your boeing prescription drug program

12
This is a Boeing Total Rewards Partner YOUR BOEING PRESCRIPTION DRUG PROGRAM EFFECTIVE JANUARY 1, 2021

Upload: others

Post on 29-Jul-2022

3 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: YOUR BOEING PRESCRIPTION DRUG PROGRAM

This is a

Boeing Total Rewards Partner

YOUR BOEING PRESCRIPTION DRUG PROGRAMEFFECTIVE JANUARY 1, 2021

Page 2: YOUR BOEING PRESCRIPTION DRUG PROGRAM

FOR THE FOLLOWING INDIVIDUALS COVERED BY BOEING-SPONSORED MEDICAL PLANS:

• Employees and their spouses and dependents

• Retirees and their spouses and dependents not eligible for Medicare

WHAT’S INSIDE:Introducing Prime Therapeutics 3

Getting Started 4

What to Expect Next 8

Support During this Change 9

Frequently Asked Questions 10

Online Resources: myprime.com/boeing

Page 3: YOUR BOEING PRESCRIPTION DRUG PROGRAM

3

Prime Therapeutics LLC (Prime)1 has been selected by Boeing as your new pharmacy benefit administrator. We are pleased to be entrusted with your care and are committed to providing outstanding service, pharmacy expertise and convenience for you and your eligible family members. Prime will replace Express Scripts,® and this change will take effect on January 1, 2021.

Prime is collectively owned by several Blue Cross and Blue Shield plans, subsidiaries or affiliates of those plans, including the main administrator of Boeing-sponsored medical plans — Blue Cross and Blue Shield of Illinois (BCBSIL). Today, Prime provides pharmacy benefit management services for over 30 million members across many medical plans.

For Boeing, we’ll provide pharmacy benefit management services for these Boeing-sponsored plans: all medical plans administered by BCBSIL, plus Cigna HMO and Aetna HMOs (except the Aetna HMO in Kansas).

We’ll offer you services and features that are similar to those you have had with Express Scripts — a large national network of retail pharmacies, a home delivery (mail order) and specialty pharmacy and a drug list that’s comparable to your current list. Plus, you’ll find new features like the opportunity to get up to a 90-day supply of medications at over 54,000 retail pharmacies.

INTRODUCING PRIME THERAPEUTICS

Page 4: YOUR BOEING PRESCRIPTION DRUG PROGRAM

4

GETTING STARTED

This section describes our prescription drug list, how to fill your prescriptions and more. It also includes tips on how to make the transition easier.

PRESCRIPTION DRUG LISTThe prescription drug list is a list of medications covered by your Boeing-sponsored prescription drug program. Same as today, the list will be split into three categories, called tiers — generics, preferred brand drugs and non-preferred brand drugs — and the amount you pay for medications in each tier in 2020 stays the same in 2021.

Effective January 1, 2021, some drugs will change coverage tiers, with some going to a higher cost tier, and some will no longer be covered. Overall, about 97% of drugs on the current list remain on the new list, and about 95% of drugs that continue to be covered will remain in their current coverage tier. These kinds of adjustments also occurred from time to time under Express Scripts.

To check coverage for any drug you’re taking now, please visit myprime.com/boeing, click on Find Medicines, answer a few questions to identify your medical plan and simply enter the name of the drug. In most cases, we’ll send you a letter in late November if you’re taking a drug where coverage may be changing. The letter will let you know the impacted drug(s) and your next steps.

In some plans, certain drugs are classified as preventive drugs and may be available at lower costs. The list of these drugs will be available early November at myprime.com/boeing and will be changed somewhat for 2021.

FILLING YOUR PRESCRIPTIONS• Retail Pharmacies — The Prime network of retail

pharmacies has over 55,000 independent and chain pharmacies, or over 99% of those used by Boeing employees and retirees today. As with the current Express Scripts pharmacy network, local Walgreens pharmacies will not be part of the Prime retail pharmacy network. To find a network pharmacy, visit myprime.com/boeing and click on Find a Pharmacy. In most cases, we’ll send you a letter in late November if you’re using a pharmacy that’s not in the network. The letter will show you nearby participating pharmacies you can use.

• Home Delivery Service — Your new Home Delivery (mail order) pharmacy will be AllianceRx Walgreens Prime. This service allows you to get up to a 90-day supply of medications that you take on a regular basis, mailed to your home.

Most prescriptions currently on file with Express Scripts Home Delivery will be transferred automatically to AllianceRx Walgreens Prime, as long as there are refills on file that extend beyond January 1, 2021. We’ll send you a letter in late November about the transfer process. The letter will also explain when and what steps you will need to take to set up a new account.

Prescriptions for compound medications or controlled substances cannot be transferred and will require a new prescription. If that’s your situation, you’ll also get a letter in late November that explains what you need to do.

• Transition Tip — If you’re not using Express Scripts Home Delivery today and want to get started after January 1, 2021, visit myprime.com/boeing on or after that date and click on home delivery sign up. Or, you can call Member Service Center. See the Support During this Change section on page 9 for details.

