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This program is designed save you money on prescrip-
How can I keep my prescription drug costs down?
tion drug costs!
We will help you find low-cost medica-
The use of generic prescription drugs, whenever
tions within the same therapeutic class as a drug you
available, is most cost effective. Don’t be shy – discuss
your prescription options with your doctor. Ask
whether an alternative, less expensive option would
and receive a full refund of the plan cost.
SAVE MONEY ON PRESCRIPTION DRUGS
THE FIRST TIER: Generic Drugs
About the Administrator
You pay up to $10
How will I know if a generic equivalent is available?
HPA is a fully licensed, full-service Third Party
■ Available at over 42,000 pharmacies nationwide
Simply ask your local pharmacist or call the customer
Administrator transacting business worldwide.
service department to find out about generic equiva-
Established in 1939, HPA is a third generation com-
■ Automatic acceptance — no health questions
SECOND TIER: Brand Name and Select Generic Drugs
lents for your prescription. Also ask your doctor to
pany providing state-of-the-art industry leading
You pay up to $20
prescribe generics whenever possible and appropriate.
insurance services, including customer service, claims
(Your new member packet will include helpful materi-
payment, billing and reporting. HPA’s specialty prod-
Preferred Brand & Select Generic: up to $20
ucts division was founded by Michael Kosloske who
THIRD TIER: Brand Name Drugs
We have negotiated special discount prices. Savings range as high
What is the difference between brand name and generic drugs?
■ No pre-existing conditions limitation
The brand name is the trade name under which the
About the Pharmacy Manager
product is advertised and sold, and is protected by
Founded in 2002, Advance Benefits develops
■ No deductible and no monthly or annual maximums
patents so that it can only be produced by one manu-
innovative benefit designs and programs to meet
To get the most out of this program you should
facturer for a predetermined number of years. Once a
the varying needs of employers and health plans.
your doctor to prescribe a drug within the first two
patent expires, other companies may manufacturer a
Advance Benefits is an experienced benefits manage-
tiers, if possible. Often drugs within the same therapeu-
generic equivalent, providing they follow stringent FDA
ment company that offers a variety of pharmacy
tic class can be prescribed in place of an expensive
benefits and leads the way in introducing novel
brand name drug. Of course if you choose the higher
Generic drugs are drugs for which the patent has
programs for employers and healthcare providers.
price brand name drug, we have negotiated a substantial
expired, allowing other manufacturers to produce and
distribute the product under a generic name. Generics
Contact the pharmacy benefit manager’s Help Desk
are essentially a chemical copy of their brand name
and Customer Service Department toll free at
equivalents. The color or shape may be different, but
Not all FDA approved Generic, Preferred
Monday through Friday from 9 a.m.
the active ingredients must be the same for both. Thelist contains a wide range of generic and brand name
or Brand name drugs are included in Tiers 1, 2 or 3.
preferred products that have been approved by the
a complete list of all drugs included in this plan are
listed at www.hpa-inc.com. Pricing and Tier Position
are subject to change without notice. Tier positionand pricing is only for quantities stated, additional
What is a preferred drug list?
quantities may result in higher costs. This is not an
When can I begin saving on my prescriptions?
A preferred drug list is a list of recommended prescrip-
The effective date is the day after HPA’s administrative
tion medications that is created, reviewed and continu-
office receives your application and your first month’s
ally updated by a team of physicians and pharmacists.
payment. Your identification card will be mailed to you.
The preferred drug list contains a wide range of generic
The Member Enrollment Kit will be sent to you via
and brand name preferred products that have beenapproved by the FDA. Your doctor can use this list to
email. A complete drug list is available at
select medications for your health care needs, while
Administered by: Health Plan Administrators, Inc., Rockford, IL
helping you maximize your prescription drug benefit. A
What is a generic drug?
medication becomes a preferred drug based on safetyand efficacy, then on cost-effectiveness.
This brochure provides a brief description of The Competitor
Once a patent on a brand name drug expires, other
Rx Co-Pay card. Plan may not include all drugs. The drug list
drug companies may make a generic version of the
is subject to change with additions or deletions without notice.
drug, with the approval of the Food and Drug
What is the difference between a preferred brand name drug
The Pharmacy Benefit Manager is Advance Benefits. This plan
Administration (FDA). The FDA’s standards for quality
versus a non-preferred brand name drug?
is not an insurance plan.
are the same for all manufacturers. This means the
A preferred brand name drug is a medication that has
generic drug contains the same active ingredients as the
been reviewed and approved by a group of physicians
2004 HPA, Inc. All rights reserved.
brand name whose patent has expired, and that it is
and pharmacists, and has been selected for preferred
status based on its proven clinical and cost effectiveness.
A non-preferred brand name drug is a medication
The Competitor Rx Co-Pay Enrollment Form
for HPA, Inc.
that has been reviewed by the same team of physiciansand pharmacists who determined that a clinically
A complete Preferred Drug List is available on the
A. TELL US ABOUT YOURSELF
C. SELECT YOUR PAYMENT OPTIONS
equivalent alternative drug that is most cost effective isavailable. These designations may change as new clini-
HPA website at www.hpa-inc.com and also is
(from calculation section on opposite page) $
included in your new member enrollment packet
along with your identification card.
Select your payment plan:
What drugs are considered preferred (formulary) on
IMPORTANT: If you choose to pay monthly, you must pay by electronic bank draft or credit card only.
