Empire Plan Report - December 2007

SUNY Student Employee Health Plan (SEHP)
for Graduate Student Employees Union (GSEU)
Represented Enrollees

The SEHP Prescription Drug Program – January 1, 2008

Beginning January 1, 2008, UnitedHealthcare will insure and administer the Prescription Drug Program. UnitedHealthcare will partner with Medco Health Solutions, Inc. (Medco) for retail pharmacy network and mail pharmacy services (Medco by Mail).

Your prescription drug benefits are not changing, but there will be some differences that enrollees should note.

• There will be some changes to the Preferred Drug List as part of the annual Prescription Drug Program review. See your HBA for the 2008 Empire Plan Preferred Drug List, administered by UnitedHealthcare or check the New York State Department of Civil Service website at www.cs.state.ny.us. Select "Employees" and follow the links to Health Benefits and select GSEU. On the resulting NYS Online page, select "Using Your Benefits." This is not a complete list of covered drugs; it includes only the most commonly prescribed generic and brand-name drugs.
• The majority of the Plan's current network pharmacies will continue to participate, including most retail chain pharmacies. To find a participating pharmacy you can:
  • Call the pharmacy and ask if they will participate in The Empire Plan participating pharmacy network beginning in January;
  • Go to the Department of Civil Service website at www.cs.state.ny.us, select "Employees" and follow the links to Health Benefits. Select GSEU then "Using Your Benefits," and scroll down to Providers, Pharmacies and Services, or
  • Call toll free at 1-877-7-NYSHIP (1-877-769-7447) and choose the Prescription Drug Program on the main menu and then the prompt for 2008 benefit information to reach a representative.
• Beginning in January 2008, a new mail service pharmacy (Medco by Mail) will fill your prescriptions by mail. The SEHP has a pharmacist on call 24 hours a day, seven days a week.

These are just the highlights of some of the changes. Please read this Report carefully. We want you and your family to have the information you need about your 2008 prescription drug coverage.

Note: The Student Employee Health Plan (SEHP) shares the Participating Pharmacy Network, Mail Service Pharmacy, Preferred Drug List and claim services with The Empire Plan.

No New Benefit Card

You will not need a new identification card to fill prescriptions. Continue to use your NYSHIP SEHP Benefit Card. This is the card you already use for your Empire Plan prescription drug benefits. Refer to information you should take along on your first visit to a participating retail pharmacy on or after January 1, 2008.

What's New…

• New insurer/administrator UnitedHealthcare
• New 2008 Empire Plan Preferred Drug List (PDL)
• New mail service pharmacy, Medco by Mail
• New Teletypewriter (TTY) number for callers with a hearing or speech disability TTY Only 1-800-855-2881 (updated 5/08)

What's The Same…

• Toll-free NYSHIP number 1-877-7-NYSHIP (1-877-769-7447) for Prescription Drug Program questions
• Copayment amounts for all covered prescriptions (generic, preferred brand-name and non-preferred brand-name drugs) including at Campus Health Centers at University of Buffalo and Stony Brook
• Annual prescription drug maximum of $2,500
• NYSHIP SEHP Benefit Card
• Mandatory generic substitution requirements
• Prior authorization for certain drugs
• Drug Utilization Review
• 90-day supply at mail service, with refills up to one year
• Preaddressed, postage paid envelopes for the mail service pharmacy

January 1, 2008 Reminders

If you are taking a prescription drug now, plan ahead to avoid any problems using your benefits on or after January 1, 2008.

• If you are now filling a prescription at a retail pharmacy and have refills available, ask if the pharmacy participates in The Empire Plan participating pharmacy network. If it does, you can continue to use your NYSHIP SEHP Benefit Card there. (See the Questions and Answers on page 3 if the pharmacy does not participate.)
• If you are now using the Caremark Mail Service and have refills available, your prescription (except for compound drugs and controlled substances that will require a new prescription) will be automatically transferred to Medco by Mail as of January 1, 2008.
• Prescriptions for compound drugs and controlled substances (Rx number begins with "C") cannot be transferred between retail pharmacy locations. You will need a new prescription from your doctor.
• The Prescription Drug Program will not cover prescriptions (including refills) dispensed by the Caremark Mail Service pharmacy after December 31, 2007.
• If the Prescription Drug Program has waived the generic substitution requirement for a specific prescription you are using, you will not need to file a new generic appeal at this time.
• If you have already received approval for a drug on the Prior Authorization List, you don't need to call at this time for another authorization.

Here's How to Use the Prescription Drug Program

When your doctor prescribes a medically necessary drug on or after January 1, 2008, you can fill the prescription using your NYSHIP SEHP drug benefits in one of three ways:

1. You can use your NYSHIP SEHP Benefit Card for covered prescription drugs at Empire Plan participating pharmacies.
2. You can order your covered prescription drugs by mail from Medco by Mail.
3. You can use a non-participating pharmacy or pay cash for your prescription at a participating retail pharmacy (instead of using your NYSHIP SEHP Benefit Card) and submit a claim for reimbursement.
   
   In most cases, you will not be reimbursed the total amount you paid for the prescription and the resulting out-of-pocket expense will likely be greater than your copayment at a participating pharmacy. So use your NYSHIP SEHP Benefit Card whenever possible.

Refer to new mailing addresses.

Controlling Your Prescription Drug Costs

One way you can help control the rapidly increasing cost of prescription drugs is by encouraging your physician to prescribe generics whenever they are available or when prescribing a brand-name drug to use the Preferred Drug List. This is not a complete list.

