state of new hampshire
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State of New Hampshire. Pharmacy Benefit Changes Effective 10/1/2010 Presented By: Melisa Briggs. Pharmacy Benefit Overview. There are two ways you can obtain your prescription medications through CVS Caremark: - PowerPoint PPT PresentationTRANSCRIPT
State of New Hampshire
Pharmacy Benefit Changes Effective 10/1/2010
Presented By:
Melisa Briggs
Pharmacy Benefit Overview
There are two ways you can obtain your prescription medications through CVS Caremark:
• Mail Order Program – To order prescriptions used on a regular basis (such as blood pressure, allergy)
• Retail Pharmacy Program – To purchase medications needed for a short-term basis or if medications are needed quickly (such as antibiotics)
Pharmacy Benefit Overview and Changes Effective 10/1/2010
*$500 Individual/$1,000 Family calendar year out-of pocket maximum; once this is met you will have a zero copay and 100% coverage for the remainder of the calendar year. Retail and mail order
copays apply towards this maximum.
Active Employees and Retirees Generic Preferred Brand-Name
Non-Preferred Brand-Name
Retail Pharmacy (co-payment per prescription or refill for up to a 31-day supply); refill limit of up to three fills (one initial plus two refills) for maintenance or long-term medications
$5 $10 $15
Mail Order (co-payment per prescription or refill for up to a 90-day supply)
$1 $20 $30
Mail Order Prescriptions – What You Should Know
You and the State’s Prescription Benefit Program save money when you order maintenance or long-term prescriptions through mail order– This is due to the cost savings received when
prescriptions are filled through CVS Caremark’s Mail Service Pharmacy
Beginning 10/1/2010, all maintenance or long-term prescriptions will be filled through CVS Caremark’s Mail Service Pharmacy
Mail Order Prescriptions – What You Should Know
To allow you time to transition to mail order for your current maintenance or long-term prescriptions
– You may fill these for up to three fills (one initial plus two refills) on or after 10/1/2010
If after three fills at the retail pharmacy you choose to fill your maintenance or long-term prescriptions at the retail pharmacy
– You will pay 100% of the cost – You should still present your CVS Caremark identification card in
order to receive CVS Caremark’s discounted price– This cost will not be applied to your calendar year out-of-pocket
maximum
Mail Order Prescriptions – What You Should Know
For any newly prescribed maintenance or long-term prescriptions that you fill on or after 10/1/2010 – You may fill up to a 31-day supply for up to three
fills (one initial plus two refills) at a retail pharmacy location
Mail Order Prescriptions – What You Should Do
Look for a letter from CVS Caremark explaining how to use the mail order pharmacy – You will receive this letter if you are currently filling
your maintenance or long-term prescriptions at the local retail pharmacy
– Ongoing notification will be sent if you have not transferred to mail order, or when you fill a new maintenance or long-term prescription
Mail Order Prescriptions – What You Should Do
Take advantage of the cost savings and convenience right away!– You do not have to wait until on or after 10/1/2010 to
begin using the mail order program to fill your maintenance or long-term prescriptions
Mail Order Prescriptions – Did You Know?
Using the mail order vs. retail pharmacy will save you time and money
– It’s convenient and an easy way to obtain your prescriptions New Prescriptions – 7 to 10 days after CVS Caremark
receives your order Refills – 5 to 7 days after CVS Caremark receives your
request– You will save money
For example, if you are taking a preferred brand-name medicine you will pay $20 for a 90-day supply through the mail order; the cost would be $30 at the retail pharmacy for the same supply
Mail Order Prescriptions – Did you know?
Doctors can fax prescriptions directly to CVS Caremark by calling 800.378.5697
FastStart Program – To get started call 800.875.0867, or log on to
www.caremark.com and click on “Start a New Prescription”, then click “FastStart”
– Provide the name of your medication, doctor’s name and phone
– CVS Caremark will contact the doctor for you to obtain a new prescription
Mail Order Prescriptions – Did you know?
Future refills can be ordered - Online at www.caremark.com; there is a one-time online
registration that only takes a minute or two- Call toll-free 888.726.1630 and use the automated refill
service- Complete the “Mail Service Order Form” and send
directly to CVS Caremark
New Mail Order Features– Automatic Refills and Renewals
Mail Order Prescriptions – Did you know?
Brand name prescriptions will automatically be substituted with a generic equivalent if available, unless your doctor indicates “dispense as written” or similar instructions
Registered pharmacist are available for consultation 24 hours a day, seven days a week, by calling CVS Caremark
Delivery will always be free – even if there is special shipping requirements
Mail Order Prescriptions – Did you know?
