You are eligible to use this prescription drug program if you are enrolled in the Early Retiree Plan. If you are less than 65 years of age and not eligible for the Early Retirement Plan you must select the Kaiser or Providence options, unless you are not within either of their service areas.
Four prescription drug options are available in this program. You decide which option to use at the time of purchase.
A number of brand name prescription drugs for allergies and stomach acid suppression now have generic equivalents or over-the-counter equivalents that can be obtained without a prescription. Therefore, brand name prescription drugs for allergies and stomach acid suppression are non-covered items unless the criteria in the next paragraph is met. This policy applies regardless of whether you obtain a brand name prescription drug for allergies or stomach acid suppression from the Kroger/Safeway Preferred Pharmacy Network, an out-of-network pharmacy, Option 90 or the Mail Order Pharmacy Drug Program. A partial list of brand name prescription drugs that will no longer be covered are set forth below.
- Allegra
- Allegra-D
- Clarinex
- Zyrtec
- Zyrtec-D
- Aciphex
- Nexium
- Prevacid
- Prilosec
- Protonix
A participant must try a generic or over-the-counter drug for allergies and stomach acid suppression before the Retired Trust Plan will cover a brand name prescription drug. In the event the generic or over-the-counter drug is not effective, the participant must do the following:
-
Your physician can obtain a Medical Exception Form by calling 1-800-482-1285. A form will be faxed to your physician.
Once completed, the physician or patient faxes the Medical Exception form to
1-630-328-2187. - The Medical Exception Form is valid for one year.
The pharmacy will dispense the authorized medication prescribed
by your physician for allergies or stomach acid suppression based on
the normal co-payment
provisions.
You can purchase up to a 30-day supply of a prescription drug through a preferred network pharmacy (Kroger/Safeway) by paying the normal co-payment.
You can purchase up to a 30-day supply of prescription drug through an out-of-network pharmacy by paying 100% of the cost and submitting your receipts for reimbursement. Reimbursement for an out-of-network prescription is based on a 30-day supply. If you get more than a 30-day supply, you will only be reimbursed for a 30-day supply.
You can purchase a 90-day supply of a prescription drug at Kroger owned pharmacies locally known as Fred Meyer and QFC. Medications taken on a long term basis (called maintenance medication), can be dispensed for 90-days. Obtain a prescription from your doctor authorizing a 90-day supply with three refills. There will be a lower out-of-pocket cost if you obtain your maintenance medication through Option 90 from Fred Meyer and QFC ONLY.
You can purchase a 90-day supply of a prescription drug from Postal Prescription Services (PPS). Medications taken on a long term basis (called maintenance medication), can be dispensed for 90-days. Obtain a prescription from your doctor authorizing a 90-day supply with three refills. There will be a lower out-of-pocket cost if you obtain your maintenance medication through Postal Prescription Services.
Retail Pharmacies Outside the Kroger / Safeway
Preferred Pharmacy Network
You do not have to obtain prescription drugs from the Kroger/Safeway
Preferred Pharmacy Network. To obtain a prescription drug from a pharmacy
other than
a Kroger/Safeway pharmacy, you must pay for the prescription at the time
of purchase. Obtain a pharmacy receipt that lists the drug name, quantity
dispensed and date of service. Contact the Trust
Office for a reimbursement
claim form. Mail the pharmacy receipt together with your name, address,
social security number and the Kroger Reimbursement Claim form to:
SXC Health Solutions
PO Box 3163
Lisle IL 60532-3163