Transcription
2016 Benefits EnrollmentSUPPLEMENTHuman ResourcesFOR PRE-MEDICARE RETIREESFinance & AdministrationNovember 2015This newsletter supplement concerns current pre-Medicare-eligible retirees and spouses.References to “retirees” generally includes surviving spouses.2015 Key DatesNovember 2Retiree Open EnrollmentBeginsWeeks of November 9and November 16Retiree MeetingsDecember 2Open Enrollment EndsRochester Institute of TechnologyDepartment of Human ResourcesGeorge Eastman Hall8 Lomb Memorial DriveRochester, New York 14623-5604 2015 Rochester Institute of TechnologyAs you are aware, we work with many different vendors who providebenefits to RIT faculty, staff, retirees, and family members. In order toensure our benefits costs remain competitive, our practice has been toreview one or two of them each year and determine whether the time isright to consider other vendors. In 2015, contracts were up for renewalwith two of our major benefit vendors: Excellus BlueCross BlueShield, thethird party administrator for our pre-Medicare medical plans, and ExpressScripts, the pharmacy benefit manager for our pre-Medicare prescriptiondrug program. In each of these cases, we conducted a competitive biddingprocess, and they yielded different results.Medical—Our current medical plan administrator, Excellus BlueCrossBlueShield, provided the most competitive proposal in response to RIT’sRequest for Proposals (RFP) and, as a result, RIT is extending our contractwith Excellus for another three years, 2016-2018.Prescription Drug—As a result of the RFP that was conducted, weare moving to a different Pharmacy Benefit Manager (PBM), OptumRx.On page 2, you will find important information about this change. Weencourage you to read it carefully so you understand exactly what you canexpect to happen, what types of changes to anticipate, and actions you mayneed to take.Good news: As a result of our favorable contracting with both ourmedical and prescription drug administrators, as well as reduced use ofmedical services, employee and pre-Medicare retiree contributions for2016 will not increase—they will remain at the 2015 levels.This is not the case with RIT’s Medicare plans; if you are part of a couplein which one person is covered by one of the Medicare plans offered byRIT, you may see an increase in that person’s contribution.We encourage you to read both of the enclosed newsletters to learn moreabout your 2016 benefits, including a new benefit, Identity Theft Protection.
Prescription Drug UpdatesANNOUNCING OUR NEW PHARMACY BENEFIT MANAGER—OptumRxSince 2005, RIT has been part of thePreferred University Rx PurchasingCoalition (PURPC), a universitygroup purchasing coalition forprescription drug products andpharmacy benefit management(PBM) services. PURPC deliversvalue to its member universities bycombining the covered membership(approximately 100,000 people) toachieve better pricing, enhancedservices, and account managementbeyond what would be achievableby any institution individually.As you may know, RIT (throughPURPC) has contracted withExpress Scripts (formerly Medcobefore it merged with ExpressScripts) for pharmacy benefitmanagement services. PURPC hasconducted Requests for Proposal(RFPs) when the contracts havebeen up for renewal and each time,the result has been that PURPChas renegotiated a new, and lesscostly, contractual arrangementwith Express Scripts.When PURPC conducted anRFP process this past spring,the results were different. As aresult, RIT and other PURPCinstitutions will be switching to anew pharmacy benefit manager,OptumRx, as of January 1, 2016.We have been working withOptumRx to implement ourprogram and have been veryimpressed by its attention to detailand willingness and ability toaccommodate the needs of thevarious universities it serves. Weare optimistic that this will extend2November 2015Human Resourcesto the experience our prescriptiondrug plan participants will havewith OptumRx.What do I need to know?Much will remain the same. RIT’splan designs will not change. Yourcopays for Tier 1 (generics), tier 2(formulary drugs), and tier 3 (nonformulary drugs) will remain thesame (although some medicationsmay switch tiers; see “Changesin the formulary” on page 3). Inaddition, you will still have accessto a network of participating retailpharmacies, including Wegmans.The reduced copays for WegmansPharmacy will still apply.While OptumRx has a fewdifferences in its network ofparticipating retail pharmacies,we have been advised that mostRIT plan participants shouldnot feel any impact from thischange, as OptumRx’s networkincludes all the large nationalchain pharmacies as well as manylocal and community pharmacies.To search for a participatingpharmacy, check OptumRx’smember website or call its memberservices telephone number.Wegmans Pharmacy, RIT’sPreferred Pharmacy, has becomevery popular with RIT planparticipants. Wegmans has beenused by RIT plan participants to fill73% of their retail prescriptions andmore than 62% of all prescriptionsfilled under the plan at