Prescription Drug Benefits

Prescription Drug Benefits

Eligibility

If you are enrolled in the POS Plus Medical Plan (Aetna) or the POS Value Medical Plan (Aetna), you and your covered dependents are enrolled in the Medco Pharmacy plan and can have a prescription filled at a participating pharmacy, or use a mail-in service through Medco.

The Aetna HDHP prescriptions are administered by Aetna.

Prescription Drug Changes

What is changing?

 
• For the first time since 2006, prescription drug co-pays are increasing in the Aetna POS Value and Aetna POS Plus medical plans. Tier Zero will remain at a $0 co-pay.
• Tier Changes
  • Lansoprozole and Pantoprozole moved from Tier 3 to Tier 1
  • Byetta, Symilin and Victoza moved from Tier 2 to Tier 1

Am I affected?

Yes, if you are enrolled in the Aetna POS Value or Aetna POS Plus plan, you will see an increase in prescription drug retail and mail order tier co-pays beginning January 1, 2012 (with the exception of Tier Zero).

What do I need to do?

Review and become familiar with the new co-pays for 2012. Plan ahead and order/refill any necessary medications prior to year end. To learn more about Emory’s Prescription Drug benefit, refer to the 2012 Benefits Guide. Here you will find information about Emory’s five-tier structure, Medco (the pharmacy vendor for the POS Plus and POS Value plans) and Aetna (the pharmacy vendor for the HDHP with HSA plan) as well as how you can save money with Tier Zero, Generic drugs and Mail Order.

The new Tier co-pays are:

Tier	2012 Retail	2012 Mail
Zero	$0	$0
1	$15.00	$37.50
2	$30.00	$75.00
3	$55.00	$137.50
4	$85.00	$212.50

* If you are enrolled in the Aetna HDHP, you receive your prescription benefits from Aetna, your pharmacy benefit manager.

For more information click here.

Tier Zero for 2012

For 2012, generic prescription drugs used to treat congestive heart failure, diabetes, high blood pressure and cholesterol will stay at Tier Zero. The co-pay for Tier Zero prescription drugs are waived to help make these drugs more affordable. Emory pays 100% and plan participants will pay $0 for a 30- or 90-day generic prescription supply. The Tier Zero structure is included for Aetna POS plus, Aetna POS Value and the Aetna HealthFund HRA.

Some drugs that are included in Tier Zero are:

• Hydrochlorothiazide
• Furosemide
• Glyburide
• Simvastatin

Here is a complete list of all Tier Zero drugs.

Brand Exclusions

• Allergy, Nasal Steriods and Sleep Aid medications will no longer be covered at the BRAND name level.  Generic level medications for these drug categories will continue to be covered by the plan.
• Nexium will be the only brand proton pump inhibitor (PPI) covered under the plan (used to treat Acid Reflux, GERD, etc.)  Generic level medications will continue to be covered.

Clinical Review Programs

Prior Authorizations and quantity limits as part of Medco and Aetna's clinical review programs will continue for the 2012 plan year for medications within certain drug categories .  These clinical review programs will ensure patient safety by implementing quantity, dose and effectiveness reviews prior to medications being prescribed.

For a list of medications subject to the clinical review program for 2012, click here .

Co-pays for mail-order drugs.

Keep in mind that you still pay less for a 90-day supply through mail-order than by purchasing three (3) 30-day supplies via retail

Generic Drugs — A Great Value
Which ever medical plan you elect, using generic drugs is a great way to lower your prescription drug costs if your physician prescribes a brand-name drug and does not specify Dispense as Written (DAW). Ask your pharmacist if a generic version is available. If your physician does check the DAW box, the pharmacist is required to dispense the brand-name drug. However, it is important to know that you will pay the higher brand-name drug co-pay/co-insurance, as well as the difference in cost between the generic and brand-name drug.

(Please be aware Tier Zero will appear as Tier 5 on some vendor information.)

How to Fill Your Prescription

Use your Medco Pharmacy Card at a participating pharmacy when you have a prescription filled.

To begin using the Mail-In Prescription service:

• Step 1: Call Medco Prescription Service at (800) 473-3455. Customer Service will assist you in getting your prescription to Medco by mail or fax.
• Step 2: Mail your written prescription with the Medco Prescription Mail Order Form or have your doctor fax in your prescription with the Medco Prescription Fax Form. Make sure your information is on the forms.
• Step 3: Mail to: Medco Health Solutions of Tampa 4

  P.O. Box 30493 Tampa FL 33630-3493

  For Aetna HDHP, please contact Aetna at www.aetna.com/docfind/custom/emory or (800) 847-9026

You can fill your prescriptions at The Pharmacy@Emory

Vendor Contacts

Medco
(800) 939-3758

Aetna

(800) 847-9026

www.aetna.com/docfind/custom/emory

How the Plan Works

Emory's prescription drug benefits for the Aetna POS and BCBS-GA PPO Plans are provided by Medco and enable you and your covered dependents to have prescriptions filled at a participating pharmacy or to use the mail service program.

Prescription drugs are divided into five tiers which affect the cost of the drug. Having the prescription filled at a retail pharmacy versus using the mail service also affects the cost.

* Your plan documentation provides you with a booklet listing the most common drugs and their tier level. Your physician and pharmacist can also provide information on the tier level for specific drugs.

** Mail Order - Maintenance medications (taken daily) should be issued by your physician and remitted to Medco as a 90 day supply, refillable 3 times.

You can take advantage of Medco's mail order program to obtain up to a three-month supply of maintenance drugs for the cost of two retail co-pays. You should request two prescriptions from your doctor; the first, for a 30-day supply to fill immediately at a participating pharmacy and second, for a 90-day supply to be filled through the mail.

Note:

• If the cost of the drug is less than the co-pay, you pay the cost of the drug.
• At retail, when a generic drug is available, but the brand name is dispensed for any reason, you pay the brand co-pay plus the difference between the brand-name drug and the generic drug.

Plan Information Documents

Tier Zero
Medco Pocket Formulary Guide

Plan Forms

Medco Prescription Mail Order Form	Medco Prescription Fax Form
Medco Prescription Claim Form	Aetna Mail Order Form

Emory University Benefits

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Disclaimer

Emory reserves the right to terminate, suspend, withdraw, amend or modify the Plan in whole or in part at any time. Further, Emory reserves the right to terminate or modify coverage for any group of employees, active or retired and their dependents or a class of dependents at any time.