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Program Statement for Members Experiencing Issues Filling Prescriptions
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July 15, 2022
The World Trade Center (WTC) Health Program is aware that some members are experiencing issues getting their prescriptions filled. The Program understands that medications, both WTC-related and non WTC-related, are important to our members’ health and well-being. Sometimes these medications can be critical for ongoing treatment.
Some members’ coverage for non-WTC-related medications are being denied at the pharmacy. This is because the billing systems list the WTC Health Program as your primary health insurance and main coverage provider for all your medications. We are working diligently to get to the bottom of the issue quickly and permanently resolve this situation. In the meantime, you can find the temporary solution to this issue, below.
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If your primary insurance plan, including Medicaid, Medicare, or other coverage plans such as Veterans Health Administration or private insurance, denied coverage for one of your prescriptions because they show the WTC Health Program as your primary coverage, you can take the following steps to resolve the issue:
- Call your primary health insurance plan for a temporary override. Let them know that you do not have alternate primary/commercial coverage. You should be able to find your primary health insurance contact information on your primary insurance card.
- You may be instructed to contact another office for a long term or permanent override. If you are unsure who to contact, call Express Scripts at 1-800-935-7179.
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If your primary health insurance requests a letter from the WTC Health Program as proof that the Program is NOT an insurance plan and is the payer of last resort, call the WTC Health Program call center at 1-888-982-4748 or email WTC@cdc.gov to request this letter to be sent by mail or email.
- A generic version of this letter (PDF, 1 page, 148 KB) is available online as well. This letter will not include your name or member number. If this is needed, please use the instructions above.
- If you need additional assistance contacting your primary health insurance to obtain an override, please contact the WTC Health Program call center at 1-888-982-4748 or email WTC@cdc.gov.
We understand that members have encountered other issues filling their WTC-related prescriptions as well. Here are brief descriptions of other known issues and their solutions.
- If you need a prior authorization, contact your program provider (doctor, PA, etc.) to have them submit the prior authorization for you.
- If the pharmacy gets a rejection for your prescription that says, “prescriber is not covered” or “provider not in network,” contact your Clinical Center of Excellence (CCE) or Nationwide Provider Network and let them know.
- If you don’t know why you cannot fill your prescription, contact Express Scripts at 1-800-935-7179.
The WTC Health Program is actively monitoring this situation. If you experience any other issues that you would like us to know about, please call us directly at 1-888-982-4748 or email WTC@cdc.gov.
For more information about WTC Health Program pharmacy benefits visit the Pharmacy Benefits webpage.