As of January 1, 2015, non-Medicare members on the Relief PPO Medical Plan will notice that a few changes have been made to the prescription benefits to comply with the Affordable Care Act (ACA) requirements, to prepare for expected ACA fees and to help maintain the best possible benefits at the lowest possible costs. All members should have received Open Enrollment materials regarding the plan changes; please review these carefully.
QUESTIONS:
Please contact Express Scripts at (800) 711-0917 and their customer care representatives will assist you with all your pharmacy-related questions and issues.
KEY CHANGES
- ID Cards: Non-Medicare members will continue to use the same ID card for medical and pharmaceutical benefits. However, spouses and dependents of Medicare-eligible members who are not on Medicare themselves will receive one new card that covers both medical and prescription benefits.
- Smart 90: Allows members to fill a prescription for a 90-day supply of long term maintenance medications at retail Walgreen’s pharmacies. Ask your provider to write a new 90-day script you can take to Walgreen’s or you may continue to use the Express Scripts Mail Order Program. If you do not use one of these two options, you will be charged a $50 penalty after the 3rd refill at a non-Walgreen’s retail pharmacy.
- Out-of-Pocket Maximums: Required by the Affordable Care Act, out-of-pocket maximums serve as a safety net to ease any potential financial burdens. As of January 1, 2015, rather than spending an unlimited amount on co-pays and percentages of your prescriptions, the most you’ll pay out-of-pocket for prescriptions in a calendar year is $5,350 for an individual or $10,700 for a family. This does NOT mean you have to pay these amounts before you receive your benefits. It is the most you’ll have to pay during a calendar year.
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According to the Affordable Care Act, the prescription out-of-pocket maximum, when combined with the Relief PPO Medical Plan’s in-network maximum, cannot be more than $6,600 for an individual and $13,200 for a family. Most people never even come close to spending the above out-of-pocket costs. But in the event of a serious illness, injury or need, the Plan now has built-in protections to limit your financial burden.
- Covered Medications: See list (click here) for your covered prescriptions.
- Additional Programs: The plan also includes Generics Preferred, Step Therapy, Prior Authorization and Quantity Limits programs. If your current medications are impacted by these programs you will receive a letter from Express Scripts outlining steps to take to ensure you are obtaining the most effective medication at the lowest possible cost. If you have any questions about these programs, please call Express Scripts at (800) 711-0917.
