PHARMACY BENEFITS MANAGER SELECTION FAQ FOR PRODUCERS

Transcription

1 FOR PRODUCERS ONLY -- DO NOT DISTRIBUTE PHARMACY BENEFITS MANAGER SELECTION FAQ FOR PRODUCERS Regence has selected Prime Therapeutics as the Pharmacy Benefits Manager (PBM) for its health plans. Prime s three-year contract begins Jan. 1, Prime s services will include pharmacy benefits administration, pharmacy customer service, website integration, and an extensive retail pharmacy network. Mail order and specialty pharmacy services will be delivered through AllianceRx Walgreens Prime (AllianceRx), a joint venture of Prime and Walgreens. Prime was chosen for its operational quality, favorable rates, customer service record and cultural alignment. FREQUENTLY ASKED QUESTIONS GENERAL Quick Links: General Specialty Mail order About Prime Therapeutics About the Prime/Walgreens Alliance About AllianceRx 1. Why did Regence make this decision? First, Prime s selection was based on alignment with our Cause and the assurance we deliver on our brand promise to our customers and members. Second, we must remain competitive in the pharmacy space, and Prime provided the most competitive bid, both near term and in the future. Third, we are keenly focused on operational excellence with regard to quality of care and compliance we strive every day to produce the best possible operational performance for the customers we serve. Prime s track record in this arena was compelling. Finally, Prime s unique business model positions us well for continued transformation with a relentless focus on helping our members get the best health benefit from their prescription coverage at the best possible price. 2. How did Regence make this decision? Seeking PBM proposals is a regular course of business to ensure we remain competitive and continue to offer the best possible outcomes and value to our customers. Regence issued a national RFP to leading PBMs. Three finalists were selected and then evaluated on several criteria, including financials, strategic alignment, quality of clinical care, customer Updated 4/3/17 Page 1

2 service, operations excellence, technological capabilities, and breadth and depth of programs and services. 3. Which lines of business are affected by these changes? All lines of business currently receiving pharmacy benefits will be affected by this change. This includes commercial, Medicare, and on-exchange. Prime will also manage the specialty pharmacy benefit for the Federal Employee Program (FEP) beginning Jan. 1, What pharmacy services will be affected by this change? Prime s services will include pharmacy benefits administration, pharmacy customer service, website integration, and the retail pharmacy network. Mail order and specialty pharmacy services will be delivered by AllianceRx. 5. How is Regence preparing for a smooth transition? Regence and Prime are collaborating to ensure a smooth transition for our members. We are committed to staffing appropriately and developing resources to be fully functional prior to Jan. 1, We have designated a project team focused on the transition. Prime s proven process includes careful planning, an experienced implementation team and extensive data testing. 6. How will this transition affect pharmacy benefits? In most cases, the prescriptions members fill at a retail pharmacy will transfer automatically. Members will only need to update the pharmacy with the insurance information on the new member ID card. In most cases, mail order prescriptions with refills will transfer automatically. Approved pre-authorizations for regular and specialty medications will transfer automatically. New prescriptions will be required for controlled substances, narcotics, compound medications or if the prescription has either expired or does not have any refills remaining. What can groups expect after implementation? Groups can expect to receive the same high quality pharmacy services they receive from Regence and OmedaRx today. Prime s track record for operational excellence and customer satisfaction will complement our full service offerings. According to the 2016 Pharmacy Benefit Management Institute (PBMI) Customer Satisfaction Survey, Prime ranked at the top of the large pharmacy benefit managers in overall satisfaction. Prime also leads in employer satisfaction according to PBMI s annual satisfaction report. 7. Will there be a new drug list? The drug list will not change because of moving to a new PBM. However, the drug list does change in response to new market developments and clinical findings. Our pharmacy team will continue to maintain our formularies to ensure they remain competitive and clinically sound. Updated 4/3/17 Page 2

3 SPECIALTY PHARMACY 8. What will the member s experience be during the transition? All members will go through a personalized onboarding process to build their medical profile, identify their communication preference, and work with the AllianceRx team to learn about all of the services available to them. If needed, members will talk with a clinician to go over important information related to their disease, and then receive a welcome packet to confirm the information discussed during their first call with the pharmacy. All questions and concerns will receive timely resolution from the service delivery team. This team is designed to handle any escalated issues as well as address any sensitive member needs during the transition. 9. How will member prescriptions be transferred? AllianceRx will work with our current PBM to obtain an open refill transfer file for active prescriptions. If needed, AllianceRx will contact a member s doctor to obtain a new prescription. 10. Will members personal payment information transfer along with their prescriptions? If a member is currently a Walgreens specialty customer, yes. If not, then member s payment information will not transfer and they will need to verify payment information at first fill. 11. How can members pay for their specialty medications? Members may use a credit card. AllianceRx will work with members who would like to use an alternative form of payment. 12. Will members who cannot afford their specialty medications continue to have access to financial assistance? Yes. AllianceRx has access to all pharmacy programs and large foundation-based programs to help members pay for their medications. 13. What if a member is taking a limited distribution drug? AllianceRx has access to an industry-leading list of limited distribution drugs. In the rare event a member s drug is not available, AllianceRx would refer the member to another pharmacy. 14. What will happen with members who are on customized programs for specialty medications like split fill programs? AllianceRx has a split fill program and can assist with plan design around the appropriate options. Updated 4/3/17 Page 3

