Your 2018 Pharmacy Plan Changes 1 New Prescription Drug Program - - PowerPoint PPT Presentation

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Your 2018 Pharmacy Plan Changes

New Prescription Drug Program Effective January 1, 2018

• Fort Bend ISD is pleased to announce that effective January 1, 2018, your pharmacy

benefit services will be provided by Express Scripts administered by RxBenefits, Inc.

• RxBenefits is your new pharmacy benefit administrator (PBA).
• Starting December 1st you will have access to RxAssure, our Member Service Team,

available Monday – Friday from 7:00 am until 8:00 pm CST to assist you with questions such as:

• Calls received after hours and weekends can leave a message or be routed to Express

Scripts Member Service.

Is my drug covered? What will it cost? Is my pharmacy in the network? Can you help me transition my mail

• rder scripts?

Are there lower cost alternatives? Can you assist me with my claim questions?

New Pharmacy ID Card

• Your new, combined ID cards will be delivered to your home address prior to

1/1/2018 by UHC

• UPDATE your home address and phone number in My Self Serve.
• Please make sure you show this new ID card to your pharmacy on or after

1/1/2018

This is an example of the 2017 ID card, the 2018 card will contain RxB/ESI information.

Network Pharmacies

 Walmart  Target  CVS  Walgreens  Rite-Aid  Kroger  HEB  Costco  Sam’s Club  Randalls

Mail Order

• Mail order prescriptions will not transfer
• ACTION is required by the member to work with their

physician to obtain new mail order prescriptions

• New prescriptions can be attached to a completed mail
• rder form and mailed to ESI after January 1st
• Your Mail Order Benefit Allows for a 90-day supply at a

$150 co-share maximum

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.

Send completed Mail Order forms to:

Pharmacy Plan Details

Retail 1-31 days Member Co-share Mail Order 90 days Member Co-share Generic 30% 25% ($150 Max) Preferred Brand 40% 35% ($150 Max) Non-Preferred Brand 50% 45% ($150 Max) Specialty 45% ($75 Max) N/A Retail 1-31 days Member Co-share Mail Order 90 days Member Co-share Generic, Preferred & Non-Preferred Brand 0% after Deductible 0% after Deductible (Choice, Choice Premium Tier, Choice HRA, Kelsey) (Choice High Deductible)

What to Expect

• Some members will be affected with higher co-insurance, while
• thers will see lower out of pocket
• Formulary list will be different – will be important to check your

prescriptions for lower cost options (through myDrugCosts tool)

• Pre-authorization and Step Therapy will apply – RxBenefits member

services will be there to help you

• Refill your scripts prior to 1/1 to give you time to work through any

changes after the first of the year

• ALL diabetic testing supplies will be covered at 100% starting

1/1/2018 (CCS Medical will no longer be available)

Specialty Medication

• Express Scripts Specialty Pharmacy is Accredo
• Specialty medications include those that are used to treat complex,

chronic conditions like cancer, rheumatoid arthritis and MS

• Specialty medications often require special handling
• Members currently using a specialty medication will need to obtain a

new prescription in order have medication filled by Accredo beginning in January 2018

• Specialty medications require prior authorization and quantity limits

may apply

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Questions

Fort Bend ISD Benefits Department Fort Bend ISD Administration Building, Suite 217 Sugar Land, Texas 77479 (281) 634-1418 Benefits@fortbendisd.com