SAW Consortium Prescription Drug Coverage Effective 1/1/17 - - PowerPoint PPT Presentation

RxBenefits efits, , Inc.

• advocacy. expertise. service.

800.334.8134

RXBENEFITS.COM

Prescription Drug Coverage

Effective 1/1/17

SAW Consortium

2 | RxBenefits | SAW

Your r Prescri scriptio ption n Drug Cover erage age 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 Prog rogram.

3 | RxBenefits | SAW

What at Does es This is Mean to You?

• 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.

New Pharmacy ID Card

• The processing information and

contact phone numbers on your new Express-Scripts ID card will no not be the same as your previous Aetna med/rx ID card. The new information is:

• RxBIN: 610014
• RxGroup: 35242Rx
• Provider Pharmacy Help Desk:

1-800-922-1557

• RxAssure Member Services:

1-800-334-8134

4 | RxBenefits | SAW

What t To Do Prior

• r to Januar

ary y 1st

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 | RxBenefits | SAW

Speci cialty lty Medic ication ation

• 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 | RxBenefits | SAW

Mail Or 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

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.

ESI Home Delivery can be reached at 87 877.5 7.503 03.40 4073. Express Scripts P.O. Box 66564 St Louis, MO 63166-6564 Send completed Mail Order forms to:

7 | RxBenefits | SAW

Your ur Member er Se Servic rvices es Team m (RxAssur Assure) e)

RxB 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:

• Calls received after hours and weekends will allow members to leave a message
• r be routed to Express Scripts Member Service; which is 24/7.

Is my pharmacy in the network? Are there lower cost alternatives? Can you assist me with my claim questions? Is my drug covered? What will it cost? Can you help me transition my mail order scripts?

8 | RxBenefits | SAW

Mobil ile Apps: myDr DrugCosts ugCosts (offered through RxBenefits) Research ch drug costs ts and alterna rnati tives ves

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

Learn More about Drugs

Evidence-based information from Consumer Reports about best buys, safety & quality

WAYS TO SAVE

Therapeutic Alternatives

Explore opportunities to switch to lower cost drugs in the same class

$4 Generics (not shown)

See available $4/$10 generics

Generic Equivalents

Know when you can switch to the generic

Medication Lists

Track medications for yourself & others

Instructions

Links to instructions, frequently asked questions and demos

Online Help

Search Help and access online support

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-of- network)

Access anytime from your smartphone or computer browser

• At your physician’s office
• At home
• At work

A simple web based tool to help reduce the costs of your prescription drugs

Your Mail Order Cost

See your out-of-pocket cost & information about home delivery of your medications

GET HELP

PLAN SPECIFIC DRUGS COSTS

9 | RxBenefits | SAW

Mobile ile Apps: Expre ress ss Scr cripts pts Manage ge Prescri scriptio ptions ns

• 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.

For Members-on-the-Go

• 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 | RxBenefits | SAW

Who Is Who? ? RxBenefits, RxAssure & Express Scripts……

• Rx

RxBenefit fits – Pharmacy Benefits Administrator

• Rx

RxAss Assure (through RxBenefits) – Member Services:

• Denied claims
• Copay inquires
• Plan questions
• Customer service

issues/questions

• Locate a pharmacy
• Pricing questions
• Included/excluded

medication

• Exp

Express Scr Scripts – Pharmacy Benefit Manager – Specialty pharmacy, Accredo – Pharmacy Help Desk – Back-up customer service – Mail Order pharmacy