prescription benefit

 

Tri-County Schools Insurance Group offers several methods

for you to obtain your prescriptions.

 

Retail Pharmacy 31 Day Supply

 

Retail 90 Day Supply

 

Mail Order Pharmacy: 90 Day Supply

 

Rx Brochure

 

 

Prescription Claim Form

Retail Pharmacy - 31-Day Supply

Present your medical I.D. card with your prescription. The pharmacist will fill your prescription and submit your claim electronically for you. You will be charged a copay based on the following criteria:

 

Generic - $5

Preferred Brand - 25% to a maximum of $35

Non-Preferred Brand - 45% to a maximum of $70

 

A covered person may elect a brand name product when a generic is available; however, the covered person will be liable for the difference in cost between the brand name and the generic drug along with the brand name copay.

 

A generic or formulary drug will automatically be substituted for a brand name drug unless there are health reasons and a letter of medical necessity from the prescribing physician has been received and approved by a panel of clinical pharmacists at EnvisionRxOptions. For your convenience letters of medical necessity can be faxed by the physician's office directly to Envision's clinical staff at (330) 405-8081. Letter of Medical Necessity Form

 

To locate a participating pharmacy or research prescription drug information, you can log onto EnvisionRx's website at www.envisionrx.com.

 

 

 

 

 

 

 

Retail Pharmacy - 90-Day Supply

Currently available at the following pharmacies: Bel Air, CVS, Kmart, Longs, Marysville Medicine Shoppe, Peach Tree Pharmacy, PJ's, Raley's, Rite Aid, Safeway, Target, Walgreens or Walmart.

 

Generic - $10

Preferred Brand - $50

Non-Preferred Brand - $90

 

When the retail cost of a Preferred or Non-Preferred Brand name drug is more than $67.00, you can save money using the Retail 90-day supply program.

 

This program was designed for individuals using maintenance medications for long-term medical conditions.

 

Have your doctor write your prescription for a 90-day supply with three refills, if appropriate.A covered person may elect a brand name product when a generic is available; however, the covered person will be liable for the difference in cost between the brand name and the generic drug along with the brand name copay.

 

A generic or formulary drug will automatically be substituted for a brand name drug unless there are health reasons and a letter of medical necessity from the prescribing physician has been received and approved by a panel of clinical pharmacists at EnvisionRxOptions. For your convenience letters of medical necessity can be faxed by the physician's office directly to Envision's clinical staff at (330) 405-8081.

 

To locate a participating pharmacy or research prescription drug information, you can log onto EnvisionRx's website at www.envisionrx.com.

 

 

 

 

 

 

 

Mail Order Pharmacy - 90-Day Supply

Generic - $10

Preferred Brand - $50

Non-Preferred Brand - $90

 

When the retail cost of a Preferred or Non-Preferred Brand name drug is more than $67.00, you can save money using the mail order pharmacy.

 

This program was designed for individuals using maintenance medications for long-term medical conditions.

 

• Have your doctor write your prescription for a 90-day supply with three refills, if appropriate.

 

• Complete the Order Form and Patient Profile questionnaire. The questionnaire will only need to be completed with
your first order.

 

• Select method of payment, i.e., credit card or check. Online ordering is available after your initial order.

 

A covered person may elect a brand name product when a generic is available; however, the covered person will be liable for the difference in cost between the brand name and the generic drug along with the brand name copay.

 

A generic or formulary drug will automatically be substituted for a brand name drug unless there are health reasons and a letter of medical necessity from the prescribing physician has been received and approved by a panel of clinical pharmacists at EnvisionRxOptions. For your convenience letters of medical necessity can be faxed by the physician's office directly to Envision's clinical staff (330) 405-8081.

Costco Web Patient Brochure

Mail your order form, prescription(s) and payment information to:

Costco Mail Order Pharmacy

215 Deininger Circle

Corona, CA  92880-9911

 

Location

802 134th St. SW

Bldg. C, Suite 140

Everett, WA 98204

 

Pharmacy Member Service

phone: 1-800-607-6861

fax: 1-800-633-0334

email: webpharmacy@Costco.com

 

Hours of Operation

Monday to Friday: 5:00AM to 7:00PM PST

Saturday: 9:30AM to 2:00PM PST

Sunday: Closed

 

Helpful hints to using the mail order pharmacy program:

• Always place your order at least 14 days before you will need your medication.

• Always ask your physician to write the prescription for a 90-day supply.

• Ask your physician to allow generic substitution.

• Always obtain a new written prescription when requested by Costco Pharmacy

• Always send your payment with your order.

 

 

 

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