4 15. Are all specialty medications required to be filled by AllianceRx? Required specialty medication dispensing is based on plan design. If under the member s plan, they must fill specialty drugs at AllianceRx, then yes. AllianceRx would only triage a member to another pharmacy in the event a member s drug is not available. 16. How can members get their specialty medications? AllianceRx typically ships specialty medications to members homes. On request, AllianceRx will ship medications to an alternate location. 17. Will members be able to pick up their specialty medications at Walgreens? Yes, Walgreens retail store pick-up may be available in some states. 18. How does shipping work? We have union groups that do not want to use FedEx for any shipping. Can members select a different express shipping vendor? AllianceRx uses multiple express shippers, including FedEx and UPS. AllianceRx would need to discuss options and reimbursement if a shipping vendor is preferred that may not be cost effective and/or delivery is not available to the requested location. 19. Where is AllianceRx located? AllianceRx has five specialty locations. The primary fulfillment location for Regence health plan members will be Beaverton, Ore. AllianceRx will over time optimize shipping timing and costs by fulfilling at facilities closest to the member s shipping address. The shipping location will be transparent to the member. MAIL ORDER PHARMACY 20. Will members have to register with AllianceRx mail order? Yes. AllianceRx will work with our current PBM to obtain an open refill transfer file that will transfer members pre-registration information. Members will need to verify their profile and provide payment information on the first fill. 21. How do members sign up for mail order? Members may sign up online, by phone or by mail. A registration form will be included in the member s welcome packet. 22. How will automatic refills be transferred? Members will have the option to enroll in automatic refill upon registration when providing credit card information. Each time a prescription is automatically filled, AllianceRx will notify the member to ensure they have the opportunity to cancel the order if desired. 23. Will members personal credit card information transfer? Payment information is retained for current Walgreens mail order customers. All other members will need to verify payment information at first fill. Updated 4/3/17 Page 4

5 24. What about members taking a controlled substance or a compound medication? AllianceRx will contact providers on behalf of members to obtain a new prescription for controlled substances or compound medications. 25. What about members whose prescriptions have expired? AllianceRx can contact a member s doctor or the member can obtain a new prescription from their doctor. 26. What happens if the member doesn t change their mail order provider? A member s mail order provider is based on the member s plan design. If a member s plan requires mail order prescriptions to be filled by AllianceRx, any other mail order pharmacy would be considered out of network. 27. What is the average turnaround time for mail order deliveries? AllianceRx will process prescriptions with no complications in less than one business day. Prescriptions with exceptions that need to be resolved typically are turned around in less than two business days. 28. Will medications be sent express mail? AllianceRx ships medications through the U.S. Postal Service, with the exception of overnight shipping for medications that require special handling. Members can always upgrade to express or overnight shipping at their own expense. 29. Where is the mail order facility located? The primary fulfillment location for mail order is Tempe, Ariz. 30. ABOUT PRIME THERAPEUTICS Prime Therapeutics is the fourth-largest PBM in the U.S., serving 20 million health plan members. It manages pharmacy benefits for health plans, employers, the health insurance marketplace, and Medicare and Medicaid. In 2016, Prime processed 305 million prescription claims and managed more than $22.6 billion in drug spending on behalf of its clients. Prime received SQM s highest customer service award for 2015 performance. Prime s member satisfaction scores exceed 90 percent. Prime is a leader in providing high quality, low-cost care. Prime s net-ingredient cost for prescription medicine has been consistently lower than the competitive average over the past seven years. Prime is experienced integrating pharmacy and medical benefits. That integration delivers tangible results. A study commissioned by the Blue Cross and Blue Shield Association compared the medical costs of members with carve-in pharmacy benefits to those of members with carve-out pharmacy benefits. The study concluded that the carve-in group experienced 11 percent lower medical costs. Updated 4/3/17 Page 5

6 Prime has 3,600 employees. The company is based in St. Paul, Minnesota, with regional offices in Orlando, Florida; Omaha, Nebraska; Albuquerque, New Mexico; and Irving, Texas. Prime Therapeutics is accredited by the following organizations: National Committee for Quality Assurance (NCQA) for Utilization Management and Health Information Products Utilization Review Accreditation Commission (URAC) for Pharmacy Benefit Management and Mail Service Pharmacy. Accreditation Commission for Health Care (ACHC) for Specialty Pharmacy National Association of Boards of Pharmacy (NABP) Verified Internet Pharmacy Practice Sites (VIPPS) for Mail Service Pharmacy More information can be found at ABOUT THE PRIME/WALGREENS ALLIANCE In September 2016, Prime and Walgreens announced a long-term strategic alliance that includes the following key components: A long-term retail services agreement that establishes Walgreens as the anchor to Prime s national pharmacy network. A specialty and mail order pharmacy services joint venture that combines Prime s and Walgreen s specialty and mail order assets and employees into a new company, AllianceRx. 32. ABOUT ALLIANCE RX WALGREENS PRIME (ALLIANCERX) AllianceRx is a joint venture of Prime Therapeutics and Walgreens that combines both the companies specialty and mail order pharmacy capabilities and expands services and access for members. Updated 4/3/17 Page 6