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. o 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) Division of Retirement and Benefits 2
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 Division of Retirement and Benefits 3
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 4
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. 5
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 6
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. 7
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! 8
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 9
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 10
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 11
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 over to OptumRx for non-EGWP members. • EGWP members may be contacted by BriovaRx to transfer their medications. • Members can contact BriovaRX at 855-4BRIOVA 12
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, or 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 13
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. 14
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. 15
Opt-Out • The Division is required to provide members the option 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. 16
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 Generic member pays 20% with minimum of medications $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 Not applicable $1,000 individual, $2,000 family Limit Coordination of Benefits Coordinates to provide up to Does not coordinate 100% coverage 17
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. 18
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. 19
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. 20
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. 21
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 overrides. • Federal Blue Cross/Blue Shield plan will move to secondary payer with AlaskaCare EGWP primary 22
Resources OptumRx Pharmacy Questions Division of Retirement & Benefits Phone: (855) 409-6999, TTY 711 Phone: (800) 821-2251 Email: doa.drb.benefits@alaska.gov Website: www.AlaskaCare.gov 23
Stay Informed! • Sign up for our new e-newsletter at http://doa.alaska.gov/drb/index.html 24
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 25
Recommend
More recommend
