Enhancements Coming to 2016 Prescription Drug Benefit

Two enhancements will be made to the NRECA prescription drug benefits for 2016.

1) During benefit plan renewal, all NRECA high-deductible health plans will include preventive drug coverage.

While there will be no difference in plan rates, co-ops may opt out of this option during annual renewal. However, the preventive drug option encourages participants to better manage chronic diseases in a cost-effective manner. Participants will share the cost of preventive drugs through copays and coinsurance until they reach the deductible; non-preventive drugs, however, require full payment of the negotiated rate until the deductible is met. Remember, there is no copayment for generic drugs on the preventive list at Exclusive Choice pharmacies.

2) Beginning January 1, 2016, all specialty drugs will be covered as part of the prescription drug benefit rather than the medical benefit. CVS/caremark, NRECA’s pharmacy benefit manager, will provide support managing and dispensing specialty prescription drugs, which can help control the costs of medical claims.

This change also connects patients directly to the CVS Specialty Drug Customer Care team. The CVS Specialty Pharmacy team is experienced in helping people with serious medical conditions get the most out of their health care through disease education, resources and support. The CVS Specialty Pharmacy team works with patients  to better understand and manage their situation.

With this enhancement, CVS/caremark will redirect participants to lower-cost sites of care (e.g. from the doctor’s office to a person’s home) when appropriate and when the doctor and participant agree.

Prior authorization will be required for all specialty drugs beginning in January 2016. However, this requirement will be waived during the first six months to ensure a smooth transition for affected participants.

Beginning this September, CVS/caremark will contact participants who have used specialty drugs in 2015 and their providers by letter and phone to inform them of this change and answer any questions.  CVS/caremark also will contact participants who begin using specialty drugs after the first letter through the end of the year.

If you have any questions about these enhancements, please contact your field representative.