OptumRx®New Pharmacy Benefit Manager for the AlaskaCare Health Plans

OptumRx® Pharmacy Manager

AlaskaCare is pleased to announce OptumRx® has been selected as the new pharmacy benefit manager effective January 1, 2019.

Watch the mail for your welcome kit, which includes new identification cards. Beginning January 1, 2019, you will need to present your new member ID card to fill prescriptions at a retail pharmacy.

General Information

A pharmacy benefit manager (PBM) is a company the Division hires to process AlaskaCare pharmacy claims. Today, these claims are processed by Aetna and CVS/Caremark. Aetna and CVS/Caremark will continue to process pharmacy claims through December 31, 2018. Medical, vision and dental claims will continue to be processed by Aetna and Moda, respectively.

Your pharmacy benefits, including copays, will remain the same, but you may notice some small administrative changes, such as where drugs fall on the formulary and the list of medications requiring preauthorization. The Division is working to ensure members will be contacted ahead of time if they are impacted by these changes.

Starting October 31, you can call OptumRx at (855) 409-6999, TTY 711 for help with:

  • finding a network pharmacy near you,
  • reviewing the formulary to see if your medications are changing,
  • ensuring your mail order medications are transitioned,
  • setting refill reminders, and more.

In addition, beginning January 1, 2019 you can accomplish these tasks by setting up your online account at OptumRx.com, or downloading the OptumRx app.

Are you currently outside of the United States? You can contact OptumRx from another country by:

  1. Dialing the USA direct access code for the country you are currently in. You can find a complete list of access codes here.
  2. Dialing OptumRx at (855) 409-6999.

For more information, please review the following documents:

AlaskaCare Defined Benefit Retiree Plan Formulary:

AlaskaCare Defined Benefit Retiree Pharmacy Plan Formulary [PDF]

AlaskaCare Defined Contribution Retiree Plan Formulary:

AlaskaCare Defined Contribution Retiree Pharmacy Plan Formulary [PDF]

AlaskaCare Employee Plan Formulary:

AlaskaCare Employee Pharmacy Plan Formulary [PDF]

AlaskaCare Employee Pharmacy Quantity Limits [PDF]

AlaskaCare Employee Pharmacy Prior Authorization [PDF]

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Retail Pharmacies

OptumRx’s retail pharmacy network includes most pharmacies in Alaska. For a list of participating pharmacies near you, use the Pharmacy Locator Tool on the OptumRx app, at OptumRx.com, or call a OptumRx representative at (855) 409-6999, TTY 711. Phone lines will open October 31, 2018.

For a list of government or federally-run pharmacies, look here.

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Medication Home Delivery

You can receive maintenance medication through the mail through OptumRx® home delivery. Enroll in OptumRx® home delivery to get up to a 90-day supply of the medications you take regularly. Your medication will come right to your mailbox. To start home delivery, log in to optumrx.com, use the OptumRx® App or call (855) 409-6999, TTY 711. If you are currently enrolled in the Aetna mail order program, any remaining prescription fills will be transferred to OptumRx® automatically.

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BriovaRx Specialty Pharmacy

Specialty medications can be important to maintaining or improving your health — and your quality of life. BriovaRx®, the OptumRx® specialty pharmacy, provides resources and personalized, condition specific support to help you manage your condition.

Beginning January 1, 2019 call BriovaRx® at 855-4BRIOVA or (855) 427-4682 to enroll in this specialty pharmacy program. If you are currently receiving medication from the Aetna specialty pharmacy, any remaining prescription fills will be transferred to BriovaRx® automatically.

Note: If you are eligible for Medicare and enrolled in the AlaskaCare Retiree Medicare Prescription Drug Plan (PDP), your specialty scripts will not automatically be transferred. If you would like your specialty prescriptions transferred to BriovaRx®, please contact OptumRx and they will be happy to assist you.

