PremiumScript Pharmacy Program

Information below is from the PremiumScript Pharmacy vendor.

Overview

Pharmacy costs will continue to increase as the population ages and new pharmaceuticals are introduced to treat various diseases. Costs are spiraling upward causing employers to look for alternatives and cost controls.

Examples of alternatives and cost controls include:

* Generic-only programs
* Closed formularies
* Annual maximum benefits
* Prior authorization edits

The PremiumScript Pharmacy Programs are designed to provide the flexibility employers need.

Marketed by:

Emerson, Reid & Co.
4651 West Chester Pike
Newtown Square, PA 19073
(610) 356-9220

Underwritten and Administered By:

Fidelity Security Life Insurance Co.
3130 Broadway
Kansas City, MO 64111

Pharmacy Benefits Manager (PBM):

Catalyst Rx
2273 Research Blvd., 2nd Floor
Rockville, MD 20850

Fidelity Security Life Insurance Co. Domicile: Missouri. NAIC No. 71870. Authorized to transact insurance in all states including District of Columbia, except New York.

Highlights

* Fully Insured
* National Pharmacy Network
* Various Co-Payment Options
* Integrated Mail Order Service for Covered Maintenance Medication
* Limitation of a 34 day supply for retail and a 90 day supply for mail order
* Available in Most States

Covered Drugs

*Non-injectable Federal Legend Drugs
* Insulin
* Compound Prescriptions
* Oral Contraceptives

Underwriting

Brochures

Affordable RX Plan | Group Specific Plan

Exclusions

Outpatient Prescription Drug Exclusions*

Prescription Drug benefits are not payable for the following items:

All over-the-counter products and medications unless shown under the definition of Prescription Drug.

This includes, but is not limited to, electrolyte replacement, infant formulas, miscellaneous nutritional supplements and all other over-the-counter products and medications.

Generic Only Drug Program

• Any Brand Name Drug
• Insulin
• All exclusions listed under brand name drug

Brand Name Drugs

• Blood glucose meters, insulin-injecting devices.
• Depo-Provera; levonorgestral; condoms, contraceptive sponges, and spermicides;
   sexual dysfunction drugs.
• Biologicals (including allergy tests); blood products; growth hormones; hemophiliac factors; MS
  injectables; immunizations; all other injectables unless shown under the definition of Prescription
  Drug.
• Aerochamber, Aerochamber with Mask; Peak Flow Meter; all other medical supplies and durable
  medical equipment unless shown under the definition of Prescription Drug.
• Liquid nutritional supplements; pediatric Legend Drug vitamins; prenatal Legend Drug vitamins;
  prescribed versions of Vitamins A, D, K B12, Folic Acid and Niacin - used in treatment versus as a   dietary supplement; all other Legend Drug vitamins and nutritional supplements.
• Anorexiants; Any cosmetic drugs including, but not limited to, Renova, skin pigmentation preps; Any
  drugs or products used for the treatment of baldness; Topical dental fluorides.
• Refills in excess of that specified by the prescribing Physician; or refills dispensed after one year
  from the original date of the prescription.
• Any drug labeled “Caution - limited by Federal Law for Investigational Use” or experimental drugs.
• Any drug which the Food and Drug Administration has determined to be contraindicated for the
  specific treatment.
• Drugs needed due to conditions caused, directly or indirectly, by an Insured Person taking part in a
  riot or other civil disorder; or the Insured Person taking part in the commission of a felony.
• Drugs needed due to conditions caused, directly or indirectly, by declared or undeclared war or an
  act of war; or drugs dispensed to an Insured Person while on active duty in any armed forces.
• Any expenses related to the administration of any drug.
• Needles or syringes unless shown under the definition of Prescription Drug.
• Drugs or medicines taken while in or administered by a hospital or any other health care facility or
  office.
• Drugs covered under Worker’s Compensation, Medicare, Medicaid or other Governmental program.
• Drugs, medicines or products, which are not Medically Necessary.
• Diaphragms; Erectile dysfunction Legend drugs, unless specifically listed in the definition of
  Prescription Drug; Infertility Legend drugs.
• Epi-Pen, Epi-Pen Jr., Ana-Kit, Ana-Guard; Glucagon-auto injection; Imitrex-auto injection.
• Smoking deterrents, Legend or over-the-counter.  

* Refer to the Master Policy for a complete list of exclusions and limitations. Some exclusions or limitations may vary depending on state of residence.

FIDELITY SECURITY LIFE INSURANCE COMPANY
3130 Broadway
Kansas City, MO 64111

Programs

Group Specific Program - 15+ Lives Enrolled

* Various Co-pay Options
* Options Deductibles
* Coinsurance
* Incentive Formulary
* Closed Formulary
* Open Formulary
* Annual Maximum Options
* Request for Proposal (Excel)
* Census (Excel)

PremiumScript Forms

1. Direct Reimbursement Form (Word)

2. Census Form (Excel)

3. Request For Proposal Form (Excel)

For state-specific Employer Applications and Employee Enrollment Forms, you may contact us at 1-866-872-7979.

Pharmacies

Emerson, Reid & Company has partnered with Catalyst Rx interactive, member area web site. Click here to go directly to the Catalyst Rx member area and use the menu to the left, so you can view the details of your benefit program, locate a participating pharmacy, lookup retail drug prices for a specific medication, and view your formulary.

If you have any other questions or concerns about the PremiumScript Rx Program, please contact your Emerson Reid sales representative or broker consultant.