$20 Brand Name and
The Competitor Rx product guide contains certain
Select your payment method:
brand drugs for which the member’s price is the sched-
❏ Check or money order. Enclose initial payment to HPA, Inc., with the application.
uled amount listed. Drugs that are chemically or thera-
peutically similar to drugs listed on the product guide
are not discounted. Prices are subject to change due to
manufacturer price changes to pharmacies.
I authorize Health Plan Administrators, Inc., to charge the above credit card for the premium
On these drugs, the participant enjoys two distinct dis-
listed according to the payment mode selected.
counts, one through the Competitor Rx pharmacy net-
work and the second through the manufacturer.
*You must list an email address since your Rx Co-Pay fulfillment kit and i.d. card are
❏ Automatic bank withdrawal. Enclose initial payment and a voided check with
What if the brand drug I am taking is not discounted?
Your Rx Co-pay monthly fee will automatically be withdrawn from your
Complete if spouse and/or children are included:
If you are currently taking a medication that has simi-
lar active ingredients or is used to treat the same con-
ditions as the preferred brand drugs on the Competitor
Rx Co-Pay product guide, it will still be discounted.
pay and charge my account debits drawn from my account by Health Plan Administrators,
You will pay the Competitor Rx negotiated price for
Inc., to its order. This authorization will stay in effect until I revoke it in writing. Until you
that drug. To take advantage of the potential program
receive such notice, I agree that you shall be fully protected in honoring any such debits. I
savings on listed preferred drugs, you should ask your
also agree that you may at any time, end this agreement by giving 30 days advanced writ-
pharmacist (where regulations permit) or a doctor to
ten notice to me and to Health Plan Administrators, Inc. You are to treat such debit as if it
change your medication, where medically appropriate,
were signed by me. If you dishonor such debit with or without cause, I will not hold you
B. CHOOSE YOUR DESIRED COVERAGE
to a less expensive product listed in the product guide.
liable even if it results in loss of my Rx Co-pay membership.
Discount Pricing for
D. SIGN THE ENROLLMENT FORM
The Competitor Rx Co-Pay card is accepted at
Brand Name Non-Preferred Drugs
SOLICITOR USE ONLY:
Attach the HPA Statement of Understanding Form
I hereby apply for membership enrollment in HPA, Inc. prescription program. I understand that
over 42,000 pharmacies throughout the United
acceptance of this enrollment for membership is guaranteed. I understand that the earliest my
States. The network includes pharmacy chains,
enrollment can become effective is the day after HPA’s receipt of the completed enrollment form
and the first month’s payment. I also understand that by participating in this program external
factors may force a change in monthly fee, benefits and/or preferred drug list at any time. I
Walgreens, Wal-Mart, and more, as well as
will be entitled to negotiated and funded discounts on eligible prescription drugs purchased from
thousands of independent pharmacies throughout
any participating pharmacy. As a member of HPA, Inc. membership program we understand that
your trust in us is one of our most important assets. In order to preserve that trust, we want
you to understand our information practices and your rights to ask us not to share certain infor-
mation about you. As a member of this plan we want you to know the following: "THIS NOTICE
DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW
YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY." Rx Options, Inc.
will without your consent or authorization submit online pharmacy claim data to manufacturers,
Eligible Single and/or Spouse ages 18 through 64 years old:
1. Select your plan monthly cost from the chart
with NO member identification, for the payment of the rebates. Online Claims data will also be
provided to employers and pharmacies regarding invoicing and payments in the standard NCPDP
Mail your enrollment form and initial payment to: HPA, Inc., P.O. Box
2. If you are prepaying more than 1 month, multiply the
claims billing format. If you have signed up for the email online reminders regarding refills of
15250, Rockford, IL 61132-5250. Make personal check or money
your current medications, emails will be sent to you directly at the email address you list on
number of months by the monthly rate (quarterly = x3;
your enrollment application. If you wish to revoke the right for us to use your personal health
*Eligible Single and/or Spouse ages 65 years and older:
order payable to: Health Plan Administrators, Inc.
information (PHI), you must do so in writing to HPA, Inc., 3703 N. Main Street, Rockford, IL,
61103-1679. Your request will be processed within 60 days upon receipt. Revoking the right
Save time and postage by paying with a credit card and faxing
for us to use your personal health information may also terminate your benefit.
toll free the completed, signed & dated application and rate and
calculation chart to: 1-888-FAX-HPA1 (329-4721)
* If either the single or spouse is age 65 years or older, you must pay the age 65+ monthly cost.
Signature authorizes release of information and enrollment into the program. The enrollment kit is sent
via email. We do not have preprinted materials.
FREQUENTLY ASKED PRE-CONCEPTUAL QUESTIONS The following is meant to provide answers to frequently asked questions during the preconceptual period. This information may be useful to you as you undergo fertility treatment. We welcome you to discuss the following issues or any other fertility-related concerns with us. Lifestyle and environment : Certain lifestyle choices and environment
Buller District Plan SIGNIFICANT RESOURCE MANAGEMENT ISSUES, OBJECTIVES AND POLICIES 4.1. Introduction 4.1.1. The important resources and the major activities which utilise or impact on the natural and physical resources of the Buller are identified and discussed in Part Three of the Plan. The effects of these activities on the natural and physical environment differ in both