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OptumRx.com: Your Digital Tool

OptumRx.com is a fast, easy and secure way to get the information you need to make the most of your pharmacy benefit.

Website features and tools:

  • Compare medication prices at different pharmacies
  • Locate network pharmacies
  • Manage medication for covered dependents and spouses
  • View real time benefits and claims history

If you use home delivery, you can:

  • Transfer retail prescriptions to home delivery
  • Track orders
  • Refill home delivery prescriptions

You can save time, money and improve your health:

  • Save time. Skip the pharmacy line. Order medications you take regularly online and make fewer trips to the pharmacy.
  • Save money. Get three-month supplies and you could pay less. Orders are sent using free standing shipping.

Learn how to register with OptumRx.com (also known as HealthSafe ID™ registration.) Registration Instructions [PDF 523K]

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OptumRx On the Go!

Access your pharmacy benefits and manage your prescriptions from your smartphone or tablet with the OptumRx App.

  • Find drug prices and lower-cost alternatives
  • View your claims history
  • Locate a pharmacy
  • Access your ID card, if your plan allows
  • Manage medication reminders
  • Transfer retail prescriptions to home delivery
  • Refill or renew home delivery prescriptions

Take care of your home delivery prescriptions at any hour, from anywhere, using the new OptumRx App. This application makes it easier than ever to refill and renew existing home delivery pharmacy prescriptions, sign up new prescriptions for home delivery, compare medication prices and more.

The My Medicine Cabinet feature contains key information for all medications you take. With At-a-Glance functionality you can easily see when you need to take action such as refilling home delivery medications or tracking orders.

Download the OptumRx App from the Apple® App Store or Google Play™.

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Authorization to Use and Disclose Protected Health Information

If you or a loved one needs assistance from a representative in receiving pharmacy benefits, you must submit a completed Authorization to Use and Disclose Protected Health Information (PHI) form [PDF 69K] to OptumRx. Use this form to request authorization for the release of PHI, including a patient profile or prescription records, to your authorized representative(s).

Please mail the completed form to:

OptumRx
Attn: Commitment and Follow Up Team
6860 West 115th Street
Mail Stop: KS015-1000
Overland Park, KS 66211-2457

or fax to (866) 889-2116.

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Manual Pharmacy Claim Form for Member Reimbursement

To submit a manual claim form to OptumRx for reimbursement of a prescription paid out-of-pocket, please fill out the prescription drug claim form below and mail or fax it to OptumRx.

OptumRx Prescription Drug Claim Form [PDF 302K]

Preferred method — Mail to:

OptumRx
P.O. Box 29044
Hot Springs, AR 71903

Optional method — Fax to:

(866) 713-6511

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Frequently Asked Questions (FAQs)

View additional FAQs on our OptumRx Transition Guide page.

Who is OptumRx?

OptumRx is one of the largest pharmacy benefit managers (PBM) in the US serving more than 13.5 million people through a national network of more than 67,000 community pharmacies.

A pharmacy benefit manager (PBM) is a company the Division hires to administer the AlaskaCare health plan pharmacy benefits claims processing, along with providing other general pharmacy benefit management support services.

The AlaskaCare plan will continue processing pharmacy claims through our current plan administrator Aetna/CVS/Caremark until midnight December 31, 2018, when OptumRx will take over.

Medical, vision and dental claims will continue to be administered and processed by Aetna and Moda/Delta Dental, respectively.

Why is this changing? What does this mean for me?

Periodically, the Division competitively bids these contracts through a Request for Proposal (RFP). This gives us an opportunity to seek better service at lower cost for members and the plan.

The new PBM contract will go into effect January 1, 2019. Over the next few months, you will receive information about the transition. Please carefully review any letters you receive and contact the Division if you have any questions.

Does that mean my pharmacy benefits will change?

Your pharmacy co-pays will remain the same, but you may notice some small administrative changes, such as adjustments to the list of medications requiring preauthorization. The Division is working to ensure these changes are limited and members know ahead of time if they will be impacted.

