Members who have used a Walgreens pharmacy at any time in the past 12 months will receive a letter about the change 60 days in advance of the end of the year if they have an individual and family plan. Group members will receive the letter 60 days in advance of their employer’s renewal date. The first letters mail late July to members of groups renewing October 1.
To make it easier than ever to find local level 1 pharmacies for your clients, refer to this Rx Choice Tiered Pharmacy list for California. A circle with either a 1 or a 2 next to each pharmacy indicates whether it’s a level 1 or a level 2.
Sharp Health Plan has added an online drug price checker tool. The online tool is powered by PilotRx. Prices quoted are specific to the rates negotiated by MedImpact on Sharp Health Plan’s behalf. For more detailed medication information, Sharp Health Plan members should log in to Sharp Connect to receive the most accurate drug pricing based on their benefit plan.
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.
Effective February 25, 2017, Sharp Health Plan is moving from Diplomat to CVS Specialty Pharmacy. According to Sharp, they found that CVS provides greater flexibility on how members can fulfill their specialty medication needs.
Blue Shield has entered into an agreement with CVS Health to support manufacturer rebate and pharmacy network contracting for its outpatient pharmacy benefit and has received approval from the Department of Managed Health Care.
Health care costs continue to rise, and specialty drugs are a big contributor. These prescription medicines are used to treat complicated and chronic conditions, such as hepatitis C, cancer and multiple sclerosis. As specialty drugs become more widely used, we’re looking for new ways to control costs while keeping members healthy. That’s why we created our Right Drug Right Channel (RDRC) program.
The letter will explain that Anthem Blue Cross has noticed a potentially risky pattern in the way they’re getting prescriptions filled. They will have 60 days to change this risky behavior. If Anthem Blue Cross doesn’t see a change in their drug claims within 60 days, they’ll follow up with another letter.
Anthem Bronze PPO members with contract codes 1FZ3 and 1FZ4 received Benefit Comparison Charts in their 2016 Open Enrollment Kits that had incorrect coinsurance amounts listed for Tier 4 pharmacy benefits. The 2016 Tier 4 Retail Pharmacy benefits were listed as 0% coinsurance up to $500, and the Tier 4 Mail Order Pharmacy benefits were listed as 0% coinsurance up to $1,500. These amounts are not correct. The correct pharmacy benefits for 2016 are as follows: