September 27, 2013 RE: Pharmacy Benefit Transition Plan for Oxford Clients Dear Valued Oxford Client, We are pleased to confirm that, effective Oct. 1, 2013, your pharmacy benefit services are being administered by OptumRx TM UnitedHealth Group s in-house pharmacy benefit manager (PBM). OptumRx is one of the largest PBMs with leading capabilities and the capacity to help support your pharmacy benefit needs. In 2012, OptumRx continued pharmacy transition preparations by increasing the scale of its platforms, operations and technology capabilities. The transition to OptumRx is designed to help us better serve your employees and help improve their overall experience: Call Center Experience: Direct access to OptumRx pharmacists. Additionally, we ve trained our staff to support medical and pharmacy questions, providing one point of contact for most member questions. Mobile Experience: Access to information and tools that support member pharmacy needs while on the go. MAIL SERVICE Most existing mail service prescriptions will transfer to OptumRx. Prescriptions for certain medications, like painkillers, will not transfer. In this case, we will send members a letter with further instructions. Prescriptions that do not transfer, including expired prescriptions, will require a new prescription. We will contact our mail service members, either by phone or letter, prior to their first prescription refill to offer assistance. Members will need to tell us their payment method, as this information is not being transferred to OptumRx. They can do this when we contact them to offer assistance with their first prescription refill. Or members can go to the Pharmacies & Prescriptions section of oxfordhealth.com, click on Online Pharmacy and log in to the OptumRx site. Instructions are included in the attached member Frequently Asked Questions document. Please note that pharmacists by law must validate prescriptions transferring from Medco, an Express Scripts company, to OptumRx. Both of these actions will take place before the member s prescription is filled. Outlined below is a high-level overview of the strategy and communication plan we developed to facilitate this transition. PREPARING FOR A SMOOTH TRANSITION We have prepared for a smooth and successful transition. OptumRx is committed to staffing appropriately and developing resources to be fully functional prior to your effective date. By the Oct. 1, 2013 Oxford membership migration, we had already successfully transitioned approximately 8 million members to the OptumRx platform. 1 We implemented multiple phases of testing including an independent third party to validate our readiness. We also created a command center as a central point of contact to support our internal teams in addressing benefit issues or questions. 1 Internal membership data. Customers are transitioning to OptumRx in a staged approach throughout 2013.
ESSENTIAL PHARMACY BENEFIT ELEMENTS While we do not anticipate changes, as a result of the transition to OptumRx, to the Prescription Drug Lists, benefit plan designs, specialty pharmacy and clinical programs members have today, changes may occur as part of the normal course of business. No action is required on the part of customers regarding these pharmacy benefit elements. Additionally, Oxford members will have access to more than 64,000 retail network pharmacies, 2 which compares in size to the network they have today. COMMUNICATION PLAN We will inform members about OptumRx and what they can expect through the following communication plan (sample communications are attached for your reference): We ll mail a letter (mail and non-mail service versions), educating members on what to expect, directing them to look for their new health plan ID card, and providing answers to Frequently Asked Questions. Members enrolled in Medco s Worry Free Fill (automatic fill) program will receive a letter in this packet, confirming the program will end upon their transition to OptumRx. Information on how to enroll in the Hassle-Free Fill SM automatic refill program through OptumRx will be included. Members will receive a new health plan ID card with the OptumRx logo. For added convenience, the card provides one Member ID number for medical and pharmacy. It also contains new pharmacy claim information and a new member phone number. We will also send targeted communications informing impacted members of specific changes (i.e., if they utilize Medco s Mobile App or their prescription will not transfer, etc.). More information on this is included in the enclosed Frequently Asked Questions document. We look forward to continuing to support your health care benefit needs, and helping your employees live healthier lives. If you have questions, please contact your Oxford representative. Please note: Oxford customers with pharmacy benefit services transitioning to OptumRx on Oct. 1, 2013 may have already received a version of this notice in the mail or via the oxfordhealth.com employer portal. We are now sending this information to new customers and those who may not have been active at the time of the original communication. Please disregard this communication if you received it previously, or if you are no longer covered by an Oxford plan for your pharmacy coverage as of Oct. 1, 2013. Sincerely, Oxford Account Management Attachments Sample Member Letter (mail service) Sample Member Letter (non-mail service) FAQ Oxford HMO products are underwritten by Oxford Health Plans (NY), Inc., Oxford Health Plans (NJ), Inc. and Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. Administrative services provided by Oxford Health Plans, LLC. MS-13-826 2 UnitedHealth Networks, Q4 2012.