Will the coverage of compound medication change when OptumRx becomes the new Pharmacy Benefit Manager?

No. OptumRx will process claims according to the AlaskaCare plan document. Compounds will continue to be covered under the Defined Benefit Retiree Health plan.

Coverage of compounds differs for the active employee and defined contribution retiree health plans. The AlaskaCare Employee Health Plan and AlaskaCare DCR Benefit Plan only cover compound drugs if:

  1. the product contains at least one prescription ingredient;
  2. the active ingredient(s) is approved by the FDA for medicinal use in the United States;
  3. the product is not a copy of a commercially available FDA approved drug; and
  4. the safety and effectiveness for the intended use is supported by FDA approval, or adequate medical and scientific evidence in the medical literature.

OptumRx maintains a National Compound Credentialing Program (NCCP) to ensure the best compounded medication quality and effectiveness for the patients who need personalized medications. You must fill your compounded medication prescription at a pharmacy which has been credentialed with the OptumRx National Compound Credentialing Program (NCCP).

Using an NCCP pharmacy ensures that you will not be charged up front for your prescription (and required to submit your own claim for reimbursement), you will not be charged for molding or other non-covered charges, and you will not be charged for shipping if the pharmacy mails your compounded medication to you. You can find a list of NCCP-credentialed pharmacies here. You can also call OptumRx at (855) 409-6999 (TTY 711) to get help locating NCCP-credentialed pharmacies.

How will OptumRx work with the Enhanced Group Waiver Program (EGWP) for retirees?

The pharmacy benefit for AlaskaCare retirees remains the same, and OptumRx will manage all pharmacy benefits. Medicare-eligible retirees and dependents will be automatically enrolled in the enhanced EGWP on January 1, 2019—members will not need to do anything to enroll and do not need to enroll in an individual Medicare Part D plan. For more information about EGWP and the AlaskaCare Retiree Health plans, visit our EGWP FAQ page.

I submit paper claims for my prescription benefits. Who should I send 2018 claims to if they haven’t been filed prior to January 1st?

For all prescriptions filled prior to January 1, 2019, you should submit your claim to Aetna/CVS. For any prescription filled on or after January 1, 2019, you should submit your claim to OptumRx. You can find claim forms here.

I received a letter from Aetna about home delivery pharmacy services. I thought OptumRx provides home delivery pharmacy services?

Some AlaskaCare members received a letter from Aetna stating that home delivery pharmacy services will be administered by CVS Caremark Mail Service Pharmacy effective next month. This letter was sent in error – please disregard. OptumRx administers pharmacy benefits, including home delivery pharmacy services for all AlaskaCare members.

AlaskaCare members should continue to use OptumRx’s home delivery program to receive medication through the mail and should continue to present their OptumRx pharmacy card to fill prescriptions at a local pharmacy. If you have any questions about home delivery pharmacy services, or your AlaskaCare pharmacy benefits please contact OptumRx at (855) 409-6999.

Why did I receive more than one ID card with different ID numbers?

Please select the scenario that best describes you:

  • I am covered under a single AlaskaCare plan, and…
    • I am an active employee:

      ID cards are issued in packs of two to active employees. If you have an eligible dependent, you can share the extra card with your dependent. If you have more than one eligible dependent, you can request additional cards through OptumRx at (855) 409-6999. Starting January 1, 2019, you can also print a temporary card from the OptumRx portal, or use the OptumRx mobile app.

    • I am a retiree that is not eligible for Medicare:

      ID cards are issued in packs of two to retirees that are not eligible for Medicare. If you have an eligible dependent, you can share the extra card with your dependent. If you have more than one eligible dependent, you can request additional cards through OptumRx at (855) 409-6999. Starting January 1, 2019, you can also print a temporary card from the OptumRx portal, or use the OptumRx mobile app.

