SAW Consortium. Prescription Drug Coverage Effective 1/1/17. RxBenefits, Inc. advocacy. expertise. service RXBENEFITS.

Transcription

1 SAW Consortium Prescription Drug Coverage Effective 1/1/17 RxBenefits, Inc. advocacy. expertise. service RXBENEFITS.COM

2 2 RxBenefits SAW Your Prescription Drug Coverage What s Changing? Effective 1/1/2017, your prescription drug coverage will be provided through Express-Scripts (ESI). Aetna will continue to provide your medical coverage. RxBenefits will administer your pharmacy plan. This means you will contact RxAssure (member services) for prescription drug questions. ESI offers over 68,000 pharmacies, including most national chains and many independents Current plan copays will not change; however, there is a change in formulary (meaning how drugs are covered). During open enrollment, you may call RxAssure to find where your current drugs fit on the new formulary. In addition, before 1/1/17, ESI will send you a notification in the mail if your drug is not covered under the new formulary. Alternatives will be offered. Mail order member will require a new prescription, as well as will need to register with ESI s Home Delivery Program.

3 3 RxBenefits SAW What Does This Mean to You? New Pharmacy ID Card Before 1/1/17, all enrolled employees will receive a pharmacy ID card from Express Scripts. This will be a separate card from your Aetna medical card. Please make sure you show this new ID card to your pharmacy on and after 1/1/2017. The processing information and contact phone numbers on your new Express-Scripts ID card will not be the same as your previous Aetna med/rx ID card. The new information is: RxBIN: RxGroup: 35242Rx Provider Pharmacy Help Desk: RxAssure Member Services:

4 4 RxBenefits SAW What To Do Prior to January 1 st, 2017 Refill all retail and mail order prescriptions through your current Aetna coverage to ensure you have adequate supply in case of transition issues. If you have particular prescription drug needs, call RxAssure to identify any impact in coverage. Look for your new ID card and welcome packet in the mail. Set up mail order through Express Scripts Mail Order can take up to two weeks for the initial order, so members should make sure to have enough medication on hand to last until delivery.

5 5 RxBenefits SAW Specialty Medication Specialty medications are covered though Accredo (Express Scripts Specialty Pharmacy). Prior to 1/1/2017, you will receive notification if your specialty drug is not covered under ESI, and what action needs to be taken. Be proactive call RxAssure during Open Enrollment to ensure you know how your current prescriptions will be covered. Specialty medications may require prior authorization and quantity limits may apply. Specialty medications are limited to a 30-day supply. DURING OPEN ENROLLMENT: Call RxAssure, your Member Services Team, to discuss how your prescription will be covered.

6 6 RxBenefits SAW Mail Order Member will utilize ESI s Home Delivery Program for their mail order prescriptions. You will need to register thru the website, and provide your new member number and payment information. New prescriptions after 1/1/17 can be attached to a completed mail order form and mailed to ESI. Mail order forms will be provided at the Open-Enrollment Events ESI Home Delivery can be reached at Send completed Mail Order forms to: Express Scripts P.O. Box St Louis, MO NOTE: Mail Order can take up to two weeks for the initial order, so members should make sure to have enough medication on hand to last until delivery.

7 7 RxBenefits SAW Your Member Services Team (RxAssure) RxBenefits is your pharmacy benefit administrator (PBA) effective 1/1/17. We partner with the country s largest Pharmacy Benefit Managers (PBMs) to bring greater discounts, enhanced access, and improved Member Services to our clients and their employees. Your coverage will be with Express Scripts. You will have access to RxAssure, our Member Service Team. We are available Monday Friday, 8:00 am till 7:00 pm EST to assist you with questions such as: Is my drug covered? What will it cost? Can you help me transition my mail order scripts? Can you assist me with my claim questions? Is my pharmacy in the network? Are there lower cost alternatives? Calls received after hours and weekends will allow members to leave a message or be routed to Express Scripts Member Service; which is 24/7.

8 8 RxBenefits SAW Mobile Apps: mydrugcosts (offered through RxBenefits) Research drug costs and alternatives A simple web based tool to help reduce the costs of your prescription drugs EASY TO USE Tailored to your Company See options specific to your health plan Quickly Find a Drug Type a few letters to lookup your drug WAYS TO SAVE Generic Equivalents Know when you can switch to the generic Therapeutic Alternatives Explore opportunities to switch to lower cost drugs in the same class $4 Generics (not shown) See available $4/$10 generics Medication Lists Track medications for yourself & others Access anytime from your smartphone or computer browser At your physician s office At home At work Your Company PLAN SPECIFIC DRUGS COSTS Your Mail Order Cost See your out-of-pocket cost & information about home delivery of your medications Your Plan Cost See your out-of-pocket cost and further information with in-network Pharmacies Cash Price See the cash price if you bought without insurance (non-covered or out-ofnetwork) GET HELP Learn More about Drugs Evidence-based information from Consumer Reports about best buys, safety & quality Instructions Links to instructions, frequently asked questions and demos Online Help Search Help and access online support

9 9 RxBenefits SAW Mobile Apps: Express Scripts Manage Prescriptions For Members-on-the-Go Register your account from their mobile device. Transfer eligible maintenance medications to Express Scripts Pharmacy. Select and schedule prescription refills and enroll eligible prescriptions in auto refills. Check Express Scripts Pharmacy order shipping information. Locate a nearby pharmacy using GPS technology. Access DrugDigest database for information, uses, possible side effects, etc. Set a reminder for medication doses.

10 10 RxBenefits SAW Who Is Who? RxBenefits, RxAssure & Express Scripts RxBenefits Pharmacy Benefits Administrator RxAssure (through RxBenefits) Member Services: Denied claims Copay inquires Plan questions Customer service issues/questions Locate a pharmacy Pricing questions Included/excluded medication Express Scripts Pharmacy Benefit Manager Specialty pharmacy, Accredo Pharmacy Help Desk Back-up customer service Mail Order pharmacy