both retailand mail-order pharmacies. Seethe separate article about WegmansPharmacy and why you shouldconsider filling your prescriptionsthere if you are not alreadydoing so.You will receive a newprescription drug ID card inDecember, so you will need to letyour retail pharmacy know aboutyour new coverage. To protect yourprivacy, you should destroy yourold Express Scripts/Medco ID cardafter the new PBM arrangementtakes effect on January 1, 2016.There will be some changes, andsome may require you and/oryour doctor to take action. As withmost transitions to new vendors,there will be some changes that willimpact some plan participants. RIThas authorized Express Scripts toprovide information to OptumRxin order to make the transition for2016 PURPC MEMBER INSTITUTIONSBoston UniversityBrown UniversityColgate UniversityCornell UniversityHamilton CollegeFinance & AdministrationHobart & William SmithCollegesPrinceton UniversityRochester Instituteof TechnologySkidmore CollegeStevens Instituteof TechnologySt. Lawrence UniversitySyracuse UniversityUniversity ofNotre Dame
OptumRx will send letters inNovember to the home addressesof those who will be impacted bychanges. The letters will includeinformation about the drug(s) thatare impacted as well as informationfor you and your physician aboutactions that need to be taken oravailable medication alternatives.participants as smooth as possible(of course, detailed informationwas not shared with RIT). Withthis information, OptumRx willsend letters in November to thehome address of those who will beimpacted by changes. The letterswill include information about thedrug(s) that are impacted as wellas information for you and yourphysician about actions that needto be taken or available medicationalternatives.Some of the common types ofchanges that will occur and thatwill impact some individuals aredescribed below.Changes in the formulary—A formulary is a list of drugs thathave preferred pricing; in RIT’splan, the formulary medicationsare “Tier 2” drugs, also referredto as preferred brand name drugs.Each PBM has its own formularythat is created by a committee ofindependent medical practitioners.If you currently take a medicationthat is on Express Scripts’ formulary(and for which you are paying aTier 2 copay), it is possible that thatdrug is now a Tier 3 drug if it isnot on OptumRx’s formulary. Anymedication that is Tier 3 will havea therapeutic alternative availableon Tier 2. You will be notified if thisapplies to any of your medications,and you and your doctor candetermine whether it makes senseto switch to the Tier 2 alternative.A link to OptumRx’s formulary ison the Open Enrollment page of theHR website.Changes in the excluded drugslist—In 2014, Express Scriptsadopted a list of excluded drugs.Since that time, this has becomea standard practice among PBMs,including OptumRx. This practiceis designed to address large priceincreases from pharmaceuticalmanufacturers. For any drugsthat are excluded from coverage,there are other less costly and atleast equally effective alternativeproducts available. You will benotified if any of your currentmedications are on OptumRx’sexcluded drug list, which you canfind on the Open Enrollment pageof the HR website.November 2015Mail-order pharmacy—OptumRx has its own mail-orderpharmacy. If you are currentlyusing Express Scripts’ mail-orderpharmacy to fill prescriptions, youwill need to move those by the endof the year since you will not beable to use Express Scripts’ mailorder pharmacy after December31, 2015. If you prefer to continuethe convenience of having yourmedications delivered by mail, youhave two options. You can switch to OptumRx’smail-order pharmacy. Activeprescriptions with one ormore refills remaining withExpress Scripts’ mail-orderpharmacy will automaticallybe transferred to OptumRx.However, you must do thefollowing before the refillswill be sent to you:º On or after January 1,2016, register and updateyour profile on OptumRx’swebsite, ANDº Place your refill order whileyou have at least three weeksof medication left.Human ResourcesFinance & Administration3
Prescription Drug Updates continuedThere are some circumstanceswhere prescriptions will nottransfer to OptumRx andwill require you to contactyour doctor for a new 90-dayprescription:º No refills remain on yourcurrent prescriptionº Your medication is classifiedas a “controlled substance”º Your prescription is expiredº Your prescription is acompound medicationº Your prescription at theExpress Scripts mail-orderpharmacy is being held fora future fill date (on or afterJanuary 1, 2016). Or, you can choose to use theWegmans new “free homeshipping” option—see thearticle on page 6 for moredetails. If you are alreadyusing Wegmans free homeshipping, then you do not needto take any action. To switch aprescription from the currentExpress Scripts mail-orderpharmacy to Wegmans, simplyask your physician to provide anew prescription to Wegmanspharmacy, or ask yourWegmans pharmacy to contactyour physician. You can makethis change at any time; you