If you’re currently enrolled in a health insurance plan through Freelancers Union, your pharmacy coverage is changing in a number of key ways -- so be sure to read this post to know what to expect.
What drugs are covered?
Our new plans through Empire BlueCross BlueShield have a different list of covered drugs. If you regularly take a medication, you should check now to see if your medication is covered.
First, look at this list of the most common covered drugs. This is not a complete list, but most drugs are listed here. If your drug is not on this list, please contact us at 800-856-9981 or email@example.com. We will be able to check the complete list. Please be sure to have the name AND dosage information for your drug handy.
What happens if my drug is not covered?
We recommend that you speak with your doctor or specialist about alternatives. In many cases, there will be a similar alternative that is covered.
If your drug is not covered, you will pay out-of-pocket for that medication. This will not go towards your deductible.
In some cases, certain dosages of your medication may be covered, even if your particular dosage is not. You may be able to talk with your doctor about making sure you have what you need.
How are drugs covered?
In 2015, the plans will cover your drugs differently; with different deductibles and copays than you have today.
Take a look at this chart and find your 2015 plan. Look at the row for “Prescription Drugs.”
You’ll notice that some plans require a deductible before copay or coinsurance. On these plans, both medical and pharmacy expenses count towards your deductible. After you meet your deductible (for example, $2450 in medical and pharmacy costs combined on a Silver FM plan), you would then pay a flat copay or coinsurance amount beyond that amount (10% coinsurance for drugs on the Silver FM plan).
For those plans that have deductible coverage, remember that you pay the negotiated rate for the prescription; not the retail price. One advantage of working with such a large carrier is that they are able to negotiate discounts.
Other plans have “Tiers”, for example on the Gold 1000 FM plan:
Tier 1: $15 copay
Tier 2: $40 copay
Tier 3: Deductible then 10% coinsurance
What do these tiers mean? Essentially, Empire BlueCross BlueShield has separated all covered drugs into 3 groups: tiers 1, 2, and 3. Check the formulary to see what group your medication is in; this will indicate what cost sharing applies.
Additionally, prescriptions count toward the deductible on some plans, but on other plans they do not. Pharmacy does go toward the Out-Of-Pocket-Maximum in either case and are covered 100% when you’ve met that maximum for the year.
Plans where pharmacy does count toward the overall deductible:
Plans where pharmacy does not count toward the overall deductible:
How do I pick up my covered prescriptions in 2015?
Where and how you pick up your prescriptions in 2015 depends on the type of drugs you take. Please keep in mind, that courtesy refills noted below do not extend to drugs that are not covered under Empire’s plans.
*If you pick up medications on occasion or in one-off situations *(such as an antibiotic for a short-term sickness), you can continue to pick up your medication at a pharmacy.
If you take a medication regularly or have a long-term prescription, like anti-depressants or cholesterol drugs, you have a “maintenance” drug which will be available through Mail Order only.
You’ll have two courtesy refills at your pharmacy, but after that, your drug must be Mail Order from Express Scripts, Empire’s pharmacy team. You will receive a letter and telephonic outreach from Express Scripts to enroll in Mail Order. You do not need to take any action now in order to set up this service.
If you take a specialty medication, one that requires special handling, administration or monitoring, like an infusible or injectible medication,and currently receive your medication from a Walgreens store location, you will have one courtesy refill available at your Walgreens store location, and will receive a letter and telephonic outreach from Accredo, Empire’s specialty drug partner, to enroll in Mail Order. You do not need to take any action now in order to set up this service.
If you take a specialty medication and currently receive your medication from Walgreens through Mail Order, you must receive Mail Order from Accredo, Empire’s specialty drug partner. Once your enrollment in Empire’s system is complete, you or your provider will be able to call in to transition your prescription.
Is my pharmacy in-network?
There are thousands of pharmacies in the new network, including most major pharmacies (like Duane Reade, CVS, and Walgreens) and some independent pharmacies. To see if your pharmacy is in-network, check this list.
Have questions about pharmacy coverage?
The fastest way to get a response is to email firstname.lastname@example.org.