Page 5: YOUR BOEING PRESCRIPTION DRUG PROGRAM

5

• Retail Pharmacies that Fill a 90-Day Supply of Medications — For added convenience and cost savings to you, over 54,000 or nearly 98% of the retail pharmacies in the network will allow you to get up to a 90-day supply of maintenance medications (other than specialty medications) for the same copay you would pay if you used the home delivery service. These retail pharmacies can fill either short-term prescriptions or prescriptions of up to 90-days. To find these retail pharmacies, visit myprime.com/boeing and click on Find a Pharmacy. A pharmacy that provides this service will show a “90-day” designation in its listing.

• Transition Tip — If you want to start getting a 90-day supply of a medication at a retail pharmacy after January 1, 2021, ask your doctor to prescribe up to a 90-day supply of your maintenance medication. You or the doctor can submit that prescription to the pharmacy.

• Specialty Pharmacy — Specialty medications are used to treat chronic and complex conditions such as multiple sclerosis, hepatitis C or rheumatoid arthritis.

As is the case today, most specialty medications need to be filled by your plan’s specialty pharmacy to be covered. Starting January 1, 2021, the specialty pharmacy will be AllianceRx Walgreens Prime. You can find out if a drug is considered a specialty medication by going to myprime.com/boeing, clicking on Find Medicines, answering a few questions to identify your medical plan and entering the name of a drug to see if it has a specialty indicator. This list changes from time to time. If you’re taking one of the drugs that will be added to the list for 2021, we will send you a letter in November.

• Transition Tip — If you’re having a specialty medication filled today at Accredo, the specialty pharmacy affiliated with Express Scripts, Accredo will transfer your prescription to AllianceRx Walgreens Prime, as long as you have refills on your prescription that extend beyond January 1, 2021.

If this applies to you, we will send you a letter in late November. Given the special handling or protocols that specialty medications sometimes require, we’ll invite you to call us then, or we’ll try to call you, to help you with this transition and make sure you’re comfortable with how the specialty process works.

Page 6: YOUR BOEING PRESCRIPTION DRUG PROGRAM

GETTING STARTED CONTINUED

PHARMACY BENEFIT REVIEW PROGRAMSAs was the case with Express Scripts, there are programs designed to encourage safe, cost-effective and appropriate use of medications. The programs described below will not take effect on January 1, 2021 for prescriptions that you take now but may affect new prescriptions after that date.

WHAT IT ISPROGRAM

Go to myprime.com/boeing, click on Find Medicines and answer a few questions to identify your medical plan to see what drugs may be subject to these special programs.

Prior Authorization (PA) Some drugs may need to be approved by the program before they are covered. This is so the program can best guide appropriate use of these drugs. Your doctor can help you with this process.

WHAT YOU NEED TO KNOW OR DO

• If you’re currently taking a drug thathas a Prior Authorization on file with Express Scripts, and it extends beyond December 31, 2020, we’ll get that information from Express Scripts and honor the authorization through the date it has been approved but no later than December 31, 2021. Then, we’ll ask your doctor to provide updated information.

• If your Prior Authorization expires soon after January 1, 2021, you’ll want to talk to your doctor now about your options and be ready to submit information to us shortly after January 1, 2021.

This program will only apply to certain drugs that you begin taking for the first time on or after January 1, 2021.

Step Therapy (ST) A “step” approach is required to receive coverage for certain high-cost drugs. This means a drug will not be covered unless you try some other lower-cost drug that works just as well first.

These limits (also called quantity limits) may be applied on select drugs. Limits may involve how much covered medicine may be filled per prescription or in a given time span. If your doctor prescribes an amount that is more than the dispensing limit, you can still get the drug. But, you may have to pay for the full cost of the prescription beyond what your coverage allows. In most cases, these limits apply for safety reasons.

This program will only apply to certain Dispensing Limits (QL)drugs that you begin taking for the first time on or after January 1, 2021.

6

Page 7: YOUR BOEING PRESCRIPTION DRUG PROGRAM

7

EXPLORE MYPRIME.COM/BOEING, THE MEMBER WEBSITE

You can now visit the website to view a preview of the:

• Prescription drug list of covered medications

• Estimated prescription drug costs

• Drugs included in pharmacy benefit review programs

• In-network pharmacies

Starting January 1, 2021, you can register on the website and get the information shown above plus:

• AllianceRx Walgreens Prime specialty pharmacy and home delivery service general information

• More precise cost estimates for different drugs

• Your prescription drug claims history

• Submit requests for home delivery refills or specialty pharmacy services online

You can access the website from your smartphone, tablet or computer. Even though an app is not available, the website is optimized for mobile devices. That makes it very easy to use. If you participate in a Boeing-sponsored medical plan administered by BCBSIL, you can go to your account on the Prime website — without having to sign in — when you log in to your Blue Access for MembersSM (BAMSM) account.

Page 8: YOUR BOEING PRESCRIPTION DRUG PROGRAM

8

WHAT TO EXPECT NEXT

1 November 3 – 24

Boeing annual enrollment

2 Early November

You will receive a letter in early November if you are having a specialty medication filled today at Accredo. Due to the special handling or protocols that specialty medications sometimes require, we’ll invite you to call us, or we’ll try to call you, to make sure you are ready to go beginning January 1.

