TLC Benefit Solutions, Inc.

Plan Overview

Your prescription drug benefit is administered by ProCare Rx (www.procarerx.com). ProCare Rx has a national network of retail and independent pharmacies where you can fill your prescriptions. The following information is an overview of The Langdale Company prescription drug benefit being administered by ProCare Rx.

Your prescription drug benefit features a formulary drug list. A formulary is a list of preferred medications organized into groups or "Tiers". To find if your drug is on the formulary and in which tier, contact ProCare Rx at 1-800-699-3542 or login to the Pharmacy Portal.

To access the Pharmacy Locator, please visit Pharmacy Benefits and Claims Login to the right.

Please note The Langdale Company has a Generic Mandatory Drug plan. If you purchase a brand name medication that has a generic equivalent available, a penalty will be added to your applicable brand co-payment. This penalty is the difference in price between the brand name medication and its available generic.

Your benefit plan may have certain restrictions regarding refills. Contact ProCare Rx Help Desk at 1-800-699-3542 if you need an early refill and for all other refill inquiries.

OTC COVID-19 Tests
How to obtain OTC COVID-19 Tests:

If your plan has chosen to designate the ProCare Pharmacy Care (PPC) direct coverage preferred pharmacy network as the zero out-of-pocket member cost distribution channel, there are a few ways to order and receive your at-home test kits:
- Call toll-free our Customer Service Center for mail order medications at 1-800-662-0586
- Visit our website and complete a new customer registration form at, https://rx.procarerx.com/
- Print, complete, and send registration form via fax to 1-800-662-0590. Find form here, https://rx.procarerx.com/docs/PPC%20Mail%20Order%20brochure_English.pdf
How to submit a claim for reimbursement:

For the separately purchased test kits, members may obtain reimbursement by completing a reimbursement request at https://web.mc-rx.com/docs/drugclaimform/Prescription%20Drug%20Claim%20Form.pdf. They will need to complete all sections A - D and include a copy of their receipt. Please note there may be an increase in processing time due to the increase of volume for this type of request.
90-Day Retail Program
The Langdale Company is proud to partner with Chancy Drugs, a locally owned community pharmacy with 5 convenient locations in Valdosta, Hahira, Adel, Moultrie and Lake Park. Chancy Drugs is the only retail pharmacy that can fill a 90 day prescription. Call the nearest Chancy Drug location for easy transfer of prescriptions. Chancy Drugs offers:
- Free local delivery
- One on one consultation services
- Fast, personalized service
Mail Order

Chancy Drugs is the only approved Mail Order pharmacy.

Mail order is an excellent way to receive prescriptions you will be taking for a long time with no worries about weather or availability of supply at the local pharmacy. For individuals who are taking maintenance medications, you may want to consider utilizing the mail order service for the convenience of home or office delivery.
Specialty Medications

Specialty Drugs are excluded from coverage under this Plan. However, Specialty Concierge Services are offered to offset costs. Covered Persons are required to provide certain documentation to receive these services.
International Drug Program

This Plan has an International Drug Formulary for certain medications. Drugs obtained through this program are at no cost to the Covered Person. When these medications are obtained outside of the International Drug Program, the Covered Person is responsible for 50% of the Allowed Amount, non-applicable to your Out-of-Pocket .
Glucometer Replacement

TLC Benefit Solutions, Chancy Drugs and Health Advocate can provide you with new glucometer.
Compound Drugs

Compound drugs must be obtained from Chancy Drugs pharmacies. Members pay $25.00 copayment, not to exceed $250 in drug cost.
Non-Preferred Network
Non-Preferred Pharmacy Providers are listed below. You will pay higher Co-payments at these pharmacies:
- CVS
- Walgreens
- Rite-Aid
- Wal-Mart
- Target
- SAM'S

Pharmacy Benefits
Preferred Network 34 Day Supply		Non-Preferred Network 34 Day Supply
	Co-payment		Co-payment
Tier 1 - Generics	$15	Tier 1 - Generics	$25
Tier 2 - Preferred Brands (Formulary Brands)	$40 or 20% (Greater Amount)	Tier 2 - Preferred Brands (Formulary Brands)	$50 or 20% (Greater Amount)
Tier 3 - Non-Preferred Brands (Non Formulary Brands)	$75 or 30% (Greater Amount)	Tier 3 - Non-Preferred Brands (Non Formulary Brands)	$90 or 30% (Greater Amount)
Compound Drugs**	$25	Compound Drugs	Not Covered
Preferred Network 90 Day Supply		Non-Preferred Network 90 Day Supply
	Co-payment		Co-payment
Tier 1 - Generics	$45	Tier 1 - Generics	Not Covered
Tier 2 - Preferred Brands (Formulary Brands)	$120 or 20% (Greater Amount)	Tier 2 - Preferred Brands (Formulary Brands)	Not Covered
Tier 3 - Non-Preferred Brands (Non Formulary Brands)	$225 or 30% (Greater Amount)	Tier 3 - Non-Preferred Brands (Non Formulary Brands)	Not Covered
* Generics exceeding $400 in drug cost will adjudicate at 20% coinsurance, not to exceed $250. ** Not to exceed $250 in drug cost. Must be filled at Chancy Drugs pharmacy stores.

Pharmacy Information

Plan Overview

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