Dear DEHIC Participants:
This is to inform you of an important update from the DEHIC Board of Trustees that will positively impact the prescription drug benefit of the Alternate PPO, Healthy Advantage PPO, and EPO Select 20 beginning July 1, 2018. This important update is estimated to save the health plan $2.2M over the next plan year.
During the Board of Trustee’s meeting held on January 24, 2018; a motion was made to approve the introduction of Mandatory Mail Order Coverage for prescription drug maintenance medications.
By definition, maintenance medications are those drugs used to treat chronic, long-term conditions taken on a regular and recurring basis. Examples of chronic conditions requiring this type of treatment include but are not limited to diabetes, high blood pressure, high cholesterol, etc. DEHIC members currently have an opportunity to obtain their maintenance medication through the mail order process under Express Scripts, Inc. The process is currently voluntary and members are able to obtain a 90-day supply for two copayments.
Beginning on July 1, 2018; members will be required to obtain their maintenance medications through Express Scripts, Inc. This process will save time and money (two copayments for 90-day supply remains in place). You will no longer need to make a trip to the pharmacy, as the medication will be delivered directly to the home address. If members will be away from the home for extended periods of time, the medication can easily be re-directed upon request. An extended period of time is 3 or more months.
We have attached materials for your review that explain the process for you as well as a list of maintenance medications. The attached list of medications is subject to change by Express Scripts, Inc; so it is important to periodically check with Empire Customer Service on such updates.
Although this does not go into effect until July 1, 2018; please enroll sooner than later so that any issues that may arise can be worked out. To ease into the transition beginning July 1, 2018; members will be allowed to obtain two prescription fills at their pharmacy if they have forgotten to enroll in the mail order service. After that, they must use the mail order service, or will have to pay the full cost of the prescription out of pocket. Should members forget to use the mail order service beginning July 1, 2018; a letter will be sent to the member from Express Scripts, Inc.; within 2 weeks after each fill at the pharmacy. The letter will remind the member to use mail order, as well as, the ways in which they can sign up. A phone number will be included for additional member support.
Please take the time to review your medications so that you can check the list to see what maintenance drugs are covered. Remember this will be mandatory as of July 1, 2018.
Pasquale Delli Carpini