Pharmacy Benefits Innovations Coventry Health Care is committed to delivering the best value for all our customers, and we are pleased to introduce several improvements to the pharmacy benefit resources. Expanded relationship On January 1, 2010, we are expanding our relationship with Medco to include pharmacy administration for our Commercial members. Our goal is to provide a smooth transition for our customers. An extensive communication campaign will address all aspects of the transition and will not require changes or action on your part. Many important processes will remain the same – some will change. These changes will be communicated to individual members as appropriate. Some key points to this transition include: • Formulary—The formulary will remain • Network—The national pharmacy network includes over 62,000 pharmacies and is comparable to the existing network. We expected very little, if any, disruption to our members. In the extremely rare instance when a member is currently using a non-network pharmacy, he or she will be notified with instructions on selecting a new pharmacy. • Open refills— • History—One year’s worth of claim history will be loaded at Medco to allow utilization review programs to run seamlessly. • Prior Authorizations—Active prior authorizations will be loaded in the Medco system and will not require any action from members or providers. • Customer service—The phone number will remain the same. Members can access the Pharmacy Customer Service Team at the number on their ID cards. • ID numbers—Members’ • New ID cards and forms—We will mail these with instructions prior to January 1, 2010. The new cards contain essential information for pharmacies to accurately process claims when administration transitions to Medco. Pharmacy Program Enhancements Transition Rx—This Coventry program will allow new members to receive one 30-day fill of select drugs that might otherwise require a prior authorization, or have other limits, during their first 90 days of eligibility. New online capabilities offer access to personalized, comprehensive benefit information with accurate real-time pricing information for more than 700 medications. Members can compare costs for generic equivalents, preferred brand and generic alternatives across drug classes, retail and mail order and over-the-counter alternatives. My Rx Choices® presents the ultimate in member engagement for prescription drugs. Through a single screen, members can select their medicines and view lowest-cost options. This tool is linked to Consumer Reports Best Buy Drugs™ recommendations with a two-page drug summary of independent ratings. Members have access to information regarding safety, efficacy and relative cost of their medicine and the options they have chosen. The information provides a strong endorsement for the value of generics with the confidence of using the guidance of the most-trusted source of consumer information in the world. Clinical innovations Medco’s Therapeutic Resource Centers®—will focus on patients with chronic and complex conditions. Specially trained pharmacists in Therapeutic Resource Centers work with patients to reduce gaps in the use of essential medications for their diseases. Specialist pharmacists utilize personalized health action plans to counsel patients and consult with physicians to assess and address barriers and connect members with important resources. The result is an incomparable experience that improves outcomes and lowers costs. Experienced specialty therapy management is centered on safety and compliance with essential therapies at the lowest cost. The clinical model provides consistent doctor and patient contact at key touch points—upon receipt of a new prescription, within three to five days after dispensing the prescription and prior to subsequent dispensing. Calls manage refill coordination, barriers to compliance, safety monitoring and side-effects providing improved patient satisfaction and quality of life. These services are available to Callout box: As we indicated, we will have an extensive communications campaign to keep our members informed. Some key dates to keep in mind are listed below: Key Communication Dates October 1 November 1 December 1 Our new programs and expanded relationship with Medco demonstrate Please contact me if you have questions |
