Welcome to Partners RxYour Prescription Benefit Program

Welcome to Partners Rx Partners Rx provides a wide range of prescription benefit programs that emphasize quality and cost-effective healthcare solutions, driven to improve overall health. We’re pleased to welcome you to your prescription benefit program.

To fill your prescription needs, we offer more than 60,000 pharmacies, representing major chain regional pharmacies and independent stores. To locate a pharmacy, you can visit our website at www.partnersrx.com or contact one of our Customer Service agents at 1.800.711.4550.

If you choose to receive your covered maintenance medications through the Mail Order Pharmacy, your out-of-pocket costs may be less. For more information on using the Mail Order Pharmacy, please refer to the Mail Order Pharmacy section in this booklet.

Please present your identification card along with your prescription to any participating pharmacy to receive your medication. If you have any questions regarding your prescription benefit program, please call Partners Rx Customer Service at 1.800.711.4550. We are open 24 hours a day, 7 days a week.

An Introduction to Your Prescription Benefit Program Your prescription benefit program is designed to help you and your eligible dependents obtain prescription medications conveniently and at reasonable prices. We are committed to:

•Providingaqualityprescriptionbenefitprogramthatmeetsyourneedsandtheneeds of your family.

•Promotingtheuseofsafe,cost-effectiveandclinicallyappropriatemedications.

•Helpingyousavemoneyandprovidingconvenientaccesstoyour prescription medications.

•Helpingyouachievethebestpossiblehealthoutcomes.

This booklet is an important resource – along with the Partners Rx website (www.partnersrx.com) and our Customer Service Department at 1.800.711.4550. We encourage you to review this booklet and visit our website to educate yourself about your prescription benefit program. Understanding how your program works will help you get the most out of your benefit.

Maximizing Your Benefits

Generic MedicationsThere are now many generic products available to you on the market. Generic medications provide quality, cost-effective alternatives to brand medications. One or more of your prescriptions may be filled with a pharmaceutically equivalent generic product. We use generic equivalents, whenever possible, in order to reduce costs to you, your Plan and the health care system – unless otherwise directed by your physician. These medications have met the standards established by the Food and Drug Administration (FDA). The FDA approves a generic equivalent if its safety, purity, strength and effectiveness are proven to match that of the brand-name product. Please refer to the label on your prescription container to determine if you have received a generic equivalent.

In general, most plans require the use of generically equivalent products to obtain savings for their members. You may request a brand-name medication by notifying us on your prescription order. The brand-name product may be subject to a higher cost or copay as determined by your Plan.

Over-the-Counter (OTC) ProductsSome brand-name drugs previously available by prescription-only are now available over-the-counter (OTC). For example, drugs such as Claritin®, Prevacid®24HR,PrilosecOTC®, and Zyrtec® no longer require a prescription and are the same strength as their prescription versions. These OTC products may represent a reasonable therapeutic alternative to other medications in the same class of drugs that still require a prescription. In consultation with your physician, consider an OTC product as it may be a lower cost option to treat your condition. If your Plan provides OTC coverage, you may be eligible for additional benefits.

Mail ServiceThe Mail Order Pharmacy makes ordering maintenance medications easy and can save you both time and money compared to a retail pharmacy. Using your mail order benefit may enable you to receive up to a 90-day supply at a discounted price. Plus, shipping is at no cost to you – so you do not have to drive to your local pharmacy. Mail service benefits include:

•Savingtime

•Savingmoney

•Convenientdoor-to-doorservice

Mail Order Pharmacy Is Mail Order Right for Me?

Certain medications classified as maintenance medications are appropriate for mail service distribution. Maintenance medications are typically taken every day and on a long-term basis for chronic conditions. Common chronic conditions include:

•Highbloodpressure

•Highcholesterol

•Diabetes

•Asthma

•Osteoporosis

If your Plan includes a mail order benefit, it is usually recommended that you ask your physician to write two prescriptions: one for a 30-day supply to get you started (to be filled at your local pharmacy), and one for a 90-day supply, plus additional refills (to be filled at the Mail Order Pharmacy). After you have taken the new medication and achieved a positive response with no side effects, you can submit the 90-day prescription to the Mail Order Pharmacy.

