Created with you in mind. Prescription Benefits Guide

Transcription

1 PHARMACY BENEFIT MANAGEMENT Created with you in mind. Prescription Benefits Guide

2 Table of Contents Southern Scripts Overview and Contact 3 Information Your Plans Preferred Set-Up 4 ID Cards 5 Register or Login on to Members Portal 6 Your Retail Pharmacy Network 7 Specialty Pharmacy 8 Mail Order Pharmacy 9 Ways to Cut Costs 10 Reporting a Problem 11 Frequently Asked Questions 12

3 Southern Scripts Overview Welcome to your prescription drug plan! Southern Scripts has been chosen by your health plan to manage your prescription drugs. We believe in providing the best prescription management to all of our members. We have provided you with this manual to help you quickly understand your prescription benefits and get the most out of your coverage. This guide will help you explain your plan set-up. Need to Talk? Contact Customer Service with any issues or concerns at for assistance. Hours of Operation and Contact Telephone Numbers Contact Customer Service with any issues or concerns at for assistance. Southern Scripts Customer Service: Monday - Friday, 8 am 6 pm (CST) & 24/7 Emergency Service Southern Scripts Fax Line: Monday - Friday, 8 am 6 pm (CST)

4 Your Plan s Preferred Setup YOUR RETAIL PHARMACY NETWORK YOUR COPAY STRUCTURE Benefit Plan: PPO60 Generic Drugs Preferred Drugs Non-Preferred Drugs Specialty 30 Day Supply 90 Day Supply 20% max of $10 20% max of $30 20% max of $200 20% max of $600 35% max of $200 35% max of $600 25% max of $150 X Benefit Plan: PPO75 Generic Drugs Preferred Drugs Non-Preferred Drugs Specialty 30 Day Supply 90 Day Supply 20% max of $15 20% max of $45 20% max of $200 20% max of $600 35% max of $200 35% max of $600 25% max of $150 X Effective Date for Group Plans: 6/1/2015 BIN Number: PCN: SSN

5 ID Cards Please make sure the name and ID number on you cards are correct before you use them. If you haven t received your card or there is incorrect information on your card contact Web TPA at Rx BIN: Rx PCN: SSN Rx Group: 2015PAC Customer Service F O O PR Pharmacy Network 1085-XX 0D8B 2015PAC-*-*-*-*-* M(VERITY)D()V() Medical Claims Submission Mail Claims to: WebTPA P.O. Box Grapevine, TX WebMD/Envoy Payer ID #75261 To Verify Eligibility, Obtain Claim Information or Pre-Certification call WebTPA: or PR O P 5/ O 12 SE /1 D 5 9: R 52 ul AMe PR PR Group #: 2015PAC Member: JOHN SAMPLE Member ID: SMPL0001 * Medical Coverage T09 Sh: 0 Bin 1 J173 Env [1] CSets 1 of 1 F O O O P 5/ O 12 SE /1 D 5 9: R 52 ul AMe Progressive Acute Care Medical Network 1085-XX 0D PAC-*-*-*-*-* M(VERITY)D()V() Member T09 Sh: 0 Bin 1 J173 Env [1] CSets 1 of 1 Eligibility or Claims Questions? call This card is not a guarantee of benefits. Pre-Certification Notification of inpatient hospitalization is required prior to admission or within 48 hours of an emergency admission. Certain outpatient procedures may require precertification. Failure to obtain pre-certification may result in reduced benefits. Outside your service area, contact or

6 Register or Login to the Members Portal Make sure you register and login to request cards, view prescription information, find a pharmacy, and more. Use the following steps to register or login to the Members Portal. Go to and click on "Members" near the top of the page. Then click on the "Member Portal" link on the left side of the page. Last, to create a new account, click "Register". 6

7 Your Retail Pharmacy Network Locate the icon... First Choice is a national network of retail chain and independent pharmacies where you can fill your prescriptions at the greatest discount. If your pharmacy is not in our First Choice network, in your pharmacy search to reduce your copay cost! and wants to join, please have the pharmacy call our customer service team and we can add them into our network. Use our Locator to find a pharmacy near you Network Pharmacy Locator Nearest in-network pharmacy Find your nearest Pharmacy +

