Comprehensive Major Medical (CMM)
If you have “CMM,” you are enrolled in a comprehensive major medical
plan. With CMM, your health plan’s deductible, coinsurance, and/or copayment
apply to your prescription drugs. Refer to your health plan’s certificate
for details about your prescription drug coverage. The Wellmark Drug
List
can help you identify cost-saving drugs.
How it Works
- Ask your physician if the drug is generic. If it isn’t, ask
whether a generic equivalent drug is available
- Choose a pharmacy that
contracts with Catalyst Rx. More than 59,000 pharmacies
throughout the United States contract with Catalyst Rx*
- To find a participating pharmacy, locate a pharmacy using our
online directory
- Show your Wellmark
ID card to the pharmacist each time you have a prescription filled.
You will automatically get the lowest price available to Wellmark members
at
that pharmacy
- Pay the pharmacist for the cost of the prescription. The pharmacist
will submit the claim for you
- Receive reimbursement by mail. Wellmark will reimburse
you for covered prescription drug expenses, less deductible and coinsurance
amounts.
What You Get
1. Nationwide pharmacy network.
The Catalyst Rx network that supports Wellmark's CMM drug customers
is one of the most expansive pharmacy networks in the country.
2. No claim forms to fill out.
When you present your Wellmark ID
card at participating pharmacies, your claims are submitted automatically
while
your prescriptions are being filled! No paper claims. No hassles.
3. Cost savings.
Presenting your Wellmark ID to the
pharmacist before the prescription is filled ensures that you
pay only your share
of the costs.
4. Wellmark Drug List.
Our drug list, a comparative
listing of drugs, helps manage the overall cost of prescription
medications
by promoting the use of more cost-effective drugs. Search
the Wellmark
Drug List.
5. Benefits at out-of-network pharmacies.
Even if an out-of-network
pharmacy is used, you still have benefits. However, these pharmacies
do not have
benefit information available. You will have to fill out and submit
a paper claim to Wellmark. Wellmark will be reimburse you for covered
prescription
drug expenses, less deductible and coinsurance amounts. Questions
About Your Specific Benefits
- Refer to your benefits certificate, coverage manual, or policy
- Call the Customer Service number
on your identification card
Who
Can Purchase
Please note: This information is only a summary of the benefits
of CMM coverage from Wellmark Blue Cross and Blue Shield; it
is to be used for
descriptive purposes only. Benefits and general provisions described
herein are subject to terms of the actual policy, benefits certificate,
or coverage manual.
* Catalyst Rx, 2nd Quarter, 2007
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