Four Ways to Get Started Using Mail Service Option 1: Your physician can fax usIf you would like to save mailing time, your physician can fax your prescriptions directly to the processing center at 1.800.491.7997, 24 hours a day, 7 days a week. (NOTE: Faxed prescriptions can only be accepted from your physician’s office.)

Option 2: Your physician can phone usWe offer the convenience of accepting phoned-in new prescriptions and refill renewals directly from your physician’s office. Our pharmacist phone team can be reached at 1.800.711.4550 (TTY/TDD 1.800.498.5428), 8 a.m.-8 p.m., CT, Monday-Friday, excluding certain holidays.

Option 3: You can mail your prescriptionsComplete the attached mail-in order form and mail along with your new 90-day prescriptions. Please include your date of birth and ID number on each prescription.

•Fornewlyprescribedmedications,askyourphysiciantowritetwoprescriptions:one for a 30-day supply to get you started (to be filled at your local pharmacy), and one for a 90-day supply, plus additional refills, to be submitted for mail order.

•Formedicationsyouarecurrentlytaking,askyourphysiciantowriteaprescriptionfor a 90-day supply, plus refills.

Option 4: We’ll call your physician for youWe will contact your physician to request each of your prescriptions be converted to a 90-day supply. You will need to:

•Call1.800.711.4550 (TTY/TDD 1.800.498.5428), available 24 hours a day, 7 days a week.

•Provideyourmedicationnamesanddosagesalongwithyour physician’s name and phone number.

Packaging and Delivery To ensure that your order is delivered to you in a timely manner, the Mail Order Pharmacy uses the United States Postal Service (USPS) along with other national carriers. Standard delivery is at no cost to you, and most orders should arrive about seven days after we receive your complete order. Refills are usually processed and shipped within 48 hours of receiving the request (please allow for postal delivery time). Each shipped order will include a reorder form and detailed drug information for each medication. Refrigerated items are shipped next day delivery in a Styrofoam container with ice packs. For certain medications, such as controlled substances, “signature service” may be required.

If we need to contact you or your physician about your order, delivery may take longer. If you prefer rush delivery, your order can be shipped overnight for an additional charge.You should fill your prescriptions locally if you are out of your medications and cannot wait for your mail order prescription to arrive.

Refills Are Even Easier It’s easy to order refills or check how many refills you have available. Refills can be ordered online at www.partnersrx.com, via the automated phone system, or by calling Customer Service. In addition, you will receive a reorder form with each shipment. Once you register online, you will receive an email reminder when it’s time to refill your medication.

Pharmacists are Available 24 Hours a Day, 7 Days a Week

If you would like a consultation with one of our pharmacists, or you have questions or concerns regarding your medications, pharmacists are available 24 hours a day, 7 days a week. Please call 1.800.711.4550 to speak with one of our consultant pharmacists.

Your Medication Safety is Protected by Our Professional Staff Every prescription submitted to the Mail Order Pharmacy is screened by our team of registered pharmacists for accuracy, drug interactions, allergies, and appropriateness of therapy. We maintain a complete record of all your current medications, regardless of where you had them filled.‡ If for any reason we believe your prescription needs clarification, we will contact you or your physician. If we are unable to resolve the issue and anticipate a delay in shipping your order, we will contact you.

‡ Refers to medications filled using your prescription benefit

Taking Your Medications As Directed Taking medications exactly as prescribed is one of the most important things you can do to enhance your health and prevent medical complications. Missing doses, stopping medication early or swapping medications with other people can lead to serious problems.

Hereareafewtipstohelpyougetthegreatestbenefitfromyourmedications:

•Readlabelscarefullybeforetakingeachmedication.

•Askyourphysicianorpharmacistwhattodoifyoumissadose.

•Takeeachmedicationasprescribedbyyourphysician.Forexample,takethecorrect number of doses each day, at the correct time of day.

•Talktoyourphysicianorpharmacistbeforeyoustoptakingamedication. Do not stop taking a medication just because you feel better.

•Talktoyourphysicianorpharmacistbeforecrushingorsplittingtablets; some medications need to be swallowed whole.

•Keeparecordofallyourcurrentmedications,includingtheirnamesand regimens (dose, time and other instructions).

•Writedownanyproblemsyouhavewithyourmedications,anddiscussthem with your physician or pharmacist.

•Keepmedicationsawayfromheat,lightandmoisture.Neverstoremedicationsin the bathroom.

•Maketakingyourmedicationsapartofyourdailyschedule.

