Pharmacy benefits for large group members
Our pharmacy package focuses on preventive medicine and vital supplies that improve overall health and wellness. It also shifts the costs of your specialty medications to the manufacturers, while offering you convenience and savings.
The pharmacy benefits in this package take effect for group members on their renewal date or effective date in 2024 and create access to more medications and supplies at $0.
For more information about the Pharmacy Benefits Package for group members, contact Member Services at 1-800-279-1301.
New drugs added to the preventive drug list (PDL) include:
- Preferred mental health medications
- Preferred brand diabetes medications
- Preferred insulin and non-insulin injectables
- Preferred diabetic supplies
- Preferred inhalers and nebulizer solutions
With a 90-day supply, you'll spend less to get more of the medication you need.
Review your cost share for 90-day refills. If you have tier 1 or tier 2 pharmacy benefits with coinsurance, you'll be responsible for the full coinsurance amount:
- Tier 1 and 2 medications through a mail-order pharmacy cost 2 times your copay.
- Tier 1 and 2 generic maintenance medications through a retail pharmacy cost 2.5 times your copay.
- Tier 3 medications through a retail or mail order pharmacy cost 3 times your copay.
- Tier 4 pharmacy benefits are not eligible for a 90-day supply.
Keeping diabetes under control can be challenging, and cost shouldn't be a barrier. That's why all our drugs lists include preferred diabetic supplies that cost $0 for large group members. They include:
- Blood glucose test strips
- Ketone test strips
- Continuous glucose monitoring supplies
- Syringes
- Lancets
- Pen needles
- Glucagon
These benefits can help you focus on staying healthy instead of worrying about the cost of getting there.
Specialty drug utilization affects less than 1% of the population but carries the highest cost of all medications. Moving from a three-tier to four-tier formulary moves many specialty drugs to their own tier and includes manufacturer coupons that can reduce your cost share.
Is there an out-of-pocket maximum for tier 4 specialty drugs?
No. Because manufacturer coupons are applied to your cost share and not applied to plan costs, those savings go directly to you. These savings can help reduce your overall health care costs.
Can I offset the increased costs of tier 4 drugs?
Yes. By using manufacturer coupons, you can lower your total costs. Lumicera, the mandatory specialty pharmacy, will automatically match you with manufacturers coupons when you begin new prescriptions with available coupons.
How do I find and apply coupons?
The specialty pharmacy Lumicara (or preferred Limited Distribution Drug (LDD) Specialty Pharmacy) will help. When they get your new prescription request for a tier 4 drug, they'll search for an available coupon for you. If there is one, they'll either automatically enroll you or reach out directly to facilitate your enrollment before they dispense your first fill of the specialty medication.
Is there a maximum coverage limit for manufacturer coupon programs?
Coupon programs can vary based on the drug and manufacturer. There are a few select drugs that have a maximum annual coverage limit. When you enroll in a coupon program, the specialty pharmacy will share these details and limitations with you. Coupon programs are subject to change at any time.
For more information about this benefit enhancement, contact Member Services at 1-800-279-1301.