donot have to wait until the newPBM is in place.Changes in utilizationmanagement programs—Examples of this include priorauthorizations, step therapies, and4November 2015Human Resourcesquantity limits. If you have alreadycompleted the requirements forone of the utilization managementprograms that is continuing fromExpress Scripts, then no action isrequired at this time. If this hasnot occurred, then you and yourphysician will need to take action.Information will be provided toyou in the letter from OptumRxif this applies to you.New specialty pharmacy—If you currently fill any of yourprescriptions through Accredo,which is Express Scripts’ specialtypharmacy, then your medicationswill now be filled throughBriovaRx, which is OptumRx’sspecialty pharmacy. The specialtypharmacy provides counseling,patient care coordination, specialshipping, and other resourcesfor patients who take very costlyand complex medications. If youreceive a letter from OptumRxabout BriovaRx, then you needto follow the instructions in theletter, including calling the tollfree number in the letter to enrollimmediately. Accredo will betransferring information aboutyour specialty medications toBriovaRx, so you may receivea phone call from BriovaRx.You will not be able to obtainyour medications from Accredothrough RIT’s plan beginningJanuary 1, 2016.Note: Two PBMs recently merged—Catamaran and OptumRx.You may see some references toCatamaran in communicationsFinance & AdministrationIf you have questions abouthow you may be individuallyimpacted and do not wish towait until you receive yourwritten notification, you maycontact OptumRx at 855209-1300/V; for deaf andhard-of-hearing people, use arelay service (VRS, Captionedtelephones or dial 711) andthen provide the OptumRxphone number. During openenrollment, OptumRx’s MemberService hours are Mondaythrough Friday 9 a.m.–7 p.m.Eastern time and weekends 9a.m.–4 p.m. Eastern time.OptumRx has set up a specialwebsite that is available duringRIT’s open enrollment period,at http://bit.ly/RITOptumRx.IMPORTANT NOTE:This is not the website to usebeginning January 1, 2016.On this special site, you willbe able to do things such asfind participating pharmacies,review the list of excludeddrugs, and review coveredmedications.If you are enrolled in the POS BNo Drug plan or thinking aboutenrolling for 2016, please seethe article on page 7, ImportantInformation Regarding the POS BNo Drug Plan.from OptumRx while they are stillin transition. You may ignore thesereferences; the PBM for RIT’s planis OptumRx.
WHAT IS A PHARMACY BENEFIT MANAGER (PBM)?OptumRx is our new pharmacybenefit manager (PBM) beginningJanuary 1, 2016. What doesthis mean? The PBM plays twodistinct roles: Administration of the plan Ownership and running of themail-order pharmacy and thespecialty pharmacySometimes we hear frompeople who are confused bythese two roles and what thedifference is between them.We hope this information helpsclarify the differences.Administration of the PlanNetwork of ParticipatingPharmacies—OptumRx contractswith a network of participatingretail pharmacies across thecountry. This includes Wegmans(the preferred pharmacy underthe RIT Rx plan) as well as othermajor national chains such as CVSand Rite Aid. It also includes someindependent pharmacies. You cancheck the participating pharmacieslist on OptumRx’s website todetermine whether your pharmacyis participating—chances are, itis. For more detailed informationabout Wegmans Pharmacy’srelationship with the RIT Rx plan,see the article on page 6.Establishment of the Formulary—A formulary is a list of preferredbrand name drugs. One importantrole of a PBM is to decide whichdrugs are on its formulary.Like many of the major PBMs,OptumRx does this by havingan independent Pharmacy andTherapeutics (P&T) Committeecomposed of independentpracticing clinicians from avariety of specialties from allacross the country. These medicalprofessionals are not employedby OptumRx. The role of theP&T Committee is to reviewmedications for inclusion in theformulary. This review of eachmedication is based on the FDAlabeling, clinical outcomes, andnational treatment guidelines.Claims Processing and Payment—When you fill your prescription ata participating pharmacy like RiteAid, for example, or at Wegmans,the pharmacy technician orpharmacist enters your participantidentification number into theOptumRx online system. Thisbrings up the RIT Rx plan designthat applies to you. It tells thepharmacy how much you need topay, and how much the plan willpay to the pharmacy. It also alertsthe pharmacy if there are anyissues needing to be resolved—anexpired prescription, a potentialdrug-to-drug interaction dueto another medication you havefilled, a requirement that priorauthorization is needed before theplan will pay for the medication,etc. The pharmacy collects yourpayment and then the PBM billsRIT’s self-funded Rx plan for thedifference. The PBM pays thepharmacy the amount that is dueNovember 2015over what you already paid.If you fill your prescription at