3 Late November

You may receive a letter that lets you and your doctor know what you need to do on or after January 1, 2021, if you:

• Are taking a drug that may have a coverage change,

• Are using a pharmacy that will no longer be in network,

• Are using the Express Scripts Home Delivery Service, or

• Have a Prior Authorization on file with Express Scripts.

4 Late December

If you’re enrolled in a Boeing-sponsored medical plan administered by BCBSIL, you will get a new Member ID card by the end of 2020. This ID card will replace the separate medical and prescription drug ID cards that you have today. You should use your new ID card for all medical providers and when filling your prescriptions starting January 1, 2021.

If you’re enrolled in a Cigna HMO or Aetna HMO (except Kansas) medical plan, you will get a new medical ID card from your medical plan. Your new prescription drug ID card will be mailed separately by the end of 2020. Be sure to use your new prescription drug ID card when filling your prescriptions on or after January 1, 2021.

5 January 1, 2021

• Your 2021 prescription drug benefits go into effect.

• You can go to myprime.com/boeing to set up your personal account.

• If needed, you can use this site to access AllianceRx Walgreens Prime and complete setting up your account.

Page 9: YOUR BOEING PRESCRIPTION DRUG PROGRAM

SUPPORT DURING THIS CHANGE

We understand that you may need help or more information during this transition, so we’ve set up a dedicated website and member service center. We can answer your questions and help you with the resources you need:

MEMBER SERVICE CENTERBCBSIL Members 888.802.8776

Aetna HMO/Cigna HMO Members 800.421.6022

Member Service Representatives are available Monday-Friday, 8 a.m. to 8 p.m., Eastern time.

ONLINE RESOURCEmyprime.com/boeing

Go online anytime using any device to view the prescription drug list, find retail pharmacies near you and more.

9

Page 10: YOUR BOEING PRESCRIPTION DRUG PROGRAM

10

FREQUENTLY ASKED QUESTIONS

Q: Why is Walgreens not in the local retail network?A: By not including Walgreens local retail pharmacies,

Prime is able to deliver a more cost-effective arrangement for Boeing. The retail network has broad geographic coverage without Walgreens. Walgreens local retail pharmacies were also excluded from the network through Express Scripts prior to January 1, 2021.

Q: If I have a Health Care Flexible Spending Account (FSA) or a Health Savings Account (HSA), will I still be able to use my debit card to pay for prescription drug expenses?

A: Yes. The debit card from either the Health Care FSA or HSA can be used at network retail pharmacies as well as the AllianceRx Walgreens Prime home delivery and specialty pharmacy.

Q: If my doctor wants to request some type of exception, whom would they contact?

A: If your doctor wants to ask Prime for an exception, a coverage determination or to make an appeal, your doctor can call the Member Service Center phone number on your ID card after January 1, 2021 to ask for a review. Prime will help guide your doctor through the next steps, including filling out any forms. If the coverage request is denied, Prime Therapeutics will let you and your doctor know why it was denied.

Q: Why will some drugs no longer be covered or change to a higher-cost tier?

A: These changes can happen for a variety of reasons: there may be over-the-counter (OTC) alternatives, or there may be lower-cost alternatives that clinical experts consider to be equally effective. If a drug you’re taking is in the small percentage that will no longer be covered, the letter we send in late November will let you know, in most cases, about other covered drugs that treat the same condition. These kinds of adjustments also occurred from time to time under Express Scripts.

Page 11: YOUR BOEING PRESCRIPTION DRUG PROGRAM

Q: Are the terms “preferred brand” and “non-preferred drug” new?

A: The term “preferred brand” is now being used to refer to the tier that had been called “formulary brand.” The term “non-preferred drug” replaces the previous term “non-formulary brand.”

Q: Are there any programs to help us learn how to save money on our prescription drug expenses?

A: Toward the end of 2020 or in early 2021, we’ll send you information about Rx Savings Solutions (RxSS).2 This is a confidential and optional service that gives personalized prescription guidance at no cost to help you save money. The service can send you a text or email if you ever pay too much for a prescription. RxSS finds other ways to get the same treatment for less money. You can pre-register for this service before January 1. You can find the link to register at myprime.com/boeing.

11

Page 12: YOUR BOEING PRESCRIPTION DRUG PROGRAM

J034

696

As always, treatment decisions are between you and your doctor. Coverage is based on the terms and limits of your Boeing-sponsored Medical Plan.

1 Prime Therapeutics LLC is an independent company providing pharmacy benefit management services for Boeing health plan members. Prime Therapeutics has an ownership interest in AllianceRx Walgreens Prime, a central specialty pharmacy and mail service company. Myprime.com/boeing is an online resource offered by Prime Therapeutics LLC.

2 Rx Savings Solutions (RxSS) is an independent company that contracts directly with Prime to provide Rx consultations. RxSS does not offer other health plan products or services and is solely responsible for the products and services that it provides. There are no endorsements, representations or warranties made regarding third-party vendors. Members should contact the vendor directly with questions about the products or services offered by third parties.

7049-A BOE © Prime Therapeutics LLC 09/20