60 they will prov ide confidential and convenient delivery of your medication to the location of your choice (i.e., home, work, doctor’ s office, vacation spot, etc.) CVS Specialty ’s pharmacist - led CareTeam also will provide condition - specific education, drug administration instruction, and expert advice to help you manage your therapy. The program includes access to pharmacists and other health experts who can provide condition - specific materials. The CareTeam also will perform follow - up calls to remind you when it’s time to refill your prescription, check on your therapy progress, and answer any questions. If you have questions, please call the toll - free CaremarkConnect ® number, 800 - 237 - 2767. If you have a hearing impairment and need telecommunications device (TDD) assistan ce, please call CaremarkConnect ® toll - free at 800 - 231 - 4403. In addition, you can always contact the Fund Office at 202 - 785 - 8148 or 800 - 457 - 3481. Contraception The Plan covers certain prescribed contraceptives and contraceptive devices for eligible female participants with no cost sharing, i.e ., no copayment , coinsurance or deductible . In all cases the drug or other contraceptive item must be prescribed by a physician or Allied Health Professional. Prescribed generics and single source brands will be covere d. Standard time limits for dispensing of such items apply. Please contact CVS Caremark directly at 866 - 282 - 8503 if you have questions about what prescribed items are covered. Male Androgens The Plan provides coverage for medical treatment of erectile dys function when caused by an established medical condition. This includes coverage for prescribed male androgens (testosterone and erectile dysfunction drugs). Prior authorization and medical neces sity are required for coverage. Your physician or Allied Heal th Professional can call CVS Caremark directly at their toll - free number 855 - 240 - 0536 to request approval. They will be required to provide supporting clinical information; which CVS Caremark will review to determine whether the medical n ecess ity standard has been met. If medical necessity is confirmed, the Plan will allow covered prescriptions, subject to a 10 - pill per month limit for on demand products, or a 30 - pill per month limit for daily use Cialis 2.5 mg or 5 mg. If CVS Caremark determines that the u se of a male androgen is not medically necessary, coverage of the p rescribed drug will be denied. Compounded Medications A compounded medication is a medication that is made by combining, mixing or altering ingredients, in response to a prescription, to c reate a customized medication that is not otherwise commercially available. Any medication classified as a compounded medication that costs more than $300 will require prior authorization before it is covered under the terms of the Plan. Bulk powders and h igh cost proprietary bases are not covered under the Plan. One fill of a compound medication is allowed in a 34 - day period. If your physician or Allied Health Professional prescribes a compound medication for you, your Spouse, or your Eligible Dependent Ch ildren, you should ask him or her to call CVS Caremark at 800 - 294 - 5979 to request prior authorization before the prescription is filled. Federally Required Coverage Federal law requires that some prescription drugs and over the counter drugs with a prescri ption be covered at 100%. CVS Caremark regularly updates the list of these drugs to reflect required changes. For current information on what is include on the list, please call the CVS Caremark Customer Care line at 800 - 282 - 8503.
2018 BTF Plan B Page 64 Page 66