•Properlydiscardalloutdatedmedications.CallCustomerService,visit www.partnersrx.com, or review FDA guidelines* for information on how to properly discard your outdated medications.

*FoodandDrugAdministration,“HowtoDisposeofUnusedMedicines,”October2009.http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm

Online ResourcesHealth Tools and Information are Just a Click Away

Our website, www.partnersrx.com, is easy to use and offers a safe and secure online environment that protects your confidentiality. Now you can take advantage of our one-stop online pharmacy for all your mail order prescription refills.

Refilling your prescriptions online is fast, easy, safe and convenient. When you order online, you eliminate mail time and can rest assured that your prescriptions are filled using the same quality and accuracy checks as any other prescription. Most health plans offer lower copays when you order from the Mail Order Pharmacy. Best of all, there is no charge to you for standard shipping with all your prescription orders.

Online tools* available at www.partnersrx.com include:

•Prescription Refills – Refill a current prescription.

• Prescription History – Track your prescription order history, expenses and savings.

•Find a Pharmacy – Locate a retail pharmacy. This is especially helpful if you travel frequently and need to find a pharmacy while you’re on the road.

•Drug Information – Find information about prescription medications, such as common uses, use instructions, cautions, side effects and more.

•Drug List – Check your Plan’s drug formulary to find out what medications are covered.

•Order Status – Track your online order history.

•Member Health Education – Get information about common diseases, medications and other consumer-related questions.

*Notallofthesefeaturesareavailabletoallusers;availabilityvariesbyPlan.

Information and Security You Can TrustYou can rest assured when you visit www.partnersrx.com that your personal information will be safeguarded. You can also be confident in the reliability and quality we provide.

Register Today! It’s Easy!Register today and take the first step to managing your prescription medications and health products needs online with www.partnersrx.com. You can register anytime.

Partners Rx Formulary A Prescription Drug List, or formulary, is a list of brand-name and generic medications that have undergone a careful review by a committee of practicing physicians and pharmacists. This committee reviews new and existing medications for safety and efficacy, and decides which medications provide quality treatment at the best value. The formulary is updated several times a year as new medications become available and is subject to change. For the most up-to-date information, or for a full formulary listing, visit www.partnersrx.com (“Members” section).

While the formulary is intended to provide a comprehensive coverage of your prescription medication needs, there are some products that are not covered or have limited availability. For medications that are not on the formulary or are not covered by your prescription benefit program, talk to your physician about alternative medications.

How Can I Find Out What Medications Are On My Plan’s Formulary?The Partners Rx Prescription Drug List is updated several times every year as new medications become available. The list is subject to change. For the most up-to-date information, visit www.partnersrx.com (“Members” section) or call Customer Service at 1.800.711.4550.

For specific coverage and limitations information, as well as details about your copay, please refer to your benefit plan documents.

Partners Rx Quick Reference FormularyMost Commonly Prescribed MedicationsAll generic medications are listed on the Partners Rx formulary. Please use this quick reference list when you receive a prescription. To receive maximum prescription drug benefits, ask your doctor to prescribe a medication on this formulary. Remember, if a preferred drug from the formulary is prescribed, your copay may be less than if a non-preferred drug (a drug not on the complete formulary list) is prescribed for you. To see the complete formulary, visit www.partnersrx.com, under Members, or call toll-free 1.800.711.4550.

Drugs are listed alphabetically by brand name.

KeyLowest Copay = (generics)Middle Copay = Preferred BrandHighest Copay = Non-Preferred Brand*

A-BAccu-Chek: Aviva, CompactActivella* (estradiol/ norethindrone)ActonelActoPlus Met, XRActosAdvairAloraAlphagan P* (brimonidine)Altace* (ramipril)Amaryl* (glimeperide)Ambien* (zolpidem)Amoxil* (amoxicillin)

Anaprox, DS* (naproxen sodium)AndroGelAnsaid* (flurbiprofen)ArixtraAsacolAsmanexAstelinAtrovent* (ipratropium bromide)Augmentin* (amox/clav)AvalideAvaproAzoptAzor

Bactrim, DS* (sulfamethoxazole/ trimethoprim)Bayer: Contour, Breeze 2Benicar,HCTBetagan* (levobunolol)BetimolBetopic SBeyazBonivaByetta

C-ECalan, SR* (verapamil, SR)

