Pharmacy Coverage

Signature Plan: Members have the below prescription benefits.
Advantage Plan: Members have the below prescription benefits once the deductible is met.

(1) Select products are eligible for a coinsurance assistance program. There is no copay for these products and they do not accumulate toward the out-ofpocket maximum. For more information contact THT at 702-794-0272, Option 1. (2) Prescriptions filled at pharmacies other than THT’s Exclusive Network Retail Pharmacies will incur a $10 per prescription choice fee in addition to applicable copays. The pharmacy choice fee does not accumulate toward your outof-pocket maximum. (3) If the generic cost of the medication is less than the copay, the individual will be responsible for that lesser amount. (4) For more information about this service, please contact CerpassRX at 844-622-1797.

The Prescription Optimization Program (POP) is a complimentary service available to THT members facing challenges in affording critical medications. The program provides assistance through Patient Assistance Programs, manufacturer copay cards, and international filling options.
All high-cost medications (exceeding $1,000 for a 30-day supply or $2,000 for a 90-day supply) require prior authorization from CerpassRx and routing through the Pharmacy Optimization Program (POP). Prescriptions for high-cost medications are denied unless they are routed through the Pharmacy Optimization Program. If your medication rejects at the pharmacy, we encourage you to call CerpassRx for 24/7 assistance. Our dedicated POP team may request additional information to meet funding requirements, which is kept confidential.

CerpassRx POP Inquiries:

Prescription assistance that is offered by pharmaceutical companies to provide free or discounted medications to people who cannot afford them.

These are provided by the pharmaceutical companies to help members afford expensive medications by reducing the out-of-pocket costs.

We direct members to a trusted organization that can supply the medication from an international pharmacy at a significantly discounted rate to the plan and FREE to the member.

Select medications are available with a $0 copay after completing 2 simple requirements. This means you can access the medications you need without any out-of-pocket expense.

1. Short online questionnaire via THT portal:

   We kindly ask for your cooperation in completing a short questionnaire that helps us gather important information about your healthcare needs. This questionnaire is a vital component of the program and must be completed once a year. To take the questionnaire, register/login to the THT member portal and click the button “Specialty Drug Questionnaire”.

   Once the questionnaire has been submitted, a Member Specialist will contact you within 24-48 business hours to guide you through the next steps of the enrollment process. Please note that appointments with the provider are currently being scheduled 1–2 weeks after the first contact with a Member Specialist, and the overall process may take some time to complete.

2. Virtual consultation with a healthcare provider:

   We have partnered with First Person Care Clinic, a trusted healthcare provider, to schedule and complete a short virtual consultation. During the virtual session, you will have the opportunity to discuss your medications and any questions you may have. This consultation must be performed once a year.

3. Pick up your meds (or have them delivered for free!):

   Once your virtual consultation and questionnaire are complete, your medications will be fulfilled through a trusted pharmacy partner. You’ll have the flexibility to choose the option that best suits your lifestyle: convenient in-person pickup or free home delivery.

The list of all the medications covered is called the formulary. CerpassRx manages THT’s formulary and recommends updates every six months as new medications appear on the market. Use the online formulary to determine which medications are covered and at what tier. For all non-covered medications, a list of covered alternatives is available. Consult with your provider to see if these covered alternatives may be right for you.

You won’t find many differences, except for names and prices. The manufacturer assigns a brand name, while a generic drug uses the chemical name; both products have the same active ingredients, strength and dosage form, such as liquid or pill.

Prior Authorization encourages safe, cost-effective medication use by allowing coverage when certain conditions are met. Prior Authorizations in most cases are approved for a specific time period and maybe subject to continuous evaluation. Your doctor can request a Prior Authorization form from CerpassRx by calling the toll-free number (844) 622-1797 to have a form sent by electronic fax. The member and prescriber will receive a letter confirmation of the outcome. If approved, the CerpassRx team will reach out to your pharmacy for reprocessing.

This claim form should be used if you purchased a prescription before receiving your CerpassRx card, didn’t use your card, or used a non-participating pharmacy. Submit the form promptly after filling your prescription(s) to ensure quick payment.

Teachers Health Trust covers your Covid-19 test at the following locations at 100 percent: (Ensure they are sending your Covid-19 test to Quest)

• CVS Minute Clinics

• In-Network Physician Offices

• Quest Diagnostics

Please verify with our benefits team at (702) 794-0272 for any freestanding Covid testing facility.

If you have been tested and are prescribed Paxlovid, your pharmacy benefit will apply.

Your initial COVID-19 vaccination and/or booster shot is covered at 100 percent at the following locations:

• CVS Minute Clinics

• In-Network Physician Offices

• In-Network Pharmacies

If you have been admitted to the hospital for Covid-19, your benefits will be aligned with your plan’s current hospital benefits.

At-home tests are available to you at no charge via federal programs or when you purchase from our in-network partners. If you choose to purchase an at-home test outside of these pharmacies, you will not be covered. A maximum of 4 per member per month still applies. If you paid for a test at a partner pharmacy, please submit a reimbursement form.