Our new pharmacy package focuses on preventive medicine and vital supplies that improve overall health and wellness. It also shifts costs of members’ specialty medications to manufacturers all while providing convenience and savings.
The pharmacy benefits in this package take effect for group members on their renewal date or effective date in 2023 and create access to more medications and supplies at $0.
For more information about the Pharmacy Benefits Package for group members, contact Customer Care at 877-230-7555.
Now more medications are covered at $0 for large group members. This helps you manage health costs—and helps your provider choose the right drugs for your needs.
New drugs added to the preventive drug list (PDL) include:
Preferred mental health medications
Preferred brand diabetes medications
Preferred diabetic supplies
Preferred insulin and non-insulin injectables
Preferred inhalers and nebulizer solutions
Specialty drug utilization affects less than 1% of the population but carries the highest cost of all medications. Moving from a three-tier to four-tier formulary moves many specialty drugs to their own tier and includes manufacturer coupons that can reduce members’ cost share.
No. The intent is to shift expenses from members by maximizing savings through manufacturer coupons.
Yes, the increase in copay or coinsurance to the member in the 4th tier will be offset by using the manufacturer coupons available. Lumicera, the mandatory specialty pharmacy, already has processes in place to connect members beginning a new prescription that has an associated manufacturer coupon.
When specialty pharmacy Lumicera (or preferred Limited Distribution Drug (LDD) Specialty Pharmacy) receives a new prescription request for a tier 4 drug, they will look for an available coupon and either automatically enroll the member or reach out to the member directly to facilitate enrollment prior to dispensing the first fill of the specialty medication.
Coupon programs vary significantly per drug/ manufacturer. There are a few select drugs that have a maximum annual limit of coverage*. The specialty pharmacy will share details and limitations of specific coupon programs with the member upon enrollment.
* Coupon programs are subject to change at any time.