A Change In The Health Funds Pharmacy Benefit Provider and Major pharmacy benefit improvements took effect on January 1, 2018
The Trustees of the Health Fund are making several improvements in the Health Fund’s Pharmacy benefits, effective Jan. 1, 2018:
- A new pharmacy benefit management company — ProAct — replaced Cigna’s pharmacy services, including home delivery — approximately doubling the number 90-day supply retail pharmacies to more than 60,000.
- Generic drugs are no longer subject to the Plan’s $100 annual prescription drug deductible — only the copay will be payable by you for drugs in this category
- All “specialty drugs” (generally high cost/high tech) will have a flat 25% copay — many such drugs formerly required a 30% copay
- The drug plan’s annual out of pocket copayment maximum has been lowered to $4,000 per individual — from the former $5,000 — and there will no longer be a 5% copay on any category of drugs, after the out-of-pocket maximum has been reached
Here is what you will need to do in connection with the move to ProAct
First, rest assured that any existing prescriptions for long-term medications you have with Cigna Home Delivery were automatically transferred to ProAct Home Delivery as of Jan. 1 – so you don’t have to concern yourself about prescriptions that extend beyond Jan. 1. To fill prescriptions that are ordered after December 31, 2017 you need to use your new ProAct ID card, which you should have already received from ProAct. If you have not received your card please call ProAct at 833-636-1400. They are available 24/7 and will help you to set up an account with them and obtain a card, you can also visit ProAct Home Delivery online, at https://secure.proactrx.com/mail-order/getting-started/ to register by completing a New Patient Profile Form (access to setup and review your account is now available for Equity-League participants). Once you have registered, you’ll be able to access ProAct’s secure portal to begin managing any mail order prescriptions beginning January 1.
Going forward, you’ll be able to use your ProAct card at any of the nearly 70,000 pharmacies in ProAct’s 30 day retail pharmacy network, as well as the more than 60,000 pharmacies in ProAct’s 90 day pharmacy network.
More details regarding the pharmacy benefit improvements
$100 annual prescription drug deductible no longer applies to
Beginning Jan. 1, you will be able to purchase all of your generic prescription drugs with a copay that is 20% of the generic drug’s cost (with a minimum of a $10 copay for a 30 day supply, and a minimum of $20 for a 90 day supply) — you won’t have to satisfy an annual deductible first. The $100 annual deductible will still apply to non-generic drugs.
Say Goodbye to “Tiers” and hello to simple categories
Going forward, the prescription drug benefit will no longer refer to tiers, but rather to simple categories of prescription drugs:
Generic – If a drug is generic, you will pay 20% of the drug’s cost with a minimum of $10 for a 30 day supply (a minimum of $20 for a 90 day supply) — and drugs in this category are not subject to the $100 annual deductible — so your generic drug benefits begin the day you fill your first prescription under the new benefit.
Specialty – If a drug is a “specialty” drug, you pay 25% — we’ve done away with the prior practice of requiring you to pay 25% for some specialty drugs and 30% for others (however, if a specialty drug is also a generic drug you pay even less — because the generic copay described above applies).
Preferred Brand Name – You continue to pay 25% of the drug’s cost, with a minimum of $20 for a 30 day supply ($40 for a 90 day supply) – but you pay a flat 25% if the preferred brand name drug is also a Specialty drug (see above).
Non-Preferred Brand Name – You continue to pay 30% of the drug’s cost, with a minimum of $25 for a 30 day supply ($50 for a 90 day supply) — but you pay a flat 25% if the non-preferred brand name drug is a Specialty drug (see above).
Some examples of Generic drugs are Atorvastatin Calcium (brand name Lipitor) and Levothyroxine (brand name Synthroid). Some examples of Specialty drugs are Truvada and Harvoni. Some examples of Preferred brand name drugs are Xarelto and Simcor. Some examples of Non-Preferred brand name drugs are Zocor and Abilify tablets.
Unsure about which category applies to a drug you are taking? Just visit equityleague.org/druglist to direct you to an alphabetical list of drugs, with each drug’s category shown right alongside. Please note that this list is provided for your convenience, but that drugs can change categories from time-to-time. So it is important that each time you fill or refill a prescription, you check with your pharmacist, or ProAct, to confirm the categorization of that drug.
What are “specialty” drugs?
Specialty drugs are high-cost medications that often have special handling or administration requirements. Specialty drugs are typically prescribed to treat rare, chronic, and/or complex medical conditions, including HIV, certain autoimmune conditions, hemophilia and certain cancers.
No coinsurance after the prescription drug out-of-pocket maximum
Beginning in 2018, if you reach the out-of-pocket maximum of $4,000 for prescription drugs, during a calendar year, the Fund will pay 100% of your eligible prescription drug costs for the balance of that calendar year.
ProAct to replace Cigna’s pharmacy services
In addition to making the benefit changes described above, the Trustees of the Equity-League Health Fund have selected ProAct Pharmacy Services to manage the Fund’s pharmacy benefits, replacing Cigna in this capacity, effective Jan. 1, 2018. Cigna will continue to provide all the services it provided for other medical and dental benefits.
ProAct is a full-service pharmacy benefit management company owned by its employees. For nearly 20 years, ProAct has provided innovative and flexible prescription solutions to benefit funds and their participants.
Overall, the ProAct program will be very similar to the Cigna program, with one major positive difference. While Cigna’s 90 day retail network consists of more than 30,000 pharmacies, ProAct’s 90 day retail pharmacy network has more 60,000 pharmacies, and it includes Walgreens and Duane Reade. Click here to see a .pdf file of the list of pharmacies in the ProAct networks (Retail and 90 Day). The list is sorted by city, then alphabetically within the city. You can search using your town’s zip code, but some pharmacies don’t have a zip code in their listing, so you may miss a pharmacy within your area if you search using the zip code instead of the city.
Other changes that will occur when you switch to ProAct will be some changes in formulary drugs, categorizations, prior authorizations, and certain quantity limits. In some cases, ProAct’s policies may be more restrictive than Cigna’s corresponding policies, and in other cases they will be less so.
You can see an alphabetical list of all prescription drugs, with an indicator of how they will be categorized by ProAct on the Fund Office’s website page: www.equityleague.org/druglist.
If you have more specific questions about these changes, or if you need assistance with the transition to ProAct Pharmacy Services, please call the Fund Office at (212) 869-9380 (New York City) or (800) 344-5220 (toll-free nationwide), Monday through Friday, 9:30 AM to 5:30 PM EST and a representative will assist you. Beginning Jan. 1, 2018, please call ProAct with any questions regarding the processing of your pharmacy benfits, at (833)636-1400. They are available 24/7.