You can request an additional supply of medication by calling CVS Caremark if you will be traveling for a long period of time
Specific procedures are followed in the rare event your medication is lost, stolen or damaged
CVS Caremark’s mail order pharmacies have the appropriate quality and safety procedures in place when shipping medications
Retail Pharmacy Prescriptions – What You Should Know
You can continue to use retail pharmacy locations for:
– Your short-term prescription needs– Other types of non-maintenance medications, such as sleep
agents and pain relief prescriptions– Compound medications
You can go to any participating pharmacy and do not need to use a CVS pharmacy
Just show your CVS Caremark ID card and pay the applicable copay
Specialty Drug Program - What You Should Know
Specialty medications are used to treat chronic and/or genetic conditions, such as multiple sclerosis and rheumatoid arthritis – Often infused or injected medications
Beginning 10/1/2010, all specialty medication will be provided by CVS Caremark’s Specialty Pharmacy
CVS Caremark’s Specialty Pharmacy is a mail order facility dedicated to dispensing specialty medications
Specialty Drug Program - What You Should Know
This program is designed to provide you with personalized care, education and support – Access to a pharmacist 24 hours a day, seven days a
week– Coordination of care with you and your doctor– Convenient delivery directly to you or your doctor’s office– Medicine- and disease-specific education and counseling– Online support through www.caremark.com/specialty,
including interactive areas to submit questions to pharmacists and nurses
Exclusive Specialty Drug Program - What You Should Do
Look for a letter from CVS Caremark explaining how to enroll in the Specialty Drug Program– You will receive this letter if you are currently taking
specialty medication(s) and purchasing them through a retail pharmacy
You should contact CVS Caremark Specialty Pharmacy at 800.237.2767 if you are newly prescribed a specialty medication
Generic Equivalent Program – What You Should Know
You and the State’s Prescription Benefit Program save money when you use generic equivalents – Generic medications often cost much less
Beginning 10/1/2010, if you request a brand-name medication when the generic equivalent is available– You will pay the generic copay plus the difference in cost
between the generic and brand-name medication– This additional cost will not be applied to your calendar
year out-of-pocket maximum
Generic Equivalent Program – What You Should Know
When your doctor recommends the brand-name medication for your treatment– Your doctor will indicate “Dispense as written” or
similar instructions– You will pay the brand-name copay
Generic Equivalent Program – What You Should Do
Look for a letter from CVS Caremark explaining which medications have generic equivalents – You will receive this letter if you are currently filling
your prescription(s) with a brand-name medication when a generic equivalent is available
– It will include the steps to take to avoid paying the added cost of the brand-name medication
Generic Equivalent Program – What You Should Do
Talk with your doctor to determine if the generic equivalent is appropriate for you
Ask for a new prescription from your doctor if you would like to change to the generic medication
Generic Prescriptions – Did You Know?
Taking generics will save you money The copay for generic medicine will always be less than
the brand name copay Generics are FDA*-approved equivalents of their brand
counterparts and cost less Generics typically cost 30-80% less than the brand
name The FDA reviews generics to make sure they are safe,
the same ingredients, strength, dosage form and performance (how it works in the body)
*U.S. Food & Drug Administration
Other Pharmacy Benefit Program Enhancements – Effective 10/1/2010
New Generic Mail Order Copay– Your copay for all generics will be reduced
to $1 when you use the mail order pharmacy Discuss generic alternatives with your
doctor Obtain a new prescription if the generic
medication is appropriate for you
Other Pharmacy Benefit Program Enhancements – Effective 10/1/2010
New Coverage for Physician-Prescribed Tobacco Treatment Medications and Over-the-Counter (OTC) Medications
You may purchase tobacco treatment prescriptions and over-the counter medications to help you quit using tobacco products
– Nicotine Replacement Therapy Patches, Gum, and Lozenge – Bupropion – Zyban– Nicotrol Nasal Spray– Nicotrol Inhaler– Varenicline – Chantix
Other Pharmacy Benefit Program Enhancements – Effective 10/1/2010
Discuss your desire to stop using tobacco products and treatment options with your doctor
Ask if a prescription or OTC medications would help you with your quit attempt – A prescription is also required for all OTC
medications Present your CVS Caremark prescription ID card
with your prescription at the local retail pharmacy, or use the mail order program
Other Pharmacy Benefit Program Enhancements – Effective 10/1/2010
The same copays apply to tobacco treatment medications and OTC medications as all other prescription copays
Covered dependents age 17 and younger are not eligible for these medications
Ask your doctor if participation in a group or individual tobacco dependence counseling program would also be of help with your quit attempt
Other Pharmacy Benefit Program Enhancements – Effective 10/1/2010
Dependence counseling programs available Your Employee Assistance Program – Call
800.852.3345, ext. 4336 NH Smokers’ Helpline 800-Try-To-STOP
(800.879.8678) Other group counseling programs are also
offered in your local community, hospital and workplace setting
Other Communications – What You Should Know
Look for a personalized prescription drug benefit booklet in the mail that will provide– Information about your prescription drug benefits and
how to make the best use of them – A convenient pull-out guide outlining plan specifics
You will not receive new prescription ID cards – Continue using your current ID cards when purchasing
prescriptions at the retail pharmacy
What is covered under your pharmacy benefits?
State-restricted drugs (i.e. cough syrups with codeine) Diabetic supplies, including insulin syringes Insulin by prescription only Federal legend Drugs, including:
-Cardiovascular Drugs -Anti-infectives -Dermatological Therapies-Ear, nose and throat medications-Ophthalmology drugs-Respiratory, allergy, cough, and cold medications-Oral diabetic drugs-Growth hormones and injectables
What is covered under your pharmacy benefits?
Compound medications Birth control devices and oral contraceptives Immunizing agents Tobacco treatment medications and over-the-counter medications
(effective 10/1/2010)
What is not covered under your pharmacy benefits?
Therapeutic devices or appliances (i.e. bandages, humidifiers) Non-federal legend drugs, except insulin (i.e. over-the-counter
medications) Anti-Obesity Medications Drugs labeled “Caution-Limited by Federal Law to Investigational Use,” or
experimental drugs Medication for which the cost is recoverable under any workers’ comp or
occupational disease law, any state or government agency, or medication furnished by any other pharmaceutical or medical service for which no charge is made to the individual
Medication taken or administered to the member while he or she is inpatient
Any prescription that has reached the maximum number of refills specified by the physician or any prescription that is more than 1-year old
Questions?