New focused network added to pharmacy portfolio for 2017
As of January 1, 2017, we’re offering a new focused pharmacy network option, called the Rx Choice Tiered Network, to members in our Individual non-standard plans sold off the exchange. Refer to our Frequently Asked Questions for details.
CA Individual Non-Standard Plans that use Rx Choice include:
- Bronze Pathway EPO 5250 (2EUZ)
- Bronze Pathway EPO 5850 (2EV1)
- Bronze Pathway EPO 6900 (2EV0)
- Silver Pathway EPO 1900 (2EV3)
- Silver Pathway EPO 2000 (2EV2)
- Silver Pathway HMO 2650 (2EVC)
- Bronze Pathway PPO 5250 (2JYD)
- Bronze Pathway PPO 5850 (2JYG)
- Bronze Pathway PPO 6900 (2JYH)
- Silver Pathway PPO 1900 (2JYF)
- Silver Pathway PPO 2000 (2JYE)
The Rx Choice Tiered Network, operated by our pharmacy benefit manager, Express Scripts, will offer members more options for choosing a retail pharmacy where they can fill their prescriptions.
Many pharmacy locations
The Rx Choice Tiered Network is comprised of more than 70,000 retail pharmacy locations in all. The network is anchored in Anthem markets, where offered, by CVS, along with Target pharmacies, now owned and operated by CVS. Members have the option to pick pharmacies at other retail chains and big box stores, as well as many independent drugstores. Examples include:
- Sam’s Club
- Giant Eagle
The network offers two levels:
Level 1 – Nearly 25,000 retail pharmacies participate in the core level 1 network. Members will pay a lower cost share compared to a level 2 pharmacy.
Level 2 – Retail pharmacies on level 2 of the network make up the remaining locations (about 45,000 pharmacies). Members who choose retail pharmacies on level 2 will pay an extra $10 copay or 10% coinsurance differential (10% of the underlying drug cost), in addition to the standard cost-share amount.
Member access to participating pharmacy information
Members shopping for insurance without login access to our website will have the opportunity to see lists of pharmacies in the Rx Choice Tiered Network and the National Plus pharmacy network. These lists are now posted to our pharmacy microsites and can also be printed.
Rx Choice Tiered Network information is now clearly displayed in the Find a Doctor tool on our member website at anthem.com/ca. They also can reach Express Scripts’ Locate a Pharmacy and Price a Medication tools on Express Scripts’ website after logging into anthem.com/ca.
Impacted members will receive one or more of the following letters, as applicable, based on their pharmacy network. If you need more information about the letters, please contact Broker Services:
- Initial member letter – Advises impacted members that their pharmacy moved to level 2 of the new Rx Choice Tiered Network on January 1, 2017; explains how they can save on their out-of-pocket costs if they switch to a level 1 pharmacy. Target drop date: February 2017
- Reactive member letter – Mails to members still using a level 2 pharmacy after January 1 to remind them of their savings if they switch to a level 1 pharmacy. Target drop date: approximately 6 months after the proactive letter mailing
Rx Choice Tiered Network – Frequently Asked Questions
Q: Where is the Rx Choice Tiered Network offered in the California Individual market?
A: The Rx Choice Tiered Network is offered in the CA Individual market within non-standard, off-exchange plans only.
Q: What is the Rx Choice Tiered Network?
A: The Rx Choice Tiered Network, operated by our pharmacy benefit manager, Express Scripts, is a new focused pharmacy network that offers members a range of options to choose a retail pharmacy where they fill prescriptions. Member cost share will vary based on the network level on which the pharmacy participates.
Q: When will the Rx Choice Tiered Network be offered?
A: This network is now available.
Q: How will the Rx Choice Tiered Network function for members?
A: The Rx Choice Tiered Network includes pharmacies participating on two levels.
CVS (as well as Target pharmacy operated by CVS) will serve as the anchor pharmacy in all markets offering this network option. In all, nearly 25,000 pharmacies will be available in the level 1 network, which will include several grocery chains and big box stores. Examples include:
- CVS (Anchor pharmacy)
- Target (Anchor pharmacy)
Members using level 1 pharmacies will be charged a lower cost share compared to what they pay using a level 2 pharmacy.
Members who choose pharmacies that participate in the level 2 network will be charged an additional $10 copay or 10% coinsurance differential in addition to their standard cost share.
More than 70,000 pharmacy providers are included on level 1 and level 2 of the Rx Choice Tiered Network combined, enabling members a wide set of options to fill prescriptions.
Q: How is this network structured?
A: CVS, Target, Walmart, Kroger and Safeway will be available within all markets offering this network option. Other chains, big box stores and independent pharmacies will vary by market.
Q: Will members using the Rx Choice Tiered Network have the option of filling 90-day supplies of their medication at a retail pharmacy?
A: No. Members in the Individual line of business must use home delivery to fill prescriptions for maintenance medications.
Q: To what extent will pharmacy availability be offered within the Rx Choice Tiered Network?
A: Network coverage estimates have been calculated as follows:
- 9% urban
- 9% suburban
- 8% rural coverage
Q: How will impacted members be notified of the Rx Choice Tiered Network?
A: Proactive Letter – Members whose pharmacy transitioned to level 2 after 1/1/17 will be notified via letter to provide details about lower out-of-pocket costs at level 1 pharmacies and how to transfer active prescriptions to those pharmacies, if they choose.
Reactive Letter – Reminder letters will be sent to any members continuing to use a level 2 pharmacy. The target letter drop date will be approximately 6 months after the proactive letter mailing.
- Proactive member letter – Advises members whose pharmacy transitioned to level 2 on 1/1/17 of the situation and the fact that they can save on their cost share if they switch to a level 1 pharmacy. Target drop date: February 2017
- Reactive member letter – Mailing to identify members still using a level 2 pharmacy after 1/1 to remind them of their cost share savings if they switch to a level 1 pharmacy: Target drop date: approximately 6 months following the proactive letter mailing.
Q: How were online tools enhanced to include information about the Rx Choice Tiered Network?
A: Information is displayed in the following ways: Find a Doctor Tool
Enhancements were made to the Find a Doctor tool on anthem.com, anthem.com/ca, bcbsga.com and empireblue.com to display the level for each participating pharmacy.
Locate a Pharmacy Tool
Pharmacies listed in Express Scripts’ pharmacy locater tool results include information on the level on which they participate. Members access this tool after login to anthem.com, anthem.com/ca, bcbsga.com or empireblue.com and then accessing Express Scripts’ website.
Price a Medication Tool
Pharmacy-level pricing in Express Scripts’ Price a Medication tool includes information about the level in the network on which each pharmacy selected participates.
Screenshots – Tools on Express Scripts’ website after login to anthem.com, anthem.com/ca, bcbsga.com or empireblue.com.
Locate a Pharmacy Tool-Express Scripts
Price a Medication Tool-Express Scripts
Mobile Platform – Express Scripts
Pharmacy Tier Network Flyer
|Date:||February 9, 2017|
Pharmacy Tier Network FAQs
|Date:||February 9, 2017|