_____________________________________________________________________________________________________________________ 2181 E Aurora Rd – Ste 201
This letter is to inform you that effective January 1, 2006, you will have a new prescriptionbenefit.
Starting January 1, 2006, Plumbers & Pipefitters Local Union 396 Health and Welfare Fundmembers will be required to utilize a formulary to determine drug coverage.A formulary dividesprescription medications into 3 categories. Tier One drugs are most generic drugs and aresubject to a co-payment of $10. Each prescription that you have filled with a formulary brandname drug (Tier 2) is subject to a co-payment of the maximum of $15 or 20%. For non-formulary brand name drugs (Tier 3) the co-payment is the maximum of $30 or 40%. A mail-service program is also available for those individuals taking maintenance medications for chronic medical conditions through the mail-order service pharmacy. Co-payments for a 90 day supply of these medications through the mail are $20 for most generic drugs, the maximum of $30 or 20% for formulary brand name drugs (Tier 2), and the maximum of $60 or 40% for non-formulary brand name drugs (tier 3).
Enclosed is a pocket formulary for you to refer to which lists the most prescribed medicationsthat are dispensed for medical conditions. For a full listing of medications on the new formulary,you may visit our website at www.envisionrx.com.
The following table lists commonly utilized non formulary drugs for Plumbers & Pipefitters LocalUnion 396 Health and Welfare Fund members. After each drug is the suggested formularyalternative. We recommend that you discuss your situation with your physician to see ifswitching to one of the recommended drugs is appropriate. GRANDFATHERED DRUGS
Use Atacand or Diovan or Atacand HCT or Diovan HCT
New prescriptions require Prior Authorization
Grandfather for 6 months. Expires 11/30/05
In addition, Plumbers & Pipefitters Local Union 396 Health and Welfare Fund is pleased toannounce a new benefit available to you. Prilosec OTC and Claritin OTC will be available as acovered benefit to Plumbers & Pipefitters Local Union 396 Health and Welfare Fund membersstarting January 1, 2006. Prilosec OTC and Claritin OTC will be covered at a zero for a 30 daysupply and $____ for a 90 day supply at mail order. You will need to have your doctor writea prescription specifically for Prilosec OTC or Claritin OTC to present to yourpharmacist. Your pharmacist will process that prescription like any other prescription. Please check with your doctor to see if these OTC therapies may be right for you.
Please feel free to contact our Help Desk at 1-800-361-4542 for any questions you mayhave regarding your new coverage.
Plumbers & Pipefitters Local Union396 Health and Welfare Fund___________________________
(Group Name) Envision/RxOptions
ESTRADIOL BOVINE ESTRADIOL ELISA TEST KIT PRODUCT PROFILE AND INSTRUCTIONS INTENDED USE The Microwell Estradiol ELISA TEST is an enzyme immunoassay system for quantitative determination of 17 beta Estradiol levels in bovine and related species serum. The test is intended for professional use as research tool in monitoring of conditions related to serum/plasma levels of Estradiol.
B. Footnotes, Version VI ( Clarified ) A. Dobutamine: 1. Start at 5 mcg/kg/min and increase by 5 mcg/kg/min increments at 15 minute intervals until ineffective circulation reversed (CI greater than or equal to 2.5 for PAC or fewer than 3 physical findings of ineffective circulation for CVP) or maximum dose of 20 mcg/kg/min reached. 2. Begin weaning 4 hours after ineffective cir
_____________________________________________________________________________________________________________________ 2181 E Aurora Rd – Ste 201
This letter is to inform you that effective January 1, 2006, you will have a new prescriptionbenefit.