Capoten* (captopril)Carafate* (sucralfate)Cardizem* (diltiazem)Cardura* (doxazosin)Ceclor, CD* (cefaclor, ER)Ceftin* (cefuroxime)Cefzil* (cefprozil)CenestinCipro* (ciprofloxacin)CiprodexClimara* (estradiol patch)Climara ProCoreg* (carvedilol)Coreg CRCorgard* (nadolol)CortifoamCosopt* (dorzolamide-timolol)Coumadin (warfarin)Cozaar* (losartan)CrestorCrolom* (cromolyn)CymbaltaDesyrel* (trazodone)Detrol, LADiabeta* (glyburide)Diflucan* (fluconazole)Dilacor XR* (diltiazem CR)DipentumDiovan,HCTDuacDyazide* (triamterene/ HCTZ)Effexor* (venlafaxine)

Effexor XR (venlafaxine XR)EffientEstrace* (estradiol)Estraderm* (estradiol)EvistaExforgeHCT

F-JFemHRT*(norethindrone/ estradiol)Flomax* (tamsulosin)Flonase* (fluticasone)Flovent,HFAForadilFosamax* (alendronate)Fosamax-D*FosrenolGlucophage, XR* (metformin, ER)Glucotrol, XL* (glipizide)Glucovance* (glyburide/ metformin)Glynase Prestab* (glyburide micro)GlysetHalcion*(triazolam)Humalog,HumulinHydrodiuril* (hydrochlorothiazide)Hytrin*(terazosin)Hyzaar*(losartanHCT)Imdur* (isosorbide mononitrate)Imitrex* (sumatriptan)

Inderal* (propranolol)Inderal LA* (propranolol LA)Indocin, SR* (indomethacin, SR)ISMO* (isosorbide mononitrate)Isoptin, SR* (verapamil, SR)Isordil* (isosorbide dinitrate)JanumetJanuvia

K-NKeflex*(cephalexin)Lanoxin (digoxin)LantusLasix* (furosemide)Levaquin* (levofloxacin)LevemirLexaproLipitor (atorvastatin)Lodine* (etodolac)Lopid* (gemfibrozil)Lopressor* (metoprolol)Lortab* (hydrocodone/ APAP)Lotensin,HCT* (benazepril/HCTZ)Lotrel* (amlodipine/ benazepril)LovazaLozol* (indapamide)

Maxzide* (triamterene/ HCTZ)Metaglip* (glipizide/ metformin)Micronase* (glyburide)Mirapex* (pramipexole)Motrin* (ibuprofen)Nalfon* (fenoprofen)NamendaNaprosyn* (naproxen)NasonexNataziaNiaspanNitro-Dur (nitroglycerin patch)NitrostatNizoral* (ketoconazole)Norpramin* (desipramine)Norvasc* (amlodipine)Novolin, Novolog

O-QOcupress* (carteolol)Ogen* (estropipate)Omnicef* (cefdinir)Ortho-Est* (estropipate)Orudis* (ketoprofen)Pamelor* (nortriptyline)Persantine* (dipyridamole)PlavixPrandinPrecose* (acarbose)Premarin

PremproPremphasePrinivil* (lisinopril)Prinzide* (lisinopril/hctz)PristiqProAirHFAPrometriumProtonix (pantoprazole)Provera* (medroxy - progesterone)Prozac* (fluoxetine)PulmicortQuestran* (cholestyramine)QVAR

R-ZRemeron* (mirtazapine)Requip* (ropinirole)Restoril* (temazepam)SafyralSeptra, DS* (sulfamethoxazole/ trimethoprim)Serevent DiskusSeroquelSeroquel XRSingulairSpirivaStarlix* (nateglinide)SymbicortSymlinSynthroid (levothyroxine)Tenormin* (atenolol)

Timoptic XE* (timolol, XE)Tolectin* (tolmetin)Toprol XL* (metoprolol XL)Travatan ZTrental* (pentoxifylline)TricorTrusopt* (dorzolamide)Uniphyl* (theophylline)Verelan* (verapamil SR)VESIcareVivelle, Vivelle DotVoltaren* (diclofenac)WelcholWellbutrin, SR* (bupropion)Wellbutrin XL* (bupropion XL)Xalatan* (latanoprost)XopenexHFAZantac* (ranitidine)Zaroxolyn* (metolazone)ZenpepZetiaZithromax* (azithromycin)Zocor* (simvastatin)Zoloft* (sertraline)Zomig, ZMTZyprexaZyprexa Zydis

Note: This is a partial list of medications that changes periodically. To ensure you have the most current version of the Partners Rx formulary, visit www.partnersrx.com, under Members, or call toll-free 1.800.711.4550. Inclusion of a medication on this formulary is not a guarantee of coverage. Please refer to your plan of benefits for coverage limitations and exclusions. Not all benefits plans in all states are subject to quantity limits. For details regarding quantity limits for your particular benefits plan, contact Customer Service at the telephone number listed on your identification card.

Additional Requirements for Coverage or Limits on Certain Medications May Include:Prior AuthorizationYour prescription benefit program may have a prior authorization process for certain medications. Prior authorization is a requirement that your physician obtain approval from your health plan to prescribe a specific medication for you. Without this prior approval, your health plan may not provide coverage for your medication.

If your physician prescribes a medication requiring a prior authorization, you will need to go through a prior authorization process. We review requests for these selected medications to help ensure appropriate and safe use of medications for your medical condition(s). Your physician can call, fax, or submit prior authorization requests electronically. For a list of select medications that require prior authorization, please contact Customer Service at 1.800.711.4550.

Quantity Limits and Step Therapy Your Plan may have additional requirements for coverage or limits for select prescription medications. These requirements and limits ensure that members use these medications in the most effective way and also help the Plan control medication costs. A team of practicing physicians and pharmacists developed these requirements and limits to help your Plan provide quality coverage to members. Please consult the formulary on our website for more information.

Quantity LimitsFor certain medications, your Plan may limit the amount of the medication that will be covered per prescription or for a defined period of time. For example, your Plan may provide up to 30 units per 30-day period for a formulary medication.

Step TherapyIn some cases, your Plan requires you to first try one medication to treat your medical condition before it will cover another medication for that condition. For example, if Drug A and Drug B both treat your medical condition, your Plan may require your physician to prescribe Drug A first. If Drug A does not work for you, then your Plan will cover Drug B.

You can find out if the medication you take is subject to these or other additional requirements or limits by looking in the current formulary on www.partnersrx.com (“Members” section), or by calling Customer Service at 1.800.711.4550.

Partners Rx Contact Information

Departments/Services for MembersWebsite www.partnersrx.com

Customer Service 1.800.711.4550

Customer Service TTY/TDD 1.800.498.5428 (For the hearing impaired)

Mail Service Pharmacy 1.800.711.4550

Departments/Services for PhysiciansPrior Authorization Phone: 1.800.711.4555, Press option 1 Fax: 1.800.527.0531

Injectable Prior Authorization Phone: 1.800.711.4555, Press option 2 (Other than insulin) Fax: 1.800.853.3844

Electronically www.partnersrx.com (The request form is located under HealthcareProfessionals.)

Department HoursCustomer Service 24 hours a day, 7 days a weekPrior Authorization Monday-Friday, 5 am - 7 pm, Pacific Time Saturday 6 am – 3 pm, Pacific Time

In Case of EmergencyIn the event of an emergency or natural disaster, contact Customer Service for assistance. We will help you obtain an immediate refill at a local pharmacy if needed.

Medications ListAllergies to MedicationsUse the chart below to list all medications, both prescription and nonprescription, to which you are allergic.

Medication Type of reaction, such as rash or breathing difficulties.

Prescription MedicationsUse the chart below to list all brand name and generic prescription medications youcurrently take. Be sure to fill in all the information for each medication. The amount of medication in each pill appears on the prescription label in milligrams (mg). Thedosage is the amount of medication in each pill multiplied by the number of pills you take at one time.

MedicationPrescribing doctor

Reason for taking the medication Dosage

How often? (such as 3x/day)

MedicationPrescribing doctor

Reason for taking the medication Dosage

How often? (such as 3x/day)

About Partners Rx Partners Rx was founded with a mission to provide comprehensive prescription benefits management (PBM) services. Our goal is to help our clients provide safe and effective prescription drugs at the lowest total cost to you. “We’re in this business together” isn’t just a marketing statement, it’s our philosophy.

How to Find Information About Your PlanFor the most up-to-date information about your prescription benefit program, visit us online at www.partnersrx.com or call Customer Service at 1.800.711.4550.

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