Division of Retirem ent and Benefits Retire Public Employee - - PowerPoint PPT Presentation

Alaska Departm ent of Adm inistration

Division of Retirem ent and Benefits

Retire Public Employee Association South Central Chapter December 11, 2018

What is AlaskaCare?

• AlaskaCare is a term used to describe the

State of Alaska self-insured health plans managed by the Division of Retirement & Benefits.

• AlaskaCare Retiree Plans including:
• Defined Benefit Medical and Pharmacy Plan
• Defined Contribution Retiree Medical and Pharmacy

Plan

• Dental, Vision, and Audio Plan
• Long Term Care Plan (not referred to as AlaskaCare)

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Division of Retirement and Benefits

Key Staff

• John Quick - Commissioner
• Ajay Desai – Director:

–Michele Michaud – Chief Health Official –Emily Ricci – Chief Health Policy Administrator –Kathy Lea – Chief Pension Officer –Vacant – Chief Financial Officer

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Division of Retirement and Benefits

Retiree Health Plan Advisory Board

• Created in 2017 through Administrative Order
• Purpose to facilitate policy engagement &

coordination with retirement system members

• Seven-member board includes: Judy Salo

(chair), Cammie Taylor, Mauri Long, Nan Thompson, Gayle Harbo, Dallas Hargrave, Joelle Hall, and John Quick (non-voting)

• All meetings available online at alaskacare.gov

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Contracting & Procurements

• Division hires contractors to administer claims,

also known as Third Party Administrator (TPA)

• For pharmacy benefits, they are called

Pharmacy Benefit Managers (PBM)

• Division competitively procured and awarded

PBM contract to OptumRx beginning 1/1/2019

• Medical, dental, & vision contract being

procured now to take effect 1/1/2020.

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EGWP

• Division also implementing an enhanced

Medicare Part D Employer Group Waiver Plan (EGWP).

• Administrative change to increase federal

subsidies without changes to benefits.

• Estimated $20 million in savings to health trust

and reduction in unfunded liability and associated state payments.

• Analysis documents available online at

AlaskaCare.gov through retiree advisory board

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AlaskaCare enhanced EGWP

• Only applies to Medicare eligible members.
• Members will be enrolled automatically.
• Will still cover same medications today at

same cost through a supplemental benefit called a wrap.

• May require prior authorization to determine

if covered by Medicare Part B, Part D, or wrap.

• No step therapy.

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What this means for members

Beginning January 1, 2019 members will transition to OptumRx and the AlaskaCare enhanced EGWP will be implemented. LOTS OF COMMUNICATIONS!

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Transition Information

• Aetna CVS/Caremark is the current PBM.
• OptumRx will be the new PBM beginning 1/1/19
• NEW! Members will have a separate card for

pharmacy (OptumRx) and medical (Aetna)

• Welcome kit with new ID cards in mail last week.
• OptumRx phone lines are open for members at

(855) 409-6999

• You can also call the Division at (800) 821-2251

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Find a pharmacy

• Is my pharmacy in network?
• Probably, but you can find out for sure by

visiting the AlaskaCare-specific locator tool at: https://www.optumrx.com/oe_alskeert/phar macy-locator

• You can also call OptumRx at (855) 409-6999,

TTY 711

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Mail Order FAQs

• Most mail order prescriptions should transfer

automatically; EXCEPT

• Opioids or controlled substances cannot be

transferred

• Prescriptions that have no more refills will not

automatically transfer

• If you have questions about your prescription

you can call OptumRx at (855) 409-6999

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Specialty Medications

• BriovaRx is the exclusive mail order specialty

medication pharmacy for AlaskaCare members.

• Prescriptions filled at other specialty pharmacies

will be subject to normal retail copay.

• Specialty medications will automatically transfer
• ver to OptumRx for non-EGWP members.
• EGWP members may be contacted by BriovaRx to

transfer their medications.

• Members can contact BriovaRX at 855-4BRIOVA

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Open Formulary

• Will my medications be covered?
• If your medication is covered by the plan today,

that coverage should not change.

• Some medications may require prior authorization,
• r have quantity limits for safety.
• Find out if your medication has these requirements

by visiting

http://doa.alaska.gov/drb/alaskacare/optumrx.html

• You can also call OptumRx at (855) 409-6999

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Prior Authorizations

• Most members will not require prior

authorizations for medications.

• Two types of prior authorizations required for the

AlaskaCare enhanced EGWP:

– Will the medications be paid by Part B or Part D? – Will the medications be paid by Medicare or the wrap?

• The formulary is available online to check.
• Typical prior authorizations returned in 72 hours;

expedited in 24.

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EGWP Enrollment

• Medicare eligible retirees and Medicare eligible

dependents will be automatically enrolled by OptumRx.