    • I am a Medicare-eligible retiree who is not covered under the enhanced Employer Group Waiver Program (EGWP):

      ID cards are issued in packs of two to retirees that are not enrolled in the AlaskaCare enhanced Employer Group Waiver Program (EGWP). If you have an eligible dependent, you can share the extra card with your dependent. If you have more than one eligible dependent, you can request additional cards through OptumRx at (855) 409-6999. Starting January 1st,1, 2019, you can also print a temporary card from the OptumRx portal, or use the OptumRx mobile app.

    • I am a retiree covered under the enhanced Employer Group Waiver Program (EGWP):

      You should have received only a single ID card with the MedicareRx logo in the lower right corner (see example below). Please contact the Division or OptumRx for additional information on why you may have received a second card.

  • I am covered under my own plan and under my spouse’s AlaskaCare plan, and…
    • Both my spouse and I are either an active employee or a retiree not yet eligible for Medicare:

      You will both receive a two-pack of ID cards with your own name and ID number. You may share one copy of your ID card with your spouse, however, you or your dependents only need to present one of these ID cards to the pharmacy. OptumRx coordinates your coverage behind the scenes.

    • Both my spouse and I are are retirees and eligible for Medicare:

      If you are both eligible for Medicare and are enrolled in the enhanced Employer Group Waiver Program (EGWP), you should each receive a single ID card that has the MedicareRx logo in the lower right (see example below). Each card will have an individual name and ID number. Although you receive only one card, when you present the card at the pharmacy you will receive the benefit of your double coverage under the plan. This means you will not be required to pay a copay at the pharmacy counter.

    • One of us is a Medicare-eligible retiree enrolled in the enhanced Employer Group Waiver Program (EGWP) and the other is either an active employee or a retiree not enrolled in EGWP:

      The retiree who is Medicare-eligible and is enrolled in the enhanced Employer Group Waiver Program (EGWP) will receive a single ID card that has the MedicareRx logo in the lower right (see example below). The card will have their individual name and ID number. Although they receive only one card, when they present the card at the pharmacy, they will receive the benefit of having double coverage under the plan. This means they will not be required to pay a copay at the pharmacy counter.

      The spouse who is not enrolled in the EGWP will receive an ID card two-pack in their own name for each layer of coverage they have (their own coverage and their dependent coverage as the spouse of a Medicare-eligible retiree). The only difference between the two packs of ID cards will be the ID number. The ID number that matches the Medicare-eligible retiree’s MedicareRx ID card will be the dependent coverage card. However, the spouse or other non-Medicare eligible dependents only need to present one of these ID cards to the pharmacy. OptumRx coordinates the coverage behind the scenes.

  • I am covered under more than one of my own AlaskaCare plans, and…
    • I am eligible for Medicare:

      If you are eligible for Medicare and are enrolled in the enhanced Employer Group Waiver Program (EGWP), you should receive a single ID card that has the MedicareRx logo in the lower right (see example below). Although you receive only one card, when you present the card at the pharmacy you will receive the benefit of your double coverage under the plan. This means you will not be required to pay a copay at the pharmacy counter.

    • I am not eligible for Medicare:

      You will receive an ID card two-pack for each layer of coverage you have. The only difference between the different packs of ID cards will be the ID number. However, you only need to present one of these ID cards to the pharmacy. OptumRx coordinates the coverage behind the scenes.

Sample card:
OptumRx EGWP pharmacy card

 

 

 

 

Why did I receive a new ID card from Aetna? I thought my medical benefits weren’t changing?

The transition to OptumRx does not affect your medical benefits—these continue to be administered by Aetna. However, because Aetna and their contractor CVS/Caremark no longer administer AlaskaCare pharmacy claims, all AlaskaCare members will receive updated ID cards from Aetna that reflects their medical benefit coverage. Retirees will receive two new ID cards from Aetna – one for medical coverage, and one for vision/audio coverage. You should use your Aetna ID card at your doctor’s office, and your OptumRx ID card at the pharmacy counter.

