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HealthSelect Prescription Drug Program transitions to OptumRx on January 1, 2017

  • The ERS Board of Trustees awarded the third-party administrator contract for the Texas Employees Group Benefits Program (GBP) HealthSelect Prescription Drug Program to OptumRx, an affiliate of UnitedHealthcare. The contract is for a four-year term beginning January 1, 2017 through December 31, 2020. Caremark will continue to administer the plan through December 31, 2016.

    > Watch the recording of Introduction to OptumRx webinar

    Deductibles, copays, coinsurance, and total out-of-pocket maximums will remain the same

    The benefit structure is staying the same for both the HealthSelect of Texas and the Consumer Directed HealthSelect plans. This means that the deductibles, copays, coinsurance and total out of pocket maximum amounts will remain the same as they are currently. The set annual prescription deductible and the copays for the different drug tiers will remain the same. Even though there are no changes to the benefits structure, there are changes to the coverage of some medications which means the cost and coverage of your drugs may be different.

    Prescription Drug List/formulary:

    Prescription Drug List/formulary (PDL) is the list of drugs that are covered under the HealthSelect of Texas and Consumer Directed HealthSelect Prescription Drug Plans. The PDL also indicates the tier the medications will be placed on beginning January 1, 2017. Changes will vary and some participants may not see any changes. To check drug coverage and cost, go to www.HealthSelectRx.com and click on Prescription Drug List. A PDF of the PDL will be available on the website very soon. Participants who are negatively affected by the change should have received a letter from OptumRx in November or early December.

    Pharmacy Network and EDS’ network

    OptumRx is a full service pharmacy provider with a broad network of retail chain and independent pharmacies, a mail service pharmacy and a specialty pharmacy, BriovaRx. Participants will continue to have the access to the Extended Days’ Supply (EDS) Network where participants can purchase up to a 90-day supply of a maintenance medication at a retail pharmacy without paying a retail maintenance fee. If you’re receiving greater than a 30 day supply of your medication you will want to check and make sure your pharmacy is in the OptumRx EDS network starting January 1. If your pharmacy is not part of the EDS network, you will be limited to a 30 day supply. If your pharmacy isn’t currently on the list, please continue to check back as updates are being made to the in‐network pharmacies.

    Some pharmacies that are in the current pharmacy network with Caremark may not be in OptumRx’s network after January 1. If you currently fill your medication at a pharmacy that is not in the OptumRx network, you may pay more after January 1 if you decide to stay at your current pharmacy.

    To check if your pharmacy is in the OptumRx network, visit www.HealthSelectRx.com and click on Find a Network Pharmacy.

    Mail service

    Beginning January 1, 2017, OptumRx® Home Delivery Pharmacy will be the mail service pharmacy for participants enrolled in both of the HealthSelect Prescription Drug Programs.

    Beginning in January, most mail service prescriptions currently being filled through Caremark’s mail service pharmacy with remaining refills will automatically transfer to OptumRx. Prescriptions for certain medications such as narcotic pain medication or sleep agents and expired prescriptions cannot be transferred. In these cases, participants will need to get a new prescription from their doctors.

    OptumRx will send a letter in January 2017 to participants who use the mail service pharmacy to inform them that their prescriptions have successfully transferred to OptumRx Home Delivery Pharmacy. The letter will include any steps participants may need to take to continue receiving their medications through the mail.

    If you’re currently using mail service, we recommend having about a 3‐week supply of the medication on hand to ensure you have the medications you need during the transition from Caremark to OptumRx.

    BriovaRx, specialty pharmacy

    BriovaRx will be a new specialty pharmacy option for participants taking a specialty medication. Your specialty medication will not automatically transfer to the OptumRx specialty pharmacy. However, you may choose to have your specialty medication transferred to the OptumRx specialty pharmacy, BriovaRx, after January 1, 2017. In January, call a BriovaRx representative at (877) 615-6636 to enroll. Our patient care coordinators will guide you through the process. Beginning January 1, 2017, you can also register online at www.briovarx.com/newpatient. After you submit the form, BriovaRx will contact your doctor and take care of everything else.

    If you want to continue to use your current specialty pharmacy, you will want to check and make sure they are in-network with OptumRx beginning January 1, 2017. To locate a list of OptumRx network pharmacies, go to www.HealthSelectRx.com and click on Locate a Pharmacy. You can also make sure your specialty drug is covered by OptumRx and get an estimate of the cost for your drug by going to www.HealthSelectRx.com and clicking on Drug Pricing Tool.

    Combined medical and prescription drug ID cards

    Participants will receive a new combined ID card in December that will have both medical and prescription drug information.

    More information

    For more information on the transition to OptumRx on January 1, 2017, please visit www.HealthSelectRx.com or contact a customer care representative toll-free at (866) 868-0609 (TTY – 711) Monday – Friday 8 a.m. ‐ 7 p.m. or Saturdays 7 a.m. ‐ 3 p.m. Representatives will be able to help answer both medical and prescription drug questions.

    For any questions about prescription drugs or claims processed through December 31, 2016, please contact Caremark at (888) 886-8490.