8 Need to find a Specialty Pharmacy? What are my Specialty Options? Search for a specialty pharmacy closest to Local specialty pharmacies are identfied with a and listed by closest distance to you. Make sure to call and check that your preferred specialty pharmacy carries the specialty drug before you go to the pharmacy. Don t feel like searching? TLC Rx Specialty Pharmacy is also an available option. Call: (888) to get set up. Not sure where you should go? Call Southern Scripts to get help in finding the right option for you. We can also check with your preferred specialty pharmacy to make sure they have your medication available. Let s talk: (800)

9 Do you want to use Mail Order for your prescriptions? Mail order is available through Drug Source Inc. Call (800) to get your prescriptions transferred from your current mail order pharmacy to Drug Source. They will transfer your prescriptions for you. Call prior to when your benefits start with Southern Scripts, so there is no delay in getting your medications! Questions Call us at (800) Fax us at (318) us at Like us on Facebook for co-pay saving coupons PHARMACY BENEFIT MANAGEMENT 9

10 Ways to Cut Costs on your Prescriptions Generic drugs are a safe and effective way for you to reduce the cost of your plan s prescription medications. Generic drugs must contain the same active ingredients as the original brand-name drug. However, they may differ from brand-name drugs in color, size, and shape. They must also be equal in strength and dosage and be able to produce the same effect in the body as the name brand drug. You can ask your doctor or pharmacist for generic drugs. Explain that you want the most effective therapy at the best price. Ask your doctor to write prescriptions for the generic drug whenever possible. You will receive a less costly mediction, but it will work just as well as the brand name drug! What do you do if your doctor prescribes a medication that isn t covered by your plan or is too expensive? How do I get the generic at a pharmacy? When your doctor gives you a prescription, ask him or her a few questions such as: What does this drug do? pharmacies will automatically switch a brand to a Is there a generic that is comparable? generic is not available, there may be an If there is not a generic, are there less costly options? alternative option that your doctor can switch you Ask your Pharmacist for the generic! Most generic equivalent, if available, unless your doctor has deemed the brand medically necessary. If a to. Talk to your pharmacist and doctor to make sure you are getting the cheapest available option that works for you! 10

11 Reporting a Problem The Southern Scripts staff strives to provide exceptional service at all times. However, if you are unhappy with anything about Southern Scripts, feel free to contact one of our live representatives in customer service. Let s Talk: 1. Call Customer Service at (800) or 2. us at support@southernscripts.net We strive to resolve all issues, so please let us know how we can help you.

12 Frequently Asked Questions How do I know if a medication is going to require a PA? Go to: and use the Prior Authorization Drug Search tool to check your medications. Or call Southern Scripts Customer Service at (800) so we can check for you. Where can I get my flu shot and other vaccines? Only pharmacies listed with the vaccine icon can administer vaccines. Make sure to call your pharmacy and make sure they have the vaccine in stock. Why does my co-payment change? Your co-payment will vary based on which type of drug is chosen, the pharmacy chosen, and your plan s benefit set-up. Check your formulary to find the most cost effective medications. How do I find cost effective diabetic supplies? Visit Tools for Diabetes link will bring you to a list of diabetic supplies that show generic and preferred copays to keep costs low for you. Where do I find coupons for expensive medications? Like us on facebook for coupons, health related tips, videos, and more. What do I do for a manual claim? Contact Customer Service for a manual claim form. Always check to see if a pharmacy takes your ID card before filling your prescription to save money and avoid the hassle of a manual claim procedure. What do I do if my prescription needs a prior authorization (PA)? Your doctor, pharmacist, or you can give us a call to verify and start the PA process. Call (800) Can I receive a medication that is not on my formulary? How do I know if a medication is covered? Yes. You can obtain a non-formulary drug by taking the prescription to your pharmacy. However, if you choose to obtain a non-formulary drug, your share of the cost may be higher than it would be for a drug on your formulary. You may also be required to pay the full price of the drug. It is more cost-effective for you to utilize drugs that are generics and preferred alternatives. Call (800) to see if your Rx is covered or to check your copay. Where can I track my prescriptions? Visit our members portal on It is best to register so you can keep track of all your prescriptions and access other member tools.

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