Last update: 7/23/09

Tamiflu and Relenza Coverage Guidelines

TeamstersCare Members, Dependents and Retirees may be eligible for reimbursement (cost of the drug minus your copay) for the antiviral drugs oseltamivir (brand name Tamiflu) and zanamivir (brand name Relenza) which are effective for the treatment of Novel H1N1 Flu (Swine Flu). These medications are not available in the TeamstersCare Pharmacies and there are significant limitations on their coverage.

TeamstersCare follows the current Centers for Disease Control and Prevention (CDC) guidelines. Coverage is limited in certain circumstances to the following high risk individuals:

• children younger than 5 years old
• adults age 65 and older
• persons with chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematologic, neurologic, neuromuscular, or metabolic (including diabetes) disorders
• immunosupression (including that associated with certain medications or HIV)
• patients hospitalized with H1N1 influenza
• pregnant women

If you are one of the above high-risk individuals, and your doctor prescribes one of these medications, you may be eligible for reimbursement (cost of the drug minus your copay). You must:

•  Fill your prescription at a Retail Pharmacy and pay out-of-pocket
•  Have your doctor complete an H1N1 Anti-Viral Reimbursement Form
  (available online by clicking here or by calling TeamstersCare Member Services)
• Submit the completed Form and the pharmacy receipt to TeamstersCare for reimbursement consideration

If you have any questions about this, or any of your other TeamstersCare benefits, please contact TeamstersCare Member Services at 617-241-9220, ext 2; or 800-442-9939, ext 2 (toll free in MA); or 800-225-6135, ext 2 (toll free outside MA).

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