Oct. 3, 2013 Dear Member: We re excited to tell you about an important change. On Oct. 1, 2013, administration of your pharmacy benefit services transitioned to OptumRx, a UnitedHealth Group company. This change is designed to help us better serve you and improve your overall experience. What does this mean for you? You ll receive a new health plan ID card in the mail, if you have not already, with OptumRx information on it. Your new health plan ID card is effective as of Oct. 1, 2013. Please keep and use your current card until that date. Your mail service transitioned to OptumRx. What happens to my mail service prescription(s)? Most mail service prescriptions with remaining refills automatically transfered. OptumRx will contact you when it s time to process your refill order. See the enclosed Frequently Asked Questions to find out which prescriptions did not transfer and what to do if you re out of refills. Questions? If you d like more information about the move to OptumRx, please see the enclosed list of Frequently Asked Questions. If you still have questions, you can now use one telephone number for both your medical and pharmacy questions. Call Customer Service at the member telephone number listed on the back of your health plan ID card. If you are hearing impaired and require assistance, please call our TTY/TDD line at 1-800-201-4875. Please call 1-800-303-6719 for assistance in Chinese, 1-888-201-4746 for assistance in Korean, or the telephone number on your health plan ID card for assistance in English and other languages. We look forward to serving you and helping you live a healthier life. Sincerely, Edward Lagerstrom President, Pharmacy Benefit UnitedHealthcare Please note: If you are covered by an Oxford plan for your pharmacy coverage as of Oct. 1, 2013, this letter applies to you. If you are no longer covered by an Oxford plan as of that date, you can disregard this communication. Additionally, if the pharmacy claim information on your new health plan ID card differs from your Certificate of Coverage or Outpatient Prescription Drug Rider, the health plan ID card should be considered the most current and factual information. Oxford HMO products are underwritten by Oxford Health Plans (NY), Inc., Oxford Health Plans (NJ), Inc. and Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. All brand medications are trademarks or registered trademarks of their respective owners. M53202-F MIG_Oxford_100113 8/13 2013 Oxford Health Plans LLC. All rights reserved. MS-13-499
Oct. 3, 2013 Dear Member: We re excited to tell you about an important change. On Oct. 1, 2013, administration of your pharmacy benefit services transitioned to OptumRx, a UnitedHealth Group company. This change is designed to help us better serve you and improve your overall experience. What does this mean for you? You ll receive a new health plan ID card in the mail, if you have not already, with OptumRx information on it. Your new health plan ID card is effective as of Oct. 1, 2013. Please keep and use your current card until that date. Questions? If you d like more information about the move to OptumRx, please see the enclosed list of Frequently Asked Questions. If you still have questions, you can now use one telephone number for both your medical and pharmacy questions. Call Customer Service at the member telephone number listed on the back of your health plan ID card. Using OptumRx Mail Service is easy and may save you money. Call the member telephone number listed on the back of your health plan ID card to get started. If you are hearing impaired and require assistance, please call our TTY/TDD line at 1-800-201-4875. Please call 1-800-303-6719 for assistance in Chinese, 1-888-201-4746 for assistance in Korean, or the telephone number on your health plan ID card for assistance in English and other languages. We look forward to serving you and helping you live a healthier life. Sincerely, Edward Lagerstrom President, Pharmacy Benefit UnitedHealthcare Please note: If you are covered by an Oxford plan for your pharmacy coverage as of Oct. 1, 2013, this letter applies to you. If you are no longer covered by an Oxford plan as of that date, you can disregard this communication. Additionally, if the pharmacy claim information on your new health plan ID card differs from your Certificate of Coverage or Outpatient Prescription Drug Rider, the health plan ID card should be considered the most current and factual information. Oxford HMO products are underwritten by Oxford Health Plans (NY), Inc., Oxford Health Plans (NJ), Inc. and Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. All brand medications are trademarks or registered trademarks of their respective owners. M53202-G MIG_Oxford_100113 7/13 2013 Oxford Health Plans LLC. All rights reserved. MS-13-500
Frequently Asked Questions OptumRx 1. Who is OptumRx? OptumRx is a UnitedHealth Group company, offering pharmacy benefit services. You will enjoy advantages, such as an easy online experience, the option to set up mobile text refill reminders, superior Customer Service and access to our in-house mail service pharmacy. Health Plan ID Card 2. What if I ve transitioned to OptumRx and haven t yet received my new health plan ID card? If you do not receive your new health plan ID card, you can download and print a temporary health plan ID card by logging in to oxfordhealth.com and clicking on Request ID Card. A permanent card can also be requested at the same page, or by calling Customer Service at the member telephone number listed on the back of your health plan ID card. Pharmacies 3. Can I go to the same pharmacy? How can I find pharmacies covered by my plan? The OptumRx network includes over 64,000 retail pharmacies 1, including all large national chains, many local, community pharmacies and the OptumRx Mail Service Pharmacy. It compares in size to the network you have today. To search for a network pharmacy near you, go to the Pharmacies & Prescriptions section of oxfordhealth.com, click on Online Pharmacy and log in to the OptumRx site. Enter your ZIP code on the right-hand side of the page, under Locate a Pharmacy, and click Go. Or, call Customer Service at the member telephone number listed on the back of your health plan ID card. There should be little, if any, disruption to members. If a pharmacy is no longer in our network, and you ve filled a prescription there in the past three months, we ll notify you by mail. Cost 4. Will the price of my medication change? Some members may experience a change. For example, medication prices may vary