Can my dependent use my card at the pharmacy and vice versa?

OptumRx coordinates all the layers of coverage for you and your dependents behind the scenes, so in many cases you and your dependents can use each other’s cards at the pharmacy. However, a non-EGWP dependent should not use the card that has a MedicareRx logo in the lower right corner. This card would only work if the pharmacist uses the correct person code (to identify them as a dependent rather than the policy holder). To avoid any confusion at the pharmacy, we recommend you and your dependents only use a card that has your name on it.

I am an active employee AND a retiree. How do I know which card is for my active plan and which one is for my retiree plan?

You can tell the difference between the cards by looking at the logo on the card. One will say AlaskaCare Employee Pharmacy Plan, and the other will say AlaskaCare Retiree Pharmacy Plan. Your employee plan will typically be the primary payer.

What happens if our new prescription cards are not received by January 1, 2019?

If you need to fill prescriptions before your card arrives, you can contact the Division and we will print or email a temporary card. As of January 1, 2019, you can also get a printable ID card from the member portal, or view your card in the mobile app.

I received a letter from OptumRx telling me I will pay more for my medication. I thought there were no changes to our benefits?

This letter was sent to Defined Benefit retirees in error. There are no changes to your benefit. Your cost will continue to be the $4 copay for generic, $8 copay for brand name medications, and $0 copay for mail order prescriptions. OptumRx will send out a follow-up letter to notify you of the error.

I received a letter from OptumRx telling me there will be a new limit on how much of my medication will be covered. I thought there were no changes to our benefits?

This letter was sent to Defined Benefit retirees in error. There are no changes to your benefit. With the exception of some controlled substances, you will have the ability to fill up to a 90-day supply of your medication. OptumRx will send out a follow-up letter to notify you of the error.

I received a letter from OptumRx telling me I am taking a medication that will require prior authorization to determine if it is covered. I thought there were no changes to our benefits?

This letter was sent to Defined Benefit retirees in error. There are no changes to your benefit. Although for some Medicare-eligible retirees there are some medications that require prior authorization, these letters reference additional prior authorization or quantity limits that do not apply to the AlaskaCare retiree health plan. OptumRx will send out a follow-up letter to notify you of the error.

How can I tell if the Prior Authorization letter I received is accurate or not?

If you are Medicare-eligible and are taking a medication that requires prior-authorization, you will receive a copy of the letter below. If you receive a letter referencing prior authorization that does not look like this, you may have received it in error. You can contact OptumRx at (855) 409-6999, TTY711 if you have questions about your prescriptions or any correspondence you have received from them.

I received a phone call from an OptumRx representative, but my caller-ID says the call is coming from United Health Care. Is this a scam?

OptumRx is a subsidiary of United Health Care, which is why “United Health Care” may appear on your caller-ID when you receive a call from OptumRx. This is not a scam. However, if you are unsure if the call is legitimate, you can always decline the call and then contact OptumRx at (855) 409-6999 to ensure the call is genuine.

I received a check in the mail from OptumRx. What is it for?

You may have received a check from OptumRx for a variety of different reasons. To find out what the check was for and what to do next, please contact OptumRx Member Services at (855) 409-6999.

I received a call from an OptumRx representative who stated my mail-order prescriptions have transferred over and then asked me for personal information. Is this a scam?

If you were previously enrolled in the Aetna pharmacy mail order program, most remaining prescription fills were transferred automatically to OptumRx’s home delivery program. The OptumRx home delivery unit has been reaching out to members to assist with setting up their home delivery accounts and to verify the prescriptions they want delivered. If you receive a call to this effect, it is not a scam. However, if you are unsure if the call is legitimate, you can always decline the call and then contact OptumRx at (855) 409-6999 to ensure the call is genuine.

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