• Enrollment and opt-out are handled by OptumRx

subcontractor, Convey, based in Sunrise, Florida.

• Convey has separate call number (855) 235-1405.

All other inquires should be directed to the AlaskaCare dedicated contact center in Salem, Oregon at (855) 409-6999.

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Opt-Out

• The Division is required to provide members the
• ption to opt-out of the AlaskaCare enhanced

EGWP.

• Members have received a letter from OptumRx

dated November 15th, stating they have 21 days to opt-out.

• This is not a hard deadline. Members can opt-out

at any time.

• If you opt out of the enhanced EGWP you will be

enrolled in a plan that is much different than the benefits offered today.

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Opt-Out Plan

Standard Plan Opt-Out Plan Days Supply at retail Up to 90-day for single copay Copay for each 30 days at retail (can still refill up to 90-day supply at one time) Days Supply at mail order Up to 90-day supply Up to 90-day supply Formulary Open 3-tier formulary: generic, preferred brand, non- preferred brand Mail order $0 copay for all medications $20 for generic, $50 for preferred brand name and $100 for non-preferred brand name medications Network retail $4 for generic, $8 for brand name medications Generic member pays 20% with minimum of $10/maximum of $50 Preferred brand name member pays 25% with minimum of $25/maximum of $75 Non-preferred brand name member pays 35% with minimum of $80/maximum of $150 Out of Network Same as in network Member responsible for 40% of the cost Out-of-Pocket Annual Limit Not applicable $1,000 individual, $2,000 family Coordination of Benefits Coordinates to provide up to 100% coverage Does not coordinate

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IRMAA

• Just like Medicare Part B, the Centers for

Medicare & Medicaid Services (CMS) does require a premium payment of high-income individuals who are eligible for Medicare.

• Applies to those with household income of

$85,000/individual or $170,000/family.

• You should receive a letter from Social Security.
• Send a copy of the letter to the Division, and you

will be reimbursed for the surcharge through a Health Reimbursement Arrangement.

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Multiple EGWP Plans

• You cannot be enrolled in more than one

EGWP plan at a time.

• If you are already covered under an EGWP

through a non-AlaskaCare plan, please contact the Division to be dis-enrolled from the AlaskaCare EGWP.

• You will receive a letter from AlaskaCare

confirming that you have been removed that you can share with your other health plan.

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EGWP & Medicare Advantage

• You cannot be enrolled in a Medicare Advantage

plan that has prescription drug coverage and a separate EGWP plan at the same time.

• We anticipate that this situation will be rare, but

if you are covered under a Medicare Advantage plan with prescription drug coverage, please provide the Division with a letter or copy of your Medicare Advantage card and we will disenroll you from the AlaskaCare EGWP.

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EGWP Odds and Ends

• LEP – Late Enrollment Penalty may apply to individuals

who did not sign up for Medicare when they first became eligible. The Division will pay this on behalf of members.

• LIS – Low Income Subsidy typically offers subsidies to

Medicare eligible members.

• Evidence of Coverage –letters that are required by

Medicare to be distributed to EGWP members.

• Donut hole, catastrophic coverage, initial coverage

stage - are all terms for different stages of Medicare coverage that are not applicable for AlaskaCare members since they have enhanced benefits.

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EGWP Odds and Ends

• Foreign Travel – Prescriptions filled outside

the United States will be covered under the wrap benefits.

• Vacation overrides – members will still be

able to receive vacation maximum refill

• verrides.
• Federal Blue Cross/Blue Shield plan will move

to secondary payer with AlaskaCare EGWP primary

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Resources

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OptumRx Pharmacy Questions

Phone: (855) 409-6999, TTY 711

Division of Retirement & Benefits

Phone: (800) 821-2251 Email: doa.drb.benefits@alaska.gov Website: www.AlaskaCare.gov

Stay Informed!

• Sign up for our new e-newsletter at

http://doa.alaska.gov/drb/index.html

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Call us out!

• Join us every month our telephonic town hall

and ask us your questions live!

• NEXT TOWNHALL- Thursday, December 20 at

10:00am

• Register at: https://vekeo.com/event/alaskacare-

town-hall-43334/

• Listen to past townhalls at

http://doa.alaska.gov/drb/headlines/2018/08/eqwp- tele-town-hall/#.XA2yU2hKhPY

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Come to a board meeting!

• Learn about the health plan

modernization process and let us know what you think.

• Visit www.alaskacare.gov and

select the RHPAB button to get a full listing past meetings and see upcoming meetings.

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Learn more

• Find us online at: www.AlaskaCare.gov
• Get up to date information about the

transition through our FAQs:

http://doa.alaska.gov/drb/alaskacare/optumrx.html

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Division of Retirement and Benefits

Emphasizing teamwork Encouraging innovation Elevating our service levels

Questions?