Chantix (varenicline) copayment reimbursement and coverage
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Defines TeamstersCare coverage and copayment reimbursement process for Chantix (smoking cessation medication) for eligible active, retiree members and their dependents who have TeamstersCare prescription drug benefits.
No material clinical or coverage changes in this revision.
Chantix Coverage and Reimbursement Criteria
Chantix reimbursement and coverage criteria
Covered and eligible for copayment reimbursement when ALL of the following are met:
If a second 12‑week course is needed, obtain another prescription from your medical provider.
Itemized receipts must include patient name, medication name, prescribing provider, date of purchase, prescription RX number, and total charge including copayment.
Coding and Quantity Limits
| No codes listed |
Prescribing, Dispensing, and Reimbursement Actions
Prescribe starter pack + continuing pack to make 12-week course
Contact the member's medical provider to request two prescriptions: one Chantix starter pack and a separate prescription for two months of the Chantix continuing pack so the total equals a 12-week supply. If a second 12-week course is needed, obtain another prescription from the medical provider.
- Request one starter pack prescription and one separate 2-month continuing pack prescription to total a 12-week course
- Obtain a new prescription from the medical provider for any second 12-week course
Dispense through TeamstersCare pharmacy or Medco/Express Scripts mail order
Ensure prescriptions are filled only at a TeamstersCare pharmacy or via Medco/Express Scripts mail order; Chantix is not covered if filled at a retail pharmacy.
- Fill at TeamstersCare pharmacies or through Medco/Express Scripts mail order
- Do not fill at retail pharmacies — fills at retail pharmacies are not covered
Submit claim form + itemized receipts within 12 months
To obtain copayment reimbursement, submit a completed TeamstersCare Copayment Reimbursement Claim Form with legible itemized prescription receipts to TeamstersCare Member Services within 12 months of the prescription fill date.
- Completed claim form must be signed and dated and received within 12 months of the fill date
- Attach legible itemized prescription receipts (cancelled checks, cash register receipts or charge card receipts are not valid)
- Receipts must show patient name, medication name, prescribing provider, date of purchase, prescription RX number, and total charge including copayment
- Send to TeamstersCare Member Services, 16 Sever Street, Charlestown, MA 02129-1305
Definitions and Receipt Requirements
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