Hospitality Rx is part of UNITE HERE HEALTH—your union’s health fund. We’re a team of pharmacists and pharmacy technicians. We manage your prescription drug benefits.

• Visit hospitalityrx.org
• Click on the “Members” tab at the top of the page
• Select your plan
• Click on the “Find your nearest pharmacy” link under the red and blue pharmacy chart; then enter your city or zip code
  

• Visit http://drugs.hospitalityrx.org to use our drug lookup tool
• Select your plan
• Enter your drug’s class or name and hit “search”
• You will see a list of brand name and generic drugs covered by your plan (also called the “formulary”), along with a copay for each one. This search will also tell you if a medication is NOT covered.

Remember: generic drugs save you money!

These programs help make sure the medicines you take are safe, effective, and are being used correctly. As always, you should work with your doctor to decide which drug works best for you.

• Prior Authorization: Before your plan will cover a certain drug, you doctor must request approval and show that it is medically necessary.
• Step Therapy: You must first try a less expensive drug (one that’s proven to be just as effective) before you can move up—or “step”—to a more expensive drug.
• Quantity Limit: Safe limits on the amount of drugs a plan covers during a certain period of time.

To find out if your medications have quantity limits or require prior authorization or step therapy, use our drup lookup tool at: https://drugs.hospitalityrx.org.

There are several reasons why a medication isn’t covered:

• You do not have a valid prescription or no prescription is needed.
• Your prescription requires prior authorization.
• It is not on your Formulary (the list of brand name and generic drugs covered by your plan).
• It is not a covered benefit.
• It is a medical device (devices aren’t covered under your pharmacy benefit but may be covered under your medical benefit).
• It is new or experimental.
• The Food and Drug Administration (FDA) has decided that it isn’t effective and/or safe.
• The medication is something given in your doctor’s office like injections or inhalers. (These may be covered under your medical)
• You no longer have coverage with UNITE HERE HEALTH.

Please call Hospitality Rx if you have questions: (844) 484-4726

 

• Visit http://drugs.hospitalityrx.org to use our drug lookup tool
• Select your plan
• Enter the name of the drug that isn’t covered or select its class
• This search will give you a list of alternative drugs or a phone number to call
• After you call the phone number, work with your doctor to decide which drug will work best for you

Please call Hospitality Rx if you have questions: (844) 484-4726

• Specialty drugs are high-cost medicines used to treat complex conditions such as cancer, rheumatoid arthritis, and HIV.
• Because these drugs require special handling, only WellDyne Specialty Pharmacy can fill and deliver these prescriptions (through mail order). To enroll with Welldyne Specialty Pharmacy, call (800) 373-1879.
• Atlantic City and Chicago members only: you can fill specialty drug prescriptions at the health center’s on-site pharmacy.

Please call Hospitality Rx if you have questions: (844) 484-4726

• Call WELLDYNE Rx: (844) 813-3860
• For specialty drugs, see question above

If you are eligible to receive a reimbursement, you must first complete the Reimbursement Claim Form.

• Visit hospitalityrx.org
• Click on the “Members” tab at the top of the page
• Select your plan
• The Reimbursement Claim Form is listed in the “Forms” section

You must complete a separate form for each family member. Please make sure to include the following:

• Original pharmacy receipt with prescription details
• Complete name, address and telephone number of the pharmacy
• You may have to contact the pharmacist to get more detailed drug information

Mail the completed form and original receipt(s) directly to WelldyneRx (the address is listed on the form). You will receive a response within 30 days.

If you or your pharmacist have questions about this form or the reimbursement process, please call WelldyneRx at (844) 813-3860. This number is available 24 hours a day.

• Contact Hospitality Rx at (844) 484-4726 and we will mail you a card.

• To get a vacation override, member and dependents must submit a copy of their itinerary that includes their name, date of birth, and medication list.
  • Fax to (877) 245-0875, or
  • Email to Hospitalityrxpa@uniteherehealth.org
• The Hospitality Rx team will contact your pharmacy to process the medication.

A pharmacy can initiate the appeal process by calling 888-886-5822 or by submitting a completed Adjudication and MAC Appeal Spreadsheet (“Appeal Form”) available on the secure website https://welldyne.com/for-pharmacies:

1.    via fax to (855) 404-0968,
2.    via email to RetailManager@NetCardsystems.com, or
3.    via mail to WellDyneRx, LLC, 500 Eagles Landing Dr, Lakeland, FL 33810, Attn: MAC Price Appeals

Tennessee Pharmacies

This initial appeal process is available for all prescription drugs or devices in Tennessee for which a pharmacy believes it did not receive its actual cost and not just for MAC appeals.

Pharmacies must file appeals within seven (7) business days of its submission of the initial claim.

WellDyne will investigate and resolve the appeal within seven (7) business days after receipt of the completed Appeal Form.

The timeline for final determination of the initial appeal will begin once WellDyne has received all of the required information including: 1) a complete version of the Appeal Form; and 2) certification from the Pharmacy that it has provided all invoices or other records demonstrating the Pharmacy’s actual costs for the drug or medical product or device at issue, including all discounts, price concessions, rebates or other reductions received as of the date that the Pharmacy filed its appeal. If a Pharmacy’s appeal does not contain all information required under TN Rule 0780-01095-.05(2), WellDyne will accept the incomplete appeal and hold it open pending receipt of additional information from Pharmacy. Within five (5) business days of receipt of an incomplete appeal, WellDyne will notify Pharmacy the information needed to complete WellDyne’s review the appeal. If the Pharmacy provides the requested information, within five (5) business days of receipt of WellDyne’s notice outlining the requested information, WellDyne’s timeline to make final determination shall begin. If the Pharmacy fails to provide the requested information within five (5) business days of receipt of WellDyne’s notice, WellDyne will deny Pharmacy’s appeal. If WellDyne fails to comply with the timing and notice requirements under applicable law, the appeal shall be resolved in favor of the Pharmacy.

Tennessee Pharmacy are required to include pharmacy acquisition cost with their appeal submission as outlined below. If a Pharmacy is using the Appeal Form to submit an appeal, please complete the template and enter acquisition cost information. If the required pharmacy acquisition cost information is not submitted at time of appeal, WellDyne will be unable to review and resolve the appeal and will request resubmission of the appeal with the required information for reprocessing, as more fully described above.

Tennessee Pharmacy are required to include the name of the wholesaler or manufacturer, as applicable, from which the pharmacy purchased the drug or medical product or device at issue. A copy of the Pharmacy’s invoice demonstrating the pharmacy actual cost as of the date of the filing can be emailed to RetailManager@netcardsystems.com.