78 If you file an appeal with the Board of Trustees, you will be deemed to authorize the Fund to obtain information relevant to your claim. Mail your written appeal directly to: Board of Trustees National IAM Benefit Trust Fund 1300 Connecticut Avenue, NW, Suite 300 Washington, DC 20036 The Bo ard of Trustees will review your appeal. They will evaluate your claim within the timeframes described above . You will be notified of the Board of Trustees decision on your appeal within 5 calendar days after the date your appeal is reviewed. Prescriptio n Drug Benefit Claims There are separate procedures fo r making claims for the Prescription Drug Benefit, including a special procedure to fill prescriptions for Specialty Medications. You do not have to complete a written claim form if you have a CVS Caremark prescription card and use a participating pharmacy. If any claim for a prescription drug benefit is denied, you have the right to appeal by following the procedures explained below. You may get your general prescriptions filled at any participatin g pharmacy by presenting your CVS Caremark prescription card to the pharmacist. CVS Caremark will treat the claim as a Post - Service Claim set forth in the medical benefit claims provisions above. Any prescription drug claim CVS Caremark receives more than one year after the date of purcha se will be denied as untimely. Specialty Medications Specialty Medications can be filled by using only CVS Caremark Specialty Pharmacy Services. Claims for Specialty Medications are treated as Pre - Service Claims because you must get prior authorizati on as a condition of coverage. If you are prescribed a Specialty Medication, or if your pharmacist tells you that an ite m you are requesting is a Specialty Medication, you must call CaremarkConnect toll - free at 800 - 237 - 2767. When notified, CVS Caremark will contact your physician or Allied Health Professional directly to obtain clinical information needed to perform a prio r authorization review, and you will not have to complete a written claim form. CVS Care mark Specialty Pharmacy Services include a program called ACSF, which means Advanced Control Specialty Formulary . With ACSF, in addition to the required medical neces sity review, Specialty Medications will also be reviewed to determine whether a preferred alternative exists that should be tried first. If an alternative is available, it will be discussed with your physician or Allied Health Professional and the script changed. This is part of the prior authorization process which will be transparent to you. CVS Caremark will notify you in writing of its determination on your claim for coverage of a Specialty Medication within a reasonable period of time, but no later t han 15 calendar days after it receives notification of the claim. This period may be extended by one 15 - day period, if special circumstances beyond CVS Caremark ’s control require that additional time is needed to process your claim. If an extension is needed, CVS Caremark will notify you in writing before the expiration of the initial 15 - day period of the circumstances requiring an extension and the date by which it expects to reach a decision. If the extension is required because a dd itional information is needed from you to decide the claim, the notice of extension will specifically describe the information that is needed from you, and you will be given at least 45 days from your receipt of the notice within whi ch to provide the inf or mation.
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