Knowing your prescription coverage WellDyne prescription coverage puts patients first, offering safe and cost-effective medicine while providing the clinical care and support you need to manage your medication treatment. From the moment you enroll with WellDyne, we make it a priority to connect with you as an individual, offering the level of support you need at every step of your treatment plan. We are skilled at dispensing specialized medications for challenging health conditions, and our involvement goes beyond the basics. Here are some of the most frequently asked questions we get regarding your prescription coverage. Do I need to take my ID card with me to the pharmacy? It’s a good idea to carry your member ID card with you at all times. When you fill a prescription at a new pharmacy or start a new insurance plan, the pharmacist will need the specific information on your member ID card. This information will allow your pharmacy to properly fill your prescription, process your claim and tell you what your copay is at the time of purchase. Once you are in the pharmacy’s system, you shouldn’t have to show your ID card again, but it’s a good idea to keep it handy just in case. Who can I call for help? If you have questions about your benefit coverage, you can contact WellDyne Member Services at 888-479-0163 or go to welldyne.com for assistance. Why can’t I get my prescription filled? There are many reasons your prescription request might not process. Here are some common reasons. Check your plan information to see if any of these apply to you. Refill requested too soon. Your prescription can’t be refilled before it’s expected to run out. ● What can I do? If you need to refill sooner than allowed, ask your doctor to call WellDyne at 888-479-0163 to request an early refill. This may also require approval from your plan. Quantity limits. Based on your plan, your prescription might not be filled if the quantity requested is too high. Limits are placed for safety and to keep you from being overcharged. ● What can I do? Ask your doctor to call WellDyne at 888-479-0163 to request approval for the quantity over the limit, or get a new prescription from your doctor for an amount less than the limit set by your plan. Prior authorization. Depending on your plan, you may need to receive approval before you can get certain drugs. ● What can I do? Ask your doctor to call or fax WellDyne a prior authorization request. What is my co-pay? Your benefit program has three medicine categories, or tiers, that determine your co-pay. For information regarding your specific Kern Legacy health plan, visit www.kerncountyhealthbenefits.com to see your pharmacy co-pay structure or see what tier your medication is on by viewing the WellDyne Universal Formulary. ● Tier 1 drugs are typically generic drugs and have the lowest co-pay. ● Tier 2 drugs include preferred brand drugs and cost more than tier 1 drugs. ● Tier 3 drugs are typically nonpreferred brand drugs, and they have a high co-pay. Your plan may have additional tiers for specialty drugs or drugs that treat conditions that are not life-threatening. The co-pay for these tiers may be more or less expensive, depending on your plan.
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