The Trust’s four-tier therapeutically based prescription plan is designed to promote the use of proven, cost-effective medications.

The Sound Health & Wellness Trust uses a pharmacy network managed by Catalyst RX to provide discounts on prescription drugs. The Trust Custom Pharmacy Network consists of pharmacies owned by employers who participate in the Trust.

If you use a Trust Custom Network pharmacy, you will only pay the required co-payment when you pick up your prescription. If you fill your prescription at a Catalyst RX pharmacy that is not part of the Trust Custom Pharmacy Network, you will have to pay the full discounted price up front and submit a claim to the Trust Office for benefit reimbursement.

Maintenance prescription drugs written for a 30-day supply can be filled at a retail pharmacy. However, any maintenance prescriptions written in excess of a 30-day supply can only be purchased from Catalyst Mail (click here for a mail order form) or a Trust Custom Network pharmacy.

Tier 0—Some highly cost-effective medications: Co-pay per 30-day supply $0

• Cholesterol Lowering Medications (Simvastatin)
• Proton Pump Inhibitors (Prilosec OTC, with physician prescription)
• Non-sedating Antihistamines: Generic Claritin (Loratadine and Loratadine D)
• Metformin
• Lancets
• Omeprazole

Tier 1—Current generics, some future generics: Co-pay per 30-day supply: $6

Tier 2—Most brand drugs, and more costly or less desirable future generics: Co-pay per 30-day supply: $22

Tier 3—Non-preferred brand drugs and some undesirable future generics: Co-pay per 30-day supply: $35

Brand Name Drug with Generic Available
If you fill a prescription for a brand name drug when there is a generic, you will pay the generic co-pay plus the actual difference in cost between the generic and the brand name drug. If you do not identify yourself or dependents as participants in the Sound Health & Wellness Trust to the pharmacist when your prescription is filled, you will be assessed a processing fee in addition to the co-pay. The processing fee for generic is $10; the processing fee for brand is $20.

Maintenance “Mail” at Retail
Tier 3 Maintenance Drugs:
$60 co-pay for a 90 day supply if purchased at certain “Trust Network” pharmacies.

Mail Order (optional):
Co-pays for a 90 day supply listed below:

• Tier 0 - $0
• Tier 1 - $18
• Tier 2 - $66
• Tier 3 - $70
• Brand Name Drug with Generic Available - Generic co-pay plus the actual difference in cost between the generic and the brand name drug

Look to your benefits booklets for more information.

Find the details of your prescription drug coverage in your Summary Plan Description (choose the link below based on whether you are in the “Sound” or “SoundPlus” plan). To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. It is printed on the far left-hand side under the Trust logo.

• Sound Plan PPO Summary Plan Description (including 1/1/11 Benefit Changes)
• SoundPlus Plan PPO Summary Plan Description (including 1/1/11 Benefit Changes)
• Eligible Dependent Children Definition

$0 co-pay flu and pneumonia shots

Eligible Sound Health & Wellness Trust PPO plan participants and their covered dependents can receive $0 co-pay flu and pneumonia shots either at a pharmacy or at the doctor’s office, with coverage up to $30 for flu shots and $60 for pneumonia shots.

If you use a Trust Custom Network pharmacy you will pay nothing, up to $30 for a flu shot and $60 for a pneumonia shot. If you use any other Catalyst Rx pharmacy, you will pay a discounted amount for your shots. You can then submit your claim to the Trust Office for 100% reimbursement, up to the covered limits. If you prefer, you can still go to your doctor for your vaccination. As long as your doctor is an approved First Choice doctor, you will pay only your co-insurance if you are charged for an office visit, if your deductible has been satisfied.

• See a list of Trust Custom Network pharmacies
• Find a First Choice provider

Getting a flu shot is the single best way to protect against the flu. Children from 6 months to 19 years of age, pregnant women, people 50 and older, and people with certain chronic medical conditions are especially encouraged to get a flu shot. People aged 65 and older or those with chronic illnesses or compromised immune systems are highly encouraged to also get a pneumonia shot.