anon-participating pharmacy, youwill need to send the receipt witha completed claim form (availableon the HR website) to the PBM.Mail-order pharmacy andspecialty pharmacySimilar to our current PBM,OptumRx owns and managesits own mail-order pharmacy. Ifyou fill your 90-day maintenanceprescriptions at their mail-orderpharmacy, the PBM is reallyperforming both roles at the sametime. They are both the claimsprocessor/payer and the owner ofthe pharmacy. OptumRx’s mailorder pharmacy works similarlyto the current PBM’s mail-orderpharmacy.See page 3 for instructions onordering from the OptumRx mailorder pharmacy.OptumRx also has a specialtypharmacy, BriovaRx. BriovaRxis a pharmacy for patients whotake medications classified asspecialty medications, which aretypically very costly and complexfor treatment of serious conditionslike rheumatoid arthritis, multiplesclerosis, and certain cancers.BriovaRx provides patientcounseling and coordination ofmedication delivery, as well asother resources. If you currentlyhave medications dispensed byAccredo, Express Scripts’ specialtypharmacy, you will be notifiedby letter from OptumRx abouttransferring to BriovaRx.Human ResourcesFinance & Administration5
Prescription Drug Updates continuedWEGMANS—RIT’S PREFERRED PHARMACYGood news! We have renewedour agreement with Wegmans tocontinue their Preferred Pharmacystatus under RIT’s prescriptiondrug plan. Wegmans has agreedto provide comparable pricingto the new OptumRx mail-orderpharmacy, making Wegmans anattractive local alternative to mailorder. This is a win-win for you(if you like having a local retailpharmacy choice with preferredcopays) and for RIT.The 30-day copays atWegmans will continue to belower compared to other retailpharmacies. In addition, it willcontinue to be the only retailpharmacy allowed to fill 90-dayprescriptions under RIT’s plan.Copays for 90-day prescriptionsat Wegmans will continue tomatch the mail-order pharmacycopays. Copays for 2016 willremain the same as in 2015 andare shown below.If you prefer the convenience ofhaving your prescriptions mailedto your home rather than makinga stop at the Wegmans pharmacy,you could take advantage ofWegmans “free home shipping”option. This is another option inaddition to the OptumRx mail-order pharmacy, and completelyyour personal choice. For moreinformation about this option, visitthe Wegmans website, ask yourWegmans pharmacist, or contactWegmans directly.The Wegmans Pharmacy websiteoffers you flexibility to order,monitor, and receive prescriptionswhen and where you want themfor you and your family. You canorder refills, check to see if yourprescription is ready, place anorder to have your prescriptionmailed to you, set up Auto-Refill,and print your prescriptionpurchase summary.POS A and POS BWegmans pharmacyCategoryOther participating retailOptumRx mail30-day supply,no limit on fills90-daysupply30-day supply,up to 3 fills30-day supply4th fill and after(1)90-day supplyTier 1: Generic Drugs 10.00 25.00 12.00 30.00 25.00Tier 2: Brand Name Formulary Drugs 25.00 62.50 30.00 75.00 62.50Tier 3: Brand Name Non-Formulary Drugs 40.00 100.00 50.00 125.00 100.00POS DWegmans pharmacyCategory30-day supply,no limit on fills90-daysupplyOther participating retail30-day supply,up to 3 fills30-day supply4th fill and after(1)OptumRx mail90-day supplyAnnual Deductible—each person must pay 1,000 annual deductible before copay amounts are charged in a plan yearTier 1: Generic Drugs 20.00 50.00 25.00 62.50 50.00Tier 2: Brand Name Formulary Drugs 60.00 150.00 70.00 175.00 150.00Tier 3: Brand Name Non-Formulary Drugs 120.00 300.00 140.00 350.00 300.00(1) applies to maintenance medications only; does not apply to acute medications or medications that cannot be filled through mail order (e.g., certaincontrolled substances)6November 2015Human ResourcesFinance & Administration
If you have a prescriptioncurrently being filled at a differentretail pharmacy or at the ExpressScripts mail-order pharmacy, andyou wish to switch it to Wegmans,you have two options: If you prefer to pick up yourprescription at the Wegmansstore at which you shop, stopin or call the store, and let thepharmacy representative knowyour patient information andprescriber (e.g., physician)name. Wegmans will contactyour prescriber and handle thetransfer. If you prefer to use Wegmansfree home-shipping option,call 1-800-934-4797, and asupport center representativewill assist you by setting up youraccount and contacting yourprescriber about obtaining newprescriptions.IMPORTANT INFORMATION REGARDING THE POS B NO DRUG PLANWe want to share informationwith those enrolled in the POSB No Drug plan as well as thosewho are thinking about enrollingfor 2016. The days when themajority of prescription drugswere relatively affordable are gone,so it is important to consider thesepotential costs when evaluatingmed
with Excellus for another three years, 2016-2018. . (formulary drugs), and tier 3 (non-formulary drugs) will remain the same (although some medications may switch tiers; see “Changes in the formu
