For Active Employees and Non-Medicare Retirees
- Effective July 1, 2018, Express Scripts, Inc. (ESI) will manage the pharmacy benefits for GIC active and non-Medicare retirees.
- The significant cost savings achieved through a smarter use of the GIC's purchasing power largely contributed to our ability to achieve a zero aggregate premium increase in FY19.
- By contracting with one pharmacy benefits manager, the GIC has standardized its prescription drug access for the very first time, ensuring all members have access to the same drugs, at the same prices.
- Several Convenient Benefit Options
- GIC members can continue to use nearly 60,000 retail pharmacies nationwide, including major drugstores like CVS, Walgreens, and Rite-Aid for a 30-day supply.
- GIC members can also obtain a 90-day supply through mail order through ESI mail order or at retail at a CVS pharmacy.
Supporting Member Transition
- ESI Member Outreach
- In June, GIC members will receive a "Welcome Kit" with member ID card(s) that members will be required to use when filling their prescriptions.
- As is the case each year with pharmacy benefits managers, there will be some changes to certain member pharmacy benefits. Members who may experience a change as part of the transition to ESI will receive personalized communications letting them know which of their medications are impacted and what their options are.
- Prescription Drug Tier Changes
- Some members will see their current medication change tiers, leading to a change in their copay.
- Any member whose prescription drug will have moved to a higher cost tier will have covered alternatives on either the same copay tier that they were paying before or a lower cost tier.
- ESI will offer a six -month grace period (until Dec. 31) for members who may be affected by the transition as follows:
- Members who will need to obtain a Prior Authorization (PA) for a drug that they are currently on. Members who already have a PA for a particular drug will not need to obtain a new one until their current PA expires.
- Members who are currently on a brand-name drug that has a generic equivalent. Members who choose to remain on the brand-name drug will pay the difference between the generic copay and the full cost of the drug plus the generic copay. A medical necessity appeals process will be available.
- Members currently utilizing a prescription that will be excluded from the ESI. Members will have either a Tier 1 or Tier 2 covered alternative to their current therapy.
- A personalized mailing will be sent to each member in these categories informing them of available alternatives. We strongly encourage members to have a discussion with their prescribers well in advance of the end of the six-month transition period.
- Effective July 1 Silverscript (owned by CVS Health) will manage pharmacy benefits for all Medicare retirees. For most members, this does not represent a change.
- Members in the Tufts Medicare Preferred Plan or in the Fallon Senior Plan will be moving to the GIC's SilverScript EGWP (Employer Group Waiver Plan) prescription drug product for 7/1/18.
- Members should not opt-out of the SilverScript Part D program. If they do, they will lose their GIC health, behavioral health, and prescription drug benefits and will not be able to re-enroll until next spring.
- These members will join the rest of the GIC's Medicare members, who are already in this EGWP product.
- Members will receive a welcome kit in mid-June which will include a copy of the formulary and ID cards.
- Some members will see a CMS income related surcharge for Medicare Part D. This only affects members who earned more than $85,000, or filing jointly earned more than $170,000 in 2018. This surcharge ranges from $13.00 per month to $74.80 per month, depending on income.
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