Understanding Your Benefits

doctor and patient talking

Pharmacy Benefit Dimensions® aims to help you take charge of your medications by keeping you educated and informed on how your prescription drug benefits work.

Below you’ll find some questions and helpful answers about the following:

Generic Drugs
Mail Order
Pre-Approval
Specialty Pharmacy Services
Safety

Generic Drugs

A generic drug is a drug that has the same active ingredient as a brand-name drug and is manufactured and marketed after the brand-name drug patent expires. In fact, about 50 percent of the generic drugs on the U.S. market are the actual brand-name drug product that has been relabeled and marketed under a generic product name.

Yes. The Food and Drug Administration (FDA) requires generic drugs to have the same quality and strength as brand-name drugs. Generic drugs also work as fast and as effectively as their brand-name versions.

In the United States, trademark laws do not allow generic drugs to appear identical to their brand-name counterparts. That’s why colors, flavors and certain other inactive ingredients may be different.

Yes. The FDA requires that all drugs be safe and effective. Since generic drugs use the same active ingredients, they have the same risks and benefits as their brand-name counterparts.

Generic drugs are typically much less expensive than brand-name drugs. This is due mainly to the absence of advertising, marketing, or research and development costs. Once generic drugs are approved, there is greater competition, which also keeps prices low.

Mail Order

Mail order is the process of having your prescriptions delivered directly to your home rather than having to pick them up at a pharmacy. The mail-order option is not only convenient, but it is also a way to save on prescription drug costs. By choosing to receive your prescriptions via mail order, you’ll receive a 90-day supply of maintenance medications at a reduced copayment (depending on your plan). Your medications are shipped to you by standard delivery at no additional cost to you (express shipping is available for an additional charge).

Medications available through mail-order pharmacies depend on the plan you have through your employer. Please check your summary plan description for the types of medications you may obtain through mail order.

Before using the mail-order pharmacies for the first time, you will have to register with the mail-order pharmacy. You may register online, by phone or by mail. You will then need to get a new prescription written by your doctor. Please ask your doctor to write a prescription for a 90-day supply for mail-order service plus refills for up to one year (as appropriate). For more information, view our Mail Order page.

You should have at least a 14-day supply of your medication on hand before you order. If you do not have enough medication, you may need to ask your doctor for a prescription for a 30-day supply to be filled at your local retail network pharmacy.

You can easily refill your prescription with the mail-order pharmacy online, by phone or by mail. Have your member ID and your prescription number for the medication handy. If you choose to pay by credit card, please have that number ready, too.

Pre-Approval

Pre-approval (also referred to as preauthorization) is the process of obtaining coverage approval for certain prescription drugs. To encourage and promote the safe use of medications, certain drugs may have to be approved for individual use prior to coverage.

Some common prescription drugs require pre-approval due to their wide range of uses and/or to ensure safety. Others may require pre-approval for quantities which are higher than the Food and Drug Administration (FDA) recommended daily dose or duration of therapy. Some types of drugs that may require pre-approval for quantity limitations are those for treatment of migraine headaches and sleep disorders.

In order to obtain a medication that requires pre-approval, certain criteria must be met. To obtain pre-approval, the prescribing physician submits a preauthorization request form to Pharmacy Benefit Dimensions. Requests are reviewed and responses are generally provided within 24 hours.

If your pharmacy rejects your prescription request, ask your pharmacist to call our Pharmacy Help Desk at 1-800-993-9898.

Specialty Pharmacy Services

Specialty medications are drugs that are typically prescribed to treat complex chronic conditions such as inflammatory conditions, cancer, growth and blood cell deficiency or multiple sclerosis. These medications usually require special storage, handling, enhanced patient counseling and support, and are distributed through designated specialty pharmacies.

Below is a listing of some of the specialty drugs that are included in our program:
Aranesp®
Arimidex®
Avonex®
Betaseron®
Copaxone®
Enbrel®
Epogen®
Gleevec®
Humira®
Iressa®
Neulasta®
Neupogen®
Procrit®
Xeloda®

Once your specialty drugs are prescribed, our specialty providers take some extra steps, including:

  • Arranging for convenient deliveries – directly to your home at no charge.
  • Supplying you with education on the drug you’re taking.
  • Offering refill reminders.
  • Providing information on additional supplies, if applicable.

Safety

When a new drug is approved by the Food and Drug Administration (FDA), we review it in detail using physicians’ and pharmacists’ input to determine potential safety rules and therapeutic concerns. We communicate this information through newsletters featuring the latest pharmacy news, educational mailings and meetings.

Yes. At the time of a pharmacist dispensing, we electronically review the medication and the patient’s current medication profile in order to identify possible safety issues.

Yes. After dispensing we may review both historical data and the latest information provided to us through our national prescription drug database. In addition, we receive timely alerts of new safety information on drugs and medical devices from the FDA. The alerts contain information that may impact both treatment and diagnostic choices for doctors and patients.

In addition, programs are in place to identify areas where certain drugs are taken too frequently and offer recommendations on drug alternatives. We offer drug compliance programs for several conditions including diabetes, asthma and cardiovascular disease.

The Food and Drug Administration’s (FDA) MedWatch page is your gateway for finding clinically important safety information and reporting serious problems with medical products. Visit the MedWatch page to learn more.

Questions? Call Us.

(716) 635-7880 or
1-888-878-9172.
TTY/TDD users may call
(716) 631-3108.

Need a Prior Authorization Form?

Download our Prior Authorization form here