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.

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 like 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 31st, you can call OptumRx® at (855) 409-6999, TTY 711 for help:

  1. Finding a network pharmacy near you
  2. Reviewing the formulary to see if your medications are changing
  3. Ensure your mail order medications are transitioned
  4. Set 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.

For more information please review the following documents:

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 health care advocate at (855) 409-6999, TTY 711. Phone lines will open October 31st.

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.

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.

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.

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.