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Prescription Drug Plan Benefits – Providers

Retail and Mail Service Pharmacy Services

Most prescription drugs or medications are covered under the UMWA Funds benefit plans. You may select from over 64,000 retail pharmacies or choose the CVS Caremark mail service pharmacy to have your prescriptions filled. Copayments are lower when you use the mail service pharmacy for your medications.

Prescribing Guide for beneficiaries under:
  • American Consolidated Natural Resources Plans
  • Crimson Oak Grove Resources Plans
  • UMWA International Plan
Prescribing Guide for all other beneficiary plans.
If you are unsure about your plan please contact our call center at (800)-291-1425.

To ePrescribe choose:

CVS Caremark MAILSERVICE Pharmacy
NCPDP ID: 0322038
9501 E Shea Blvd.
Scottsdale, AZ 85260

See Link below to fax:


​Making sure your patients have access to affordable medications is our priority. Hyperinflation Medication drugs seeing very high price inflation or big price tags compared to clinically equivalent alternatives require a medical necessity review before coverage by the Funds. Medications requiring medical necessity review may change. See link below for the current list.

Hyperinflation Medication List

Generic Substitution Program

A generic drug is identical to a brand name drug in safety, strength, quality and performance. The generic drug substitution program requires that generic drugs be dispensed. Therefore, if a beneficiary chooses a brand name drug when a generic drug is available, they will need to pay the difference between the costs of the brand name drug and the generic drug.

If a beneficiary has already tried and cannot take the generic drug due to a specific medical reason(s), their doctor should fax a letter of medical necessity to 1-888-487-9257 to provide medical information as to why the generic medication should not be dispensed. If approved, the beneficiary will not pay the difference between the brand name drug and the generic drug.

Review Medical Necessity Form here.

Specialty Pharmacy Program

The Funds utilizes CVS Specialty Pharmacy to receive specialty medications to beneficiaries. Pharmacists at this pharmacy work with you and the beneficiary to ensure proper dosing and testing to achieve maximum effectiveness of the drug while minimizing side effects. You can enroll a Funds’ beneficiary in CVS Caremark’s® Specialty Drug Program by one of the following methods:

1. Call CVS Specialty Pharmacy at 1-800-237-2767
2. Email CVS Specialty Pharmacy at [email protected]
3. Fax CVS Specialty Pharmacy at 1-800-323-2445
4. ePrescribe:
CVS Specialty Pharmacy
NCPDP ID 1466033
800 Biermann Court
Mount Prospect, IL 60056

The Funds currently participates in a Specialty Preferred Products Program. The program requires the use of a preferred product in select categories before a non-preferred medication will be covered. The select categories of medications are those that treat autoimmune diseases, Multiple Sclerosis, Hepatitis C and Growth Hormone. To see the complete list of specialty drugs covered under the Funds’ Specialty Preferred Products Program. Please see link below.

Advanced Controlled Preferred Product Program Drug List

Preferred Product Program

The Preferred Product Program allows Funds’ beneficiaries to obtain preferred medications from five drug classes for the standard copayment.

  • ARB/ARB Combinations (Blood Pressure Drugs)
  • Hypnotics (Sleep Aids)
  • DPP-4 Inhibitors and Combination (Diabetes Drugs)
  • Urinary Antispasmodics (Overactive Bladder)
  • Irritable Bowel Syndrome with Constipation/ Chronic Idiopathic Constipation

The program only applies to the medications listed in the specified drug classes. The program is administered in two different ways, depending on the which plan the beneficiary is enrolled in.  It requires either a prior authorization or some plans allow for a surcharge.

Review Standard Formulary Preferred Product Program Drug List here.

Review Supplemental Formulary Preferred Product Program Drug List here.

Prior Authorization

A prior authorization review process, which is based upon medical necessity, is available if you believe that the beneficiary must have the brand or the non-preferred product for medical reasons. You may call CVS Caremark® at 1-800-294-4741 with questions about the Preferred Product Program. To obtain a prior authorization call 1-800-294-5979.

Prior Authorization Form