum reimbursement for al
prescribed sleeping aid medications wil be limited to $30 per 30 day supply.
Ulcer Drugs (PPls)
Much like the story with sleep aid medications, the highly advertised drug Nexium costs the Fund $186 for a 30 day supply and a similar drug, Aciphex costs $247. The generic equivalent costs less than $18 for a 30 day supply and in most cases over-the-counter products, like Prevacid and Prilosec are every bit as effective.
Again, to protect the Fund from these exorbitant costs, effective October 1,
2013 prescribed PPI medications wil be limited to $30 per 30 day supply.
According to Consumer Reports:
“Overprescribed and overpriced:
Co-Pay Changes
Just say ‘no’ to Nexium”
Our prescription drug plan has traditionally had a two-tier co-pay structure; one co-pay for Brand name drugs and a lower co-pay for the generic equivalents to Brand name drugs.
Effective October 1st, we will have two Brand name drug co-pays. One will be for Preferred Brand Drugs and one for Non-Preferred Brand Drugs. With all of the choices in medications now available to treat a given illness or condition, Preferred Brand Drugs are proven to be clinically appropriate and cost-effective. CVS CAREMARK’s Preferred Brand Drug List is published each calendar quarter and is available from the CVS CAREMARK website or the Fund Office.
Effective October 1, 2013, the co-pays under the prescription drug plan wil be as fol ows:
(Drugs listed on the CVS Caremark Preferred Drug List)Tier 3: Non-Preferred Brand (Drugs not listed on the CVS Caremark Preferred Drug List)
If you or a family member is taking, or recently received a prescription drug that wil be subject to higher cost share or
co-pay as a result of these changes, you wil receive a letter directly from CVS CAREMARK specifical y alerting you to
the medication(s) that wil be impacted. This wil enable you to discuss possible alternatives with your physician that
wil save you and the Fund money
Important Health & Welfare Benefit Changes Effective October 1, 2013 (Continued)
Benefit Improvement
Between the savings expected to be realized through the prescription drug changes and the improved employment levels we have seen recently, the Board of Trustees of the Health & Welfare Fund voted to reverse one of the cost-cutting changes they were forced to implement in 2011 when the Health & Welfare Fund was experiencing severe financial difficulties.
Effective with services received on or after October 1, 2013 the annual deductible for medical care received
from an In-Network provider wil decrease from $350 individual/$1,050 family to $250 individual/$750 per
family.
Dependent Audit
The Health & Welfare Fund exists to provide medical, prescription, dental and vision coverage to eligible members and their eligible dependents (legal spouses and children). In order to continue to provide the very best benefits possible within available financial resources, it is important to protect the Fund from fraud and by not covering individuals that are not eligible for coverage through the Fund. The Trustees have hired a firm to assist in this process. If you have a dependent spouse covered under the Fund, you will receive a letter in the near future asking you to provide simple proof that you and your spouse are still legally married. We ask for your patience and cooperation in this effort to protect the Fund from fraud.
The above is only intended as summary. Please consult your Summary Plan Description booklet for further Reminder:
You can now receive up to a 90-day supply of maintenance type medications directly from your local CVS
pharmacy.

Source: http://www.oefunds.org/forms/benefit%20announcement%20ltr%20-%20Changes%20eff%20Oct%201%202013.pdf