In the fall, the Trust launched a partnership with CVS Health to provide the Trust’s self-insured prescription drug benefits, which were previously provided through Blue Shield of Northeastern New York. CVS Health became the Trust’s prescription drug benefit manager (PBM) on September 1, 2016.
We want to explain a bit about how we selected CVS Health and provide an overview of some of the changes you need to know about.
The PBM Selection Process
The RCG Health Insurance Trust requested proposals from various PBMs as part of our continuing efforts to promote wellness and provide our member Districts and our covered employees, retirees and dependents with the best value possible.
CVS/Caremark was selected for a number of reasons, including a larger pharmacy network with about as many chain and independent pharmacies as the prior PBM (78% of Trust participants live within five miles of a CVS retail pharmacy) and additional benefits available at CVS pharmacies, including wellness programs and a 20% discount on over-the-counter products for our participants.
Filling a Prescription through CVS Health
In almost all cases, you can still use your local pharmacy to fill your prescriptions. On top of that, the new network is larger than the one we were using. To find a nearby network pharmacy, you can go to www.caremark.com, log in (you’ll need to create an account if you don’t already have one), click on plan and benefits, and then click on pharmacy locator, or you can call CVS Health at 866-808-7159.
You can choose where to fill your maintenance prescriptions—at CVS retail pharmacies or through the CVS mail service. And, you can move prescriptions between CVS retail pharmacies and the CVS mail service any time you want. You can enroll in the mail order program at www.caremark.com or by calling 800-875-0867.
CVS Health Formulary
A formulary is the list of medications covered by your prescription drug benefits. The list is determined by the PBM—not by the Trust. The CVS Health formulary is reviewed regularly by a committee of independent, unaffiliated pharmacists and physicians. The committee bases its decisions on scientific evidence, standards of practice, peer-reviewed medical literature, accepted clinical practice guidelines, and other appropriate information to ensure that the clinical alternatives selected are safe, effective and clinically appropriate.
As a result of the committee’s review, drugs are added or removed from the formulary, or may change from preferred to non-preferred. When the status of a drug changes, CVS Health sends notices to affected participants. This process is similar for all PBMs.
The costs of prescription drugs are constantly increasing. PBMs and manufacturers are offering new savings opportunities through pricing discounts and rebates. And government regulations around prescription drug benefits are constantly changing. As a result of this constantly changing environment, the cost and complexity of providing prescription drug benefits is also increasing. For all of these reasons, we regularly review our PBM relationship in an effort to provide you with the coverage and access you need at costs that are affordable for you, our member Districts and the Trust.
Before the change to CVS Health went into effect, CVS Health reviewed the prescriptions being used by our participants and contacted all participants taking medications that would not be on the CVS Health formulary. The letters explained the change and provided information for the participants and their doctors about covered alternative medications and the process for requesting formulary exceptions.
In addition, the RCG Health Insurance Trust instructed CVS Health to provide an override of a payment rejection for any drugs that transitioned to an excluded status under the CVS Health formulary (i.e., a medication that a participant was taking, and which was covered, under the prior plan) to allow participants more time to consult with their doctors.
While the large majority of participants and medications were not impacted by the change, we know that the change was not easy for the affected participants.
If you have questions about the formulary, please contact CVS Health at 866-808-7159 or www.caremark.com.
Specialty Medications
If you take a specialty medication, you are now required to fill your prescription through the CVS Specialty Pharmacy. CVS Health should have contacted you about the change. To find out more about specialty medications and filling their prescriptions, please go to www.cvsspecialty.com or call 800-237-2767.
New CVS Health Features
You should have received a CVS ExtraCare Health Card in the mail. You can use the card to at CVS retail pharmacies or on www.cvs.com to get a 20% discount on many over-the-counter products and CVS brand products. When you use the card, you also get 2% back in ExtraBucks Rewards on your purchases.
You have 24/7/365 access to CVS/Caremark Customer Care representatives by calling 866-808-7159.
Among other things, you can find out the costs of your prescriptions and find network pharmacies. You can also go to www.caremark.com anytime.
CVS Health has several free apps that you can download onto your smart phone or tablet. The apps include Caremark.com, CVSspecialty.com and CVS.com. Through the apps, you can:
- View your ID card
- View prescription costs for yourself and your family
- Find an in-network pharmacy
- Refill your prescriptions
- Manage and track your mail, retail and specialty prescriptions
- Transfer prescriptions to CVS Caremark to receive your medications by mail.
CVS Health ID Cards
You should have received a CVS Health ID card in the mail. If you have any questions about your ID card, you did not receive one, or you need more cards, please contact CVS at 866-808-7159 or go to www.caremark.com.