Prescription Drug Benefits Overview

For full details about the prescription drug benefits available from the DGA–Producer Health Plan, refer to the March 2020 Health Plan Summary Plan Description, beginning on page 67.

Prescription Drug Network

CVS Caremark is the Health Plan’s prescription benefit manager.

To locate CVS Caremark network pharmacy, go to caremark.com or call (855) 271-6601.

Below is a summarized schedule of prescription drug benefits under the Health Plan.

There are special rules for coverage of proton pump inhibitors and sleep aides. See the “Lifestyle Drugs” section beginning on page 70 of the March 2020 Health Plan Summary Plan Description for more information.

Generic contraceptives are covered at 100% under the Health Plan’s Preventive Care Services benefit.

If you choose to take a brand name drug when a generic equivalent is available, you will pay the cost difference between the two drugs plus the generic co-pay.

MAINTENANCE MEDICATIONS

If you are taking a maintenance medication (three months or more), you are allowed two 30-day fills at a retail pharmacy. After the first two fills, to avoid paying the entire cost of the medication, you will be required to obtain your medication in 90-day supplies, using one of the following two options:

1. Delivery with CVS Mail Service
   1. Ask your doctor to send an electronic prescription to CVS Caremark Mail Service Pharmacy. This is the easiest way to get started – you can expect to get your medication in 7-10 business days.
   2. Sign in or register for an account at caremark.com, and request that CVS Caremark contact your doctor and get the process started for you. Once we reach your doctor and receive approval, it will take 7-10 business days for your medication to be delivered.
2. Local Pick-up at any CVS, Longs, or Navarro Pharmacy
   1. Obtain a 90-day prescription for your maintenance medication from your doctor.
   2. Fill your 90-day prescription in person at any CVS, Longs or Navarro pharmacy.

   For questions about the program, please call (855) 271-6601 or visit caremark.com.

For more information on maintenance medications, please refer to pages 67-69 of the March 2020 Health Plan Summary Plan Description.

NON-NETWORK PHARMACIES

You may purchase your medication at a non-network pharmacy, but you will have higher costs and will have to file a claim with CVS Caremark for reimbursement.

RX SAVINGS PLUS CARD FROM CVS CAREMARK

All Health Plan participants, beneficiaries and DGA members can now obtain the RxSavingsPlus card from CVS Caremark free of charge regardless of Health Plan coverage status. With the RxSavingsPlus card, you can save on the full cost of brand name and generic medications at more than 65,000 participating pharmacies nationwide.

A few benefits of the card include:

• discounts on many diabetic supplies
• over-the-counter products with a doctor’s written prescription
• certain pet medications

For more information or to sign up to receive the card, visit www.dgaplans.org/rxsavingspluscard.

WEIGHT MANAGEMENT MEDICATIONS

Beginning July 1, 2024, due to the significant costs of the new classes of weight loss drugs and to ensure continuing support to sustain weight loss, any medications prescribed for weight loss on or after July 1, 2024 for participants age 18 and older will only be covered if you are enrolled in the Health Plan’s new weight management benefits through Flyte Medical (“Flyte”), a medically supervised weight management program, and are prescribed by a Flyte physician. If you are prescribed any of these drugs for treatment other than weight loss, the Health Plan will continue to cover your prescription as before and you are not required to enroll in Flyte.

Access to the Flyte weight management program is free to those who meet the following program eligibility requirements:

• Be a participant or dependent currently covered under the DGA-Producer Health Plan,
• Be 18 years of age or older,
• Be physically located within the United States, and
• Have a BMI of 30 or higher or have a BMI of 27 or higher AND a weight-related health condition (such as diabetes, sleep apnea, cardiovascular disease, or liver disease).*
  * Even if your current BMI does not meet the program eligibility criteria, Flyte may consider your historical BMI or past weight-related condition in determining eligibility. You are encouraged to submit the complete eligibility questionnaire by going to https://www.joinflyte.com/dgaplans and clicking Get Started.

Participants who are under 18 years of age are ineligible for Flyte and are allowed to continue treatment from non-Flyte providers. Weight loss medications will continue to be subject to Health Plan rules and prior authorization from CVS Caremark.

MEDICATION DENIAL INFORMATION

If your weight loss medication was denied at the pharmacy, common reasons are:

1. If age 18 and over – a Flyte provider did not prescribe this medication. Please enroll by visiting https://www.joinflyte.com/dgaplans and filling out the enrollment application.
2. If under age 18 – a Prior Authorization has not yet been processed. Please wait 5 business days and then call your pharmacy to attempt processing again. We do not recommend going to your pharmacy directly as there may be other issues delaying processing.
3. Refill too soon. You may be attempting to refill a prescription too soon. Please check your prescription label for the number of refills allowed and how long your supply should last before attempting to refill.

For questions, please contact the Health Plan for assistance at (877) 866-2200, Ext. 401.