Pharmacy Data Management

Pharmacy Data Management, Inc.
(PDMI)

Prescription Drug Plan co-payments:

	Generic Drugs are the 1st tier (lowest co-pay): $5.00
	Preferred Brand Drugs are in the 2nd tier (middle co-pay): $15.00
	Non-preferred brand drugs are in the 3rd tier (highest co-pay): $25.00

In most cases, brand drugs with a generic equivalent fall into the 3rd tier while the generic equivalent will be available in the 1st tier.

Effective May 1, 2006, Coordination of Benefit prescription reimbursements will no longer be handled through the Health Plan Office. All reimbursements will be processed directly through Pharmacy Data Management, Inc. (PDMI)

The process will work as follows:

	RX will first run through the Primary Insurance Carrier.
	Member pays cash at pharmacy for co-pay amount and submits the claim, along with the necessary paperwork, for Manual reimbursement to PDMI.
	The claim is keyed at PDMI and a check is cut for the member for their co-pay portion that was to be reimbursed. Based on the remaining balance, the Toledo Firefighters co-pay is still taken out therefore the member may still have to pay, at a minimum, the TFFHP co-pay amount.
	All reimbursements must be submitted to PDMI within 90 days of purchase. The Direct Prescription Drug Reimbursement Form must be completed in full for consideration of reimbursement. Please note that there is a section on the form that your pharmacist must complete and sign. You can print out a copy of the form by following: Coordination of Benefit Drug Reimbursement Form

Any questions, please feel free to contact:
Plan office: 419-255-5314

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