UNDERSTANDING & MAKING THE MOST OF YOUR PHARMACY BENEFITS

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1 UNDERSTANDING & MAKING THE MOST OF YOUR PHARMACY BENEFITS Prescription drug benefits are an important part of your medical plan benefit. Here s how you can find important information to help you understand, use, and manage your pharmacy benefits. Visit myuhc.com This website includes all of your UnitedHealthcare medical and pharmacy plan information. You can find out how much your medication costs, check prices of other medications and determine how much you may save by moving to home delivery. When you register at myuhc.com, you can use the website s helpful tools and features to: Look up the price of drugs covered by your plan Find out if a drug is covered under your plan and check to see if it requires additional approvals Refill and renew home delivery prescriptions View your order status and claims history Sign up for text reminders to take and refill your medicine View your benefits in real time Order medical supplies Shop for health and wellness products Log into myuhc.com and select Manage My Prescriptions 1

2 At the Pharmacy homepage, select Drug Pricing Enter the drug name, select the drug from the list & then select the strength and quantity 2

3 Pricing for retail and mail service will be provided. Any coverage alerts will also be provided (Click the + sign for more detailed information). Any lower cost alternatives available will also be shown. Example of a medication that isn t covered Example of a medication requiring Prior Authorization 3

4 Use the Health4Me App The Health4Me App for your smartphone has many useful pharmacy features. Download it today! You can use the app to access the following: Search Pharmacies enjoy the convenience of a pharmacy locator to find an in-network retail location Estimate Drug Costs look up prescription drug costs and view potential savings Prescription Claims review all past pharmacy claims in a simple, easy-to-view format Manage My Medications access and refill home delivery medications in one simple, quick transaction Order Status view all of your medications in a clear and concise format Call Customer Care Call the toll-free member phone number on the back of your health plan ID card. We can answer any questions you have about your pharmacy benefit including whether or not your medication is covered, the availability of lower-cost options, how to switch to home delivery and more. What s new for prescription coverage in 2016 Some programs are being put into place to help address the rising costs of prescription drugs. In some cases, a drug may be grandfathered from the newly implemented programs if there is a current valid prescription; however, any new prescriptions will be subject to the new programs. Prior Authorization Starting in January 2016, some medications will require Prior Authorization. You can look up the medication (after January 1 st ) on myuhc.com to see if a Prior Authorization is required by going to My Prescriptions/Drug Pricing. If a medication requires Prior Authorization, you will see the note below when you price the medication. Prior Authorization requires your doctor to tell UnitedHealthcare why you are taking your medication in order to determine if you will receive benefit coverage. This is based on uses listed in the U.S. Food and Drug Administration (FDA) approved medication labeling and other clinical criteria. If your medication requires a Prior Authorization, and you have not already submitted for and received approval of a Prior Authorization, you will receive a rejection at the point of sale notifying the pharmacy that a Prior Authorization is required for the medication. If this happens then follow the steps below. 4

5 It s easy to begin the Prior Authorization process 1) Your doctor will need to request a Prior Authorization review with UnitedHealthcare by calling the UnitedHealthcare Prior Authorization team at OR 2) Your doctor can log into Professionals> Prior Authorizations to submit an online Prior Authorization request Once the information is received and a decision is made, UnitedHealthcare will: 1) Send your doctor a fax advising of the approval or if denied, the reason for the denial and an explanation of what would be needed for an approval 2) Mail a letter to the member advising of the decision 3) Call to inform the member of the decision If coverage of the medication is approved, you can go ahead and fill your prescription using your pharmacy benefit. If coverage of the medication is not approved, you can still get the medication, but you will have to pay the full cost of the prescription. If the medication is not covered, then you have the right to appeal. The Prior Authorization denial notice will include instructions on how to appeal the decision. Exclusions There are many different medication options on the market. Many of them work the same way and some may have been shown to work better than others for most people. Some brand name medications have generic or over-the-counter equivalents available. With so many options available, it often comes down to how effective a medication is, how safe it is, and how much it costs. When lower-cost options are available, UnitedHealthcare often chooses to exclude the higher-cost options from coverage under the pharmacy benefit. If you are taking one of these medications, there are several resources available to learn about and find lower-cost options that you can discuss with your doctor. After January 1, 2016, you can check the Price a Medication tool on myuhc.com to see if your medication is excluded. Go to my Prescriptions/Price a Medication. If you believe that one of the lower cost options will not work, you can request to have a clinical review completed for your particular situation via the appeals process. You can initiate this request by calling the number on your ID card. All new-to-market medications are excluded from coverage until they are reviewed by a UnitedHealthcare committee of medical professionals that will determine coverage of the medication and placement within the Prescription Drug List (PDL). 5

6 Other things to know about prescription coverage Preventive Medications Some medications are defined as preventive and are covered at 100%. You can find out if a medication is part of the preventive drug list by logging on to myuhc.com and clicking on the Pharmacies & Prescriptions tab on the top menu bar and then selecting Preventive Drug List. Using myuhc.com or the Health4Me app to price medications is another way to see if a medication is considered a preventive drug and is covered by your plan at 100%. Enter the drug name 6

