For PacifiCare Early Retirees, Medicare Supplement Plan and Premium Reimbursement Plan

If you are eligible for Retiree Health Plan and are a participant in either the PacifiCare Early Retiree Plan, Medicare Supplement Plan or Premium Reimbursement Plan then you and your covered spouse are entitled to prescription drug benefits, as described herein and in the Plan.

The Mandatory Generic Prescription Drug Plan is designed to help you meet the cost of prescription drugs prescribed by your doctor, for you or your eligible spouse, for the treatment of illness or injury.

This plan is called "Mandatory Generic", which means that the pharmacist will dispense a generic drug substitute whenever it is available.  However, you may obtain a brand name drug instead of a generic, but it will result in increased out-of-pocket expense as explained below.

You must use a generic drug substitute whenever it is available.  If you or your doctor requests a brand name drug instead of a generic equivalent, you will be charged the difference between the brand name drug and the generic, in addition to the $10 co-payment for a 30 day supply or a $20 co-payment for a 100 day supply for maintenance medications.

To fill your prescription, you can use any of the following:

• Prescription Solutions Walk-In Pharmacy Plan (contracted network of Pharmacies)
• Prescription Solutions Mail Service Pharmacy Plan
• The participant must contact the Administrative Office to request a direct member reimbursement form for purchasing prescriptions out of network.