This list offers alternatives that are safe and effective equivalents to higher cost drugs. The drugs listed have been determined by a panel of pharmacists and physicians to be safe and effective for treating disease and reducing drug therapy cost.

There will be some differences between the 2007 Empire Plan Preferred Drug List and the 2008 Empire Plan Preferred Drug List. If you are an enrollee taking a drug that will become a non-preferred brand-name drug as of January 1, 2008 you may have received a letter in the mail with lower cost generic or preferred brand-name alternatives. You should discuss using alternatives with your doctor or you will pay a higher cost for the non-preferred brand-name drug.

The 2008 Empire Plan Preferred Drug List will be sent to participating Empire Plan physicians to use in selecting drugs for you. They are encouraged – but not required – to use this list. Medically necessary non-preferred brand-name drugs that are not on the Preferred List are covered, but at a higher cost to you.

You can help control your prescription drug costs by reminding your doctor of the Empire Plan Preferred Drug List as you discuss the best treatment options for your health conditions. Be sure to keep the drug list on the following pages with your medical records as a handy reference.

Questions and Answers About The Empire Plan Prescription Drug Program

Q. What are my options to fill a prescription after January 1, 2008 if my current retail pharmacy does not participate in The Empire Plan participating pharmacy network?

A. You have three choices:

1. Ask the pharmacy if they will transfer the prescription to a participating pharmacy (except for compound drugs and controlled substances, which cannot be transferred);
2. Pay cash and submit a claim for reimbursement; or
3. Ask your doctor for a new prescription to fill at a participating retail pharmacy or Medco by Mail.

Q. Can I send my prescriptions to the Medco Mail Service now?

A. Since Medco by Mail will not become your new mail service pharmacy until January 1, 2008, you should not begin sending your prescriptions to Medco by Mail until December 28, 2007.

Q. I currently use a credit or debit card to pay for my mail order prescriptions. Will my payment information transfer to Medco by Mail on January 1, 2008?

A. No, you will need to reestablish your payment arrangement with Medco the first time you use the mail service pharmacy. If you are currently using the Plan's mail service pharmacy, you will receive additional information before January 1, 2008 about using Medco by Mail.

Q. What is the deadline for submitting direct reimbursement claims to Caremark for prescriptions filled in 2007?

A. You should file claims as soon as possible. However, you have until 90 days after the end of the calendar year – or March 31, 2008 – to submit claims to Caremark for prescriptions filled in 2007.

Q. Will certain drugs still require prior authorization?

A. Yes, you must continue to obtain prior authorization for certain drugs. While these drugs can have medical results of immeasurable value, they are sometimes prescribed inappropriately. The Empire Plan Prior Authorization Program administered by UnitedHealthcare ensures that these drugs are used appropriately, for medically necessary treatments.

Q. Will Medco by Mail provide any additional pharmacy services?

A. For prescriptions written on or after January 1, 2008, you will be asked to complete a Health, Allergy, and Medication Questionnaire to alert your doctor to possible drug allergies or interactions. Download the form at www.cs.state.ny.us. Select "Employees" and follow the links to Health Benefits. Choose GSEU if prompted, then select "Using Your Benefits", click on Forms and find "Empire Plan Prescription Drug Program Forms".

When You Call

For anything related to your Prescription Drug Program beginning in 2008, you can call toll free at 1-877-7-NYSHIP (1-877-769-7447) 24 hours a day, seven days a week. Choose the Prescription Drug Program on the main menu and then the prompt for 2008 benefit information to connect to a representative or pharmacist.

Effective January 1, 2008, you will be able to:

• Verify your eligibility
• Locate a participating pharmacy
• Use the mail service pharmacy
• Talk to a representative
• Request prior authorization or a generic appeal
• Talk to a pharmacist

The NYSHIP SEHP Prescription Drug Program

Up to a 30-day supply from a participating retail pharmacy or Medco by Mail

$5 Copayment – generic drug
$15 Copayment – preferred brand-name drug
$30 Copayment – non-preferred brand-name drug

31- to 90-day supply through Medco by Mail

$5 Copayment – generic drug
$20 Copayment – preferred brand-name drug
$55 Copayment – non-preferred brand-name drug

Your First Visit to a Participating Pharmacy after January 1, 2008

NYSHIP SEHP and the Prescription Drug Program administrator have made every effort to ensure that participating pharmacies are aware of the change in administrators and know how to submit claims. However, you should cut out the information below and take it with you the first time you go to a retail pharmacy on or after January 1, 2008.

Your first visit to an Empire Plan participating retail pharmacy on or after January 1, 2008

Below is information that may be helpful the first time you use an Empire Plan participating retail pharmacy to fill your prescription:

UnitedHealthcare administers The SEHP Prescription Drug Program

Rx Group: UH0712959
Bank Identification Number: 610014

 

New Addresses You Need to Know

Addresses for using the mail service pharmacy, submitting claims for prescriptions from non-participating pharmacies and general correspondence are changing. Use the addresses below on and after January 1, 2008:

1. Mail prescriptions to:
   Medco by Mail
   P.O. Box 747000
   Cincinnati, OH 45274-7000
2. Mail completed claim forms for prescriptions from retail pharmacies to:
   Medco
   P.O. Box 14711
   Lexington, KY 40512
3. Mail general correspondence to:
   The Empire Plan Prescription Drug Program
   P.O. Box 5900
   Kingston, NY 12402-5900

For directions on where to send written appeals and prior authorization documentation, call toll free 1-877-7-NYSHIP (1-877-769-7447) and select The Empire Plan Prescription Drug Program.