7 Select the drug from the list shown Then select the strength and quantity 7

8 The Your Cost section will reflect $0 for your member responsibility at both mail order and retail for preventive medications. Specialty Pharmacy Program Living with a complex health condition can be challenging. At UnitedHealthcare, we give you the information, tools and resources you need to learn about your condition, manage your specialty medications, find supportive resources and get the most from your pharmacy benefits. Simply go to UHCSpecialtyRx.com and myuhc.com to get started. Specialty Pharmacy Program Conditions Allergic Asthma Hemophilia Anemia Hepatitis B Arthritis/Crohn s Disease Hepatitis C Cancer Hereditary Angioedema Cystic Fibrosis HIV/AIDS Endocrine Disorder Immune Deficiency Enzyme Deficiency Infertility Excess Iron Multiple Sclerosis Growth Hormone Deficiency Muscle Spasms Neutropenia Osteoporosis Parkinson s Disease Psoriasis Pulmonary Arterial Hypertension (PAH) Respiratory Syncytial Virus (RSV) Thrombocytopenia Transplant Vaccines During the first half of 2016 the specialty pharmacy dispensing specialty medications will change from the OptumRx Specialty Pharmacy to BriovaRx. BriovaRx is an Optum company. 8

9 During the transition period, you will be contacted when your specialty medications are being transferred to BriovaRx. Until you are contacted, please continue using the same contact information you are using today for the OptumRx Specialty Pharmacy. Remember, you can always call the number on the back of your ID card and the customer advocate will transfer you to the Specialty Pharmacy Program. What will be different at BriovaRx? Only the specialty dispensing pharmacy name and location is different the support and services you are familiar with will stay the same. Your specialty pharmacy contact information will change (again, only after you are contacted to make the change to BriovaRx): Your new customer care/refill phone number is Customer care is available Monday through Friday, 8:30AM to 10:00PM ET and on Saturdays from 9:00AM to 5:00PM ET a pharmacist is available at any time Your new website for specialty medications is BriovaRx.com You can still go to myuhc.com to review your specialty and non-specialty claims history and order refills for any non-specialty medications. However, you will fill your specialty medications through a web form available at BriovaRx.com. Home Delivery Discover the convenience of the OptumRx Home Delivery Pharmacy With the OptumRx Home Delivery Pharmacy you ll get: The opportunity to save money and time 24/7 phone access to pharmacists with specialized training Information about potential lower-cost medication options Standard shipping of your medications at no cost to you Are you missing out on a simple way to save money? If you fill your prescriptions at a retail pharmacy consider this with prescription home delivery, your medication is shipped directly to you, likely for less than you pay now. You can also use your WageWorks HSA card for any payments. Why do millions of people prefer OptumRx Home Delivery Pharmacy? You may save money; you will save time You could potentially save money by ordering up to a three-month supply of medication. You will make fewer trips to the pharmacy and avoid waiting in line. Your medication is shipped directly to your home with standard shipping at no cost to you. You can also sign up for hassle-free refills that make getting your refills even easier! 9

10 A pharmacist is always ready to help Pharmacists are available around the clock to answer your questions. They also review your medication for potential harmful interactions with your other medications on file. If there is a potential problem, an OptumRx pharmacist will contact your doctor. Home delivery puts you in control of your medication With home delivery you can go online to compare medication pricing, check the timing for your next order and even set up text reminders to take your medication on time (OptumRx provides this service at no cost but standard message and data rates charged by your cellular carrier may apply). You can also: Order your medications online Refill current prescriptions Renew prescriptions if you are out of refills Take action now to start saving Choose one of these ways to fill your first prescription using OptumRx Home Delivery Pharmacy: Online Log on to myuhc.com Click on Manage My Prescriptions and select Transfer Prescriptions Select the medication you would like to switch to home delivery By mail Get a prescription from your doctor for up to a three-month supply, plus refills for up to one year (if needed) Go to myuhc.com and download an order form Mail the new prescription and order form to the address provided on the form With your doctor Get a prescription from your doctor for up to a three-month supply, plus refills for up to one year (if needed) Ask your doctor to fax your prescription to OptumRx Home Delivery Pharmacy your doctor can call the number on the back of your ID card for instructions (faxed prescriptions must come from your doctor s office) Timing Once OptumRx receives your order for a new prescription, your medication should arrive within 10 business days. Completed refill orders should arrive in about seven business days. Need your medication right away? When your doctor prescribes a new medication that you will take regularly, request a prescription for one month and another for three months of medication plus refills for up to one year (if needed). Fill the one-month prescription at your participating retail pharmacy Fill the three-month prescription with OptumRx Home Delivery Pharmacy That way you ll have the medication your doctor wants you to take right away, and you ll save time and money in the future. 10