Coordination of Benefits

Getting your medication as a survivor in the WTC Health Program

The World Trade Center (WTC) Health Program covers prescription drugs to treat certified (approved) conditions. Optum is the company that manages the WTC Health Program pharmacy benefits.

For survivors, the WTC Health Program is the secondary payer, meaning the pharmacy must bill the member’s primary insurance first and then bill the WTC Health Program for any remaining costs. This is called Coordination of Benefits and is required by the James Zadroga 9/11 Health and Compensation Act.

How does Coordination of Benefits work for prescription drugs?

Your primary insurance will be billed first for WTC-related prescription medicines. Primary insurance may be a type of private insurance, group health, or government program such as Medicare or Medicaid.

Any remaining costs will be covered by the WTC Health Program. Prescriptions covered by the WTC Health Program will have no copayments.

How do I get my prescriptions filled?

Your WTC Health Program doctor or specialist will write the prescription for your WTC-related condition.

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Step 1: You may fill your prescriptions in a retail pharmacy or through a mail order pharmacy.
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Step 2: In both cases, you will always need to present your primary insurance and WTC Health Program card to the pharmacy.
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Step 3: Tell the pharmacist that the WTC Health Program is the secondary payer.
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Step 4: The pharmacy will bill your primary insurance first, and then bill any remaining costs to the WTC Health Program.

What happens if there is a problem?

If there is a problem billing your prescription to your primary insurance, you or the pharmacy will need to contact that insurance company to resolve the issue. Your pharmacy should notify you when there is a problem.

If there is a problem billing the WTC Health Program, you or the pharmacy must contact Optum at 1-855-640-0005 to resolve the issue.

How do I find a pharmacy that works with the WTC Health Program?

Find a retail pharmacy near you at http://www.helioscomp.com/resources/pharmacy-locator or by calling 1-855-640-0005.

Mail order offers convenience, privacy, and the security of never missing a refill. You can register for mail order through Optum by visiting http://www.helioscomp.com/resources/home--delivery or calling 1-855-640-0005 to resolve the issue.

Where can I get the Coordination of Benefits brochure?

The Coordination of Benefits brochure is available as a PDF download in four languages: