Page 5 - PWH.19 Employee Benefits

Member Inquiries 513.598.2929

(Toll-Free) 800.598.2929 Member Inquiries 866.900.3711
Pharmacy Inquiries 800.571.4757

WHAT YOU NEED TO KNOW ABOUT FILLING PRESCRIPTIONS

 Which Pharmacies Can I Use?

Walmart and Sam’s Clubs are contracted nationally but there are also many other pharmacies in your
area that are able to process two insurance cards. A list of participating pharmacies is available upon
request at open enrollment, from your HR contact or you can contact Appro-RX by phone.

The ability to process two insurance cards is relatively new and not all pharmacies are able to support
this. If your pharmacist has problems, please ask them to call the Appro-RX number on your ID Card for
pharmacies. Appro-RX is staffed 24/7 and can walk your pharmacist through the steps to make this
work.

CVS and Walgreens are NOT able to process two insurance cards. If you use these pharmacies or
another pharmacy that cannot process two insurance cards, you will have to pay up front and submit the
claim to Custom Design Benefits to be paid back.

 My Pharmacy Charged Me The Full Amount Rather Than My Copay – What Do I Do Now? Or
My Pharmacist Can’t Get This To Work…..

1. Ask the pharmacist if they processed both insurance cards.
2. If both were processed and they couldn’t get the prescription to go through, indicate that you

should have a copay and ask that they contact the toll-free pharmacy phone number for Appro-
RX located on your Custom Design Benefits’ ID Card before you leave the pharmacy.

 Why Did My Copay Change – My Prescription was Preferred and now it is on the Non-preferred
Drug List?

Preferred Drug Lists (also called Formularies or Tiered Prescription Plans) are never the same from one
insurance to the next and Preferred Drug Lists are subject to change at any time. We cannot guarantee
that your prescription will be on Appro-RX’s Preferred Drug List. You may call Appro-RX to confirm if
your prescription is on their Preferred Drug List (see phone number at top).

 What About $4 Generic Programs?

If your drug is available at a reduced cost such as a $4 generic program, do NOT use either card as this
will increase the cost to you.

 What About Mail Order?

If you choose to use the ANTHEM mail order program, you will need to pay upfront for the full cost of
prescriptions and submit a claim with your ANTHEM explanation of benefits and receipts to Custom
Design Benefits. Custom Design Benefits will send reimbursement for prescriptions that apply to the in-
network Deductible only. If the prescription is a 90 day prescription, copays will apply for all 3 months.