Prescription Drug Benefits

Plan Administrator

Navitus

Plan Benefits

The Los Angeles Machinist Benefit Trust offers the following prescription drug plans options. If you are enrolled in a PPO, refer to your Schedule of Benefits to see which plan option is available to you. If you enroll in an HMO, your prescription benefits will be provided under the HMO.

Prescription Drug Plan Options

Walk-In Pharmacies

  • High Plan

    • 30-day supply
    • Generic drug: $2 copay
    • Brand-name drug: $2 copay. Brand-name drugs are only covered when medically indicated or when a generic is unavailable.

  • Medium Plan

    • 30-day supply
    • Generic drug: $10 copay
    • Brand-name drug: $30 copay. Brand-name drugs are only covered when medically indicated or when a generic is unavailable.

  • Low Plan

    • 30-day supply
    • Generic drug: $10 copay
    • Brand-name drug: $30 copay. Brand-name drugs are only covered when medically indicated or when a generic is unavailable.

Mail-Order Service

  • High Plan

    • 60-day supply
    • Generic drug: $2 copay
    • Brand-name drug: $2 copay. Brand-name drugs are only covered when medically indicated or when a generic is unavailable.
    • Use of the mail-order service is not mandatory.

  • Medium Plan

    • 60-day supply
    • 2x retail copay
    • Use of the mail-order service is mandatory.

  • Low Plan

    • 60-day supply
    • 2x retail copay
    • Brand-name drugs are only covered when medically indicated or when a generic is unavailable.
    • Use of the mail-order service is mandatory.

To Locate Participating Pharmacies and Mail Order Facility

Call the Navitus Customer Service Center at 1-(866) 333-2757 to find the pharmacy nearest you.

What the Plan Covers

The prescription drug plan covers:

  • All Federal Legend drugs, including new drugs approved by the FDA;
  • Insulin, insulin syringes and needles, and certain diabetic supplies;
  • Compound medications, if at least one ingredient requires the Federal Legend; and
  • Smoking deterrents—up to a maximum benefit of $100 per person per lifetime.

Refer to your Summary Plan Description for complete details on Plan coverage, limits, and exclusions.

Filing a Claim

You do not need to file a claim for prescription drug benefits. You pay the applicable copay each time you fill or refill a prescription and the Plan pays the remainder of the cost.