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November 2009 <MEMBER NAME> <ADDRESS> <CITY, ST ZIP> Changes to the Charleston Water System Prescription Drug Plan. The Charleston Water System (“CWS”) is pleased to continue offering its associates an outstanding prescription drug benefit to complement the CWS medical plan. To help ensure you receive your medicines in amounts that effectively treat your condition, starting January 1, 2010, the CWS prescription drug plan is adding two new programs (the Prior
Authorization Program and the Quantity Management Program), for certain medicines.
Prior Authorization
The Prior Authorization Program is a new cost-savings program that helps prevent improper use of medications for certain health conditions. Generally, under the Prior Authorization Program, you must have approval of medication that is on the attached list before it will be covered under the CWS prescription drug plan. If you do not get prior authorization of a medication that is on the attached list, it will not be covered by the CWS prescription drug plan. Quantity Limits The Quantity Management Program is a new quality and safety program that encourages the safe use of medications to treat health conditions. Your plan will only pay for a certain quantity of the medications listed in the attached brochure. You may be able to get a higher amount for some of these medicines if your doctor documents that the higher quantity is medically necessary for you. Brochures describing the Prior Authorization Program and the Quantity Limits Program in greater detail (and listing the medications that are subject to each program) are included with this letter. Please review each of these and discuss these new programs with your doctor. If you are now using one of the drugs included in either of the programs, please talk to your doctor about this change. If you will require prior authorization for a medication or more than the monthly limits, please have your doctor call CVS Caremark toll-free at 1-800-294-5979. Questions? Visit Caremark.com or call CVS Caremark toll-free at 1-888-963-7290 or contact TCC Member Services toll-free at 1-800-815-3314. What is Quantity Management? It’s a quality and safety program that promotes the safe use of medications. The program limits the amounts of some medications that we cover. The Food and Drug Administration (FDA) has approved some drugs only for short-term use. And some drugs may not work as well or even be harmful when you take more than the amounts The pharmacist enters your prescription information into the computer system. If the drug has a limit on the amount that is covered, the pharmacist will fill We base the Quantity Management program on your prescription as long as it does not exceed the FDA and manufacturer dosing guidelines, medical limit. If your prescription exceeds the quantity limit, literature, safety, accepted medical practice, appropriate use and benefit design. Our program only affects the amount of medication your 1. Your pharmacist can reduce your prescription benefit plan covers. You and your doctor should to the quantity your health plan covers. make the final decision about the amount of medication that is right for you. 2. You can pay full price for all of your prescription or for the portion that exceeds the limit. 3. You or your pharmacist can ask your doctor to get a quantity override if one is available. If your plan approves the additional quantity, it will See the list on the back. For most medications, your pay for it. If your plan does not approve it or the plan will only cover a set amount within a set override is not available, you can still choose option timeframe. Your plan will cover higher amounts of some medications when medically necessary. If a drug on this list has an asterisk (*) next to it, you may be If you submit your prescription to the mail-order able to get a medical necessity override for a larger pharmacy and do not meet the requirements for an amount. If you need more of any of these medica additional quantity, the pharmacy will not fill your please have your doctor call the Caremark Prior prescription. It will also not fill your prescription if an Authorizations department at 1-800-294-5979. On additional quantity is not available for that drug. The behalf of your health plan, Caremark administers Quantity Management program. Caremark is an independent company that manages pharmacy benefits. For the most updated list of medications included in the Quantity Management program, contact Caremark Customer Care at 1-888-963-7290. albuterol inhalation solution (5 boxes per hydrocodone with acetaminophen (varies by albuterol inhalation solution UD (30s) (4 hydrocodone with aspirin (varies by strength) albuterol nebulizer solution (120 ml per Intal Solution for Inhalation (1 box per month) ipratropium nebulizer solution (4 boxes per Maxair Autoinhaler (1 inhaler per month) butorphanol nasal spray (5 ml per month)* Morphine Immediate release (180 doses per codeine with aspirin (varies by strength) Medications and limits are subject to change oxycodone immediate release (90 tablets per without prior notice. When brand-name drugs oxycodone with aspirin (varies by strength) The monthly migraine (+), sleep aid (++) and oxycodone with ibuprofen (varies by strength) ulcer (+++) drug quantity limits apply to all prescriptions for all medications within the drug class. For example, if coverage for a sleep aid is limited to one tablet per day, only one sleep aid tablet per day will be covered. What is Prior Authorization (PA)? It’s a cost-savings program that helps prevent improper use of medications for certain health conditions. If your doctor prescribes a medication that requires a PA, you must get approval before your plan will pay for it. We determine prior authorization guidelines on a medication-by-medication basis and may base them on U.S. Food and Drug Administration (FDA) and manufacturer guidelines, medical literature, safety, accepted medical practice, appropriate use and benefit design. The pharmacist enters your prescription information into the computer system. If your medication requires prior authorization and you already have it, the pharmacist will fill your prescription. If you do not See the list on the back. If your doctor prescribes a have prior authorization, you have three choices. medication that needs prior authorization, please have your doctor call the Caremark Prior 4. You or your pharmacist can call your doctor Authorizations department at 1-800-294-5979. On behalf of your health plan, Caremark administers the Prior Authorization program. Caremark is an independent company that manages pharmacy benefits. 5. You can pay full price for your medication. Contact Caremark Customer Care for updated 6. You or your pharmacist can ask your doctor information on the medications included in the Prior Authorization program at 1-888-963-7290. If you do not meet the requirements for prior authorization, you can still choose option 1 or 2. If you submit your prescription to your plan’s mail- order pharmacy and do not get prior authorization, the pharmacy will not fill your prescription. You will The drug names listed herein may be the registered or unregistered trademarks of third- trademarks are included for informational purposes only and are not intended to imply or suggest any third-party affiliation. A member’s benefit document defines actual benefits available and may exclude coverage for certain drugs listed herein. This list may change or expand from time to time without prior notice. When we list brand-name drugs, programs also apply to any available generic equivalents.

Source: http://www.detyensbenefits.com/CWS_Prior_Authorization_and_Quanity_limit_letter.pdf