As shared during Open Enrollment, the Prescription Benefits Manager (PBM) for all Indiana University health care plans transitioned from Express Scripts to CVS Caremark effective January 1, 2018. Human Resources (HR) partnered with Express Scripts and CVS Caremark to make the transition as smooth as possible. Below is a collection of helpful information and resources to help you manage the transition.
The PBM transitioned from Express Scripts to CVS Caremark alongside all other state-funded institutions of higher education, such as IU, Purdue, Ball State, Indiana State, and Ivy Tech. Indiana legislation mandates that all institutions of higher education participate in the Indiana Aggregate Prescription Purchasing Program (IAPPP) along with the employees of the State of Indiana. The program is managed by the State of Indiana and CVS Caremark was selected as the new PBM in the fall of 2017, the first change in PBM since 2011.
The best way to manage your prescriptions is through Caremark.com. Once you register, your account will reflect your coverage based on your health care plan and your deductible status. This is a great way to quickly check prescription coverage and costs.
To make the PBM transition as seamless as possible, your prescription history, any open refills, and approved prior authorization information were transferred to CVS Caremark. Due to federal law, prescriptions for controlled substances require a new script from your doctor and were not transferred.
You can still use most of the same pharmacies as before. The CVS Caremark pharmacy network includes most retail chain pharmacies, such as CVS, Walmart, Target, and many supermarket pharmacy chains. Some independent pharmacies are also included. Walgreens pharmacy is NOT in-network.
When you or a family member needs to see a health care provider or have a prescription filled, don’t forget to take your health plan ID card with you. Due to the change in your Prescription Benefits Manager, all health care plan enrollees received new ID cards for 2018. For members covered by Anthem plans, your ID card contains information needed to use your health, prescription, and vision benefits, so be sure to update your insurance information with all of your health care providers. For those enrolled in the IU Health HDHP, you received separate medical, prescription, and vision ID cards to share with providers. If you do not have your new prescription benefits plan information updated with your pharmacy, your prescription may be denied or you may have to pay the full cost of the prescription.
Specialty medications must be filled through CVS Specialty Pharmacy and are limited to a 30-day supply. If you are travelling outside of the country and need more than a 30-day supply, contact HR at least a week ahead of your departure and IU HR will work with CVS Caremark to authorize additional refills for the duration of your trip. If you’re travelling within the country, the CVS Caremark network has locations across the US and mail order refills can be sent to alternative addresses while you are travelling.
CVS Caremark has a different drug formulary than Express Scripts. If your prescription was impacted by the difference, you should have received a notice from CVS Caremark. If you take a medication that is not in the CVS Caremark formulary, speak to your doctor about an alternative or generic drug in the CVS Caremark formulary. If that is not possible due to a medical necessity, your doctor can request a prior authorization review with CVS Caremark for you to remain on the non-formulary medication. Keep in mind that a medication not in the formulary may be more expensive than the formulary option.
Each PBM manages their own preventive medication list and CVS Caremark has developed their preventive medication list based on federal guidance. Due to the preventive nature of these medications, HDHP members can bypass their deductible and pay only the 20 percent co-insurance for preventive medications. Once the out-of-pocket maximum is met, prescription costs are covered by the HDHP at 100 percent.
Different PBMs have different formularies and manage their medication costs differently. Using a medication not in the formulary may result in a higher cost. If you are enrolled in a Health Savings Account (HSA), IU makes its contribution to HSA accounts in January to help with out-of-pocket prescription costs. These HSA funds can be used to pay for prescriptions and medical care. Regardless of your health care plan, don’t forget that any amount you pay toward a covered prescription applies to your annual deductible and/or out-of-pocket amounts in your plan.
To request prior authorizations and appeals, contact CVS Caremark Customer Care at 866-234-6952.
Grab your health plan ID card and visit Caremark.com to create an account or use the Caremark app to:
Page updated: February 2018
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