Effective January 1, 2020, for those groups that have CVS/Caremark through TCC, OptumRx will replace CVS/Caremark as TCC’s Pharmacy Benefit Manager (PBM).
What is OptumRx?
OptumRx is an independent company that has been contracted with to provide certain services related to prescription drug coverage.
What to expect with this change—New ID Cards
How will the change affect members?
- There will be little or no effect for you. The only change that will affect everyone is that you will be sent a new ID card to use in 2020.
- The CVS/Caremark logo that is currently on your ID card will no longer appear.
- Your new ID card will have a new Pharmacy Customer Service telephone number in the lower left corner on the front of the card. This allows for 24/7 pharmacy benefit information access.
- As before, the new ID card is for both medical and pharmacy benefits.
- Be sure to show the new ID card at the pharmacy when you have your first prescription filled in 2020.
- If you are currently taking a drug that will be affected by any coverage or program changes taking effect on Jan. 1, we will mail you a letter in early November describing the change and any actions needed.
Drug List or Formulary changes
Will the formulary (drug list) change?
The current BlueCross formulary, as detailed in the Preferred Drug List (PDL) available through our website, will not change beyond the minor updates that take place routinely at the beginning of each year. Note that TCC will be changing the name of the PDL to the Lowest Net Cost Formulary.
Will the price I pay for prescription drugs change?
Your pharmacy benefit is based on tiers. Tiers are the different cost levels you pay for medications. For most members, the drugs you take will stay at their current tier. However, from time to time, some drugs may move to a higher tier. If a drug you are taking will be moving to a higher tier on Jan. 1, we will send you a letter to let you know.
Prior Authorization Program
What will happen to existing prior authorizations?
Active prior authorizations (PAs) will be transferred and will remain active until their current expiration date.
What should a member do if his or her PA does not transfer?
In November, TCC will mail disruption letters with instructions to affected members.
Can I still use my same pharmacy?
Most likely. CVS pharmacies are included in our new national pharmacy network.
All major chain pharmacies and most independent pharmacies used by our members today already participate in our new networks. If you will be impacted because your pharmacy will no longer be in network in 2020, you will receive a letter in December to let you know. This letter will include other network pharmacies to choose from that are nearby. A pharmacy locator tool will also be available online beginning in November.
What if I use the Advanced Choice Network?
If applicable, beginning January 1, the Advanced Choice Network will have a new name. The network will be called Narrow Retail Network excluding Walgreens. The retail pharmacy network access will be the same under the Narrow Retail Network excluding Walgreens.
What if I have a Mandatory Maintenance Choice program that I must follow?
If applicable, beginning January 1, the Mandatory Maintenance Choice network will have a new name. The network will be called CVS90 SaverPlus. The retail pharmacy network access will be the same under CVS90 SaverPlus. After the first two purchases of a maintenance drug at any participating retail pharmacy, you will need to fill a 90-day prescription at CVS or using the OptumRx Home Delivery pharmacy, mail order service.
What is a specialty drug?
Specialty prescription drugs treat complex or chronic medical conditions. They may require patient-specific dosing and careful clinical monitoring.
Will there be a new specialty pharmacy?
Yes. Beginning January 1, 2020 you will have a new specialty pharmacy, BriovaRx. BriovaRx is a division of OptumRx. Open prescription refills of specialty drugs will be transferred from CVS Specialty Pharmacy to BriovaRx for you.
Do I need to do anything regarding my specialty prescriptions?
- Yes--All members who use the specialty pharmacy services today will receive a letter in November 2019 with instructions to contact and set up their specialty pharmacy account and payment method with BriovaRx.
- As mentioned, existing prescriptions will be transferred from CVS Specialty to BriovaRx for you. However, some scripts will not transfer, for example prescriptions with no refills left, compound medications and controlled substances. These are often oral or self-injected and usually require patient-specific dosing and careful clinical monitoring.
- Any members whose prescription(s) will not transfer will be notified in their November 2019 letter, and instructed to ask their provider to send a new specialty script to BriovaRx.
- On or after Dec. 2, 2019, you will need to call 877-259-9428 to set up their specialty pharmacy account and refills. Before this date you will not have a profile in the BriovaRx system. This contact information and instruction will be in your November 2019 letter.
Mail-Service Pharmacy/Home Delivery
Will there be a new mail service pharmacy?
Yes. Beginning January 1, 2020, your prescription drug mail service will be provided by OptumRx Home Delivery. Open prescription refills will be transferred from CVS Mail Service to OptumRx Home Delivery for you.
Do I need to take any action regarding my mail order scripts?
- Yes--All members who use the CVS Home delivery services today will receive a letter in November 2019 with instructions to contact and set up their new account and payment method with OptumRx Home Delivery.
- Existing prescriptions will be transferred from CVS Home delivery to OptumRx Home Delivery for you. Some scripts will not transfer: compounds, controlled substances and prescriptions with no refills left.
- Any members whose prescription(s) will not transfer will be notified in their November 2019 letter, and instructed to ask their provider to send a new script to OptumRx Home Delivery.
- On or after Dec. 2, 2019, you can call 855-811-2218 to set up your new mail order account and refills. Before this date you will not have a profile in the OptumRx Home Delivery system. This contact information and instruction will be in your November 2019 letter.
Will I still have access to my pharmacy claims history?
OptumRx will be loading one year of historical data for each member. This will be available when you log in to the Members page on paisc.com. For older information, please log in to the Caremark website.
If you have other questions please contact the customer service phone number on the front of your ID card for help.
TCC Customer Service: 800-815-3314
Pharmacy Help Desk: 855-811-2218