Looking Ahead to Annual Enrollment: Understanding Your EverTrue Pharmacy Benefits
EverTrue’s pharmacy drug coverage is available to members enrolled in one of the four EverTrue medical plans. The Pharmacy Benefit Manager or “PBM” is Express Scripts, which has a retail pharmacy network of over 64,000 pharmacies. This network includes most major chain pharmacies as well as some local, independent pharmacies. Pharmacy benefits are often the most complex of benefits team members use, so this blog is intended to spotlight three key subjects: Mail-order, Plan formulary, and Specialty drugs.
Mail-order: One key feature of our pharmacy plan is that all maintenance medications must be ordered through Express Scripts via mail or home delivery after three fills at a retail pharmacy. The efficiency of this mail-order program helps to lower the prescription costs for both our plan as a group as well as individual members. Most members find that receiving scheduled prescriptions by mail is very convenient and saves them money because they receive a 90-day (3 months) supply of Rx drugs for the cost of only 60-days (or 2 months). You can sign up for home delivery, refill and renew prescriptions, track deliveries, and view claims, balances, and prescription history through the Express Scripts mobile app. Just visit the mobile app store on your smartphone and search for Express Scripts.
Plan formulary: A “plan formulary” is an official list of prescription medicines covered by an insurance plan. To learn what medications are covered, review the Express Scripts formulary. The plan formulary may be updated twice a year— once on January 1st and again on July 1st. The latest formulary, along with a link to price a new or existing medication, can be found at www.evertruebenefits.org/pharmacy-benefits. The button labeled “comparing Rx costs b/w plans” allows you to see what each type of Rx drug will cost under each of the four different EverTrue plans.
Specialty drugs: Specialty medications must be filled through Accredo, which is Express Scripts’ specialty pharmacy. Specialty pharmacies handle medications that are often expensive, complex, and require special handling, such as biologics, drugs requiring refrigeration, precise dosing, or injections and infusions. Not everyone will need to use the specialty pharmacy services, but if you do, make sure to tell your prescribing provider to send the prescription to Accredo. Express Scripts/Accredo may need to contact your provider for prior authorization to ensure that your medication is appropriate for you. Step Therapy may also be required; this “step therapy” process reviews whether you are receiving a safe, effective, and affordable medication for your condition.
Because pharmacy benefits involve many details, we encourage you to review all available information and tools on the Pharmacy Benefits page of the EverTrue Benefits website at www.evertruebenefits.org/pharmacy-benefits.
If you have questions, please contact your local HR Manager.