Eligible prescription drugs are covered under the medical plan. You pay your share of the cost for coverage with a coinsurance payment when you fill your prescription at a participating pharmacy.
Your copay is determined by the type of medication you use and whether you fill your prescription at a participating pharmacy or through the mail-order program.
Retail Pharmacy: When you use a participating ProAct retail pharmacy, simply present your Aetna/ProAct ID card and pay the applicable coinsurance when you fill a prescription. You can locate a locate local retailer at www.proactrx.com, once enrolled, or by calling (877) 635-9545.
Mail Service Pharmacy: Use the mail-order program through ProAct as a convenient, cost-effective way to obtain maintenance medication, up to a 90-day supply. ProAct Home Delivery delivers your prescription right to your door. To participate, call (866) 287-9885 or access the home delivery website at www.proactrx.com.
Mandatory Mail Order or 90 Day Supply Retail Network: If your prescription is considered a maintenance drug, you will be required to participate in ProAct’s program to obtain your prescriptions. After the first time you fill a maintenance drug at a retail pharmacy, ProAct will send you instructions in the mail on how to utilize the mail-order program. You can also learn more about ProAct Mail Service Pharmacy program by visiting the ProAct website. Medicines that are used to treat conditions like arthritis, asthma or diabetes are covered through the Mail Service Pharmacy program where you can get up to a 90-day supply sent to you by mail.
Formulary: To determine which tier a prescription belongs to, you can call ProAct at (866) 287-9885.
Mandatory Generic Prescription Drugs: If your prescription is available in a generic form, you will be asked to use the generic version. If you choose not to use the generic version, you will be responsible for paying for the cost difference between the generic and the formulary or non-formulary prescription you prefer, even if the physician prescribes as “Dispense as Written” (DAW).
Tobacco Cessation Prescriptions: Prescriptions prescribed by your physician for tobacco cessation will be covered 100 percent by the prescription plan. These prescriptions include: Chantix; buproban (generic to Zyban, same as bupropion); bupropion (generic to Zyban) and Zyban; Nicotrol NS, Nicotrol inhaler, with a 180-day supply limit.
Diabetes: Prescriptions prescribed by your physician for diabetes are covered at 100 percent by Daymon (no copay) if generic or formulary brand name. You will only be responsible for a $15 copay if the prescription is a non-formulary brand name.
Step Therapy: With this requirement, some drugs are covered only after a member tries more clinically appropriate alternatives first. The alternative drug works the same and treats the same conditions. But it may cost less.
90 Day Supply Retail Network: This program limits the retailers Associates can visit for in-person 90-day prescription medication and includes Costco, Rite Aid, Kroger, etc. and allows Daymon to support its retailer partners while still providing convenient service to our Associates. This is an alternative to using the standard mail order program.A member may have a legitimate medical need for a drug that normally requires step therapy. When this happens, the prescribing doctor can ask for a medical exception. If the request isn’t approved, members can still get the drug. They would have to pay the full price of the prescription.
To learn more, go to www.proactrx.com or call ProAct at
Prior Authorization: A program which monitors certain prescription drugs and their costs to get you the medication you require while monitoring your safety and reducing costs. It makes certain you are getting the prescription that is suitable for the intended use and covered by your pharmacy benefit. When your pharmacist tells you your prescription needs prior authorization it means they need information from your physician. ProAct prior authorization phone lines are open 24 hours a day, seven days a week so your physician can provide the necessary information and the determination can be made right away.
Please note: You are automatically enrolled in prescription drug coverage if you participate in the Value, Consumer or Premium medical plan.
Group #: 657360
Member Services Phone: (877) 635-9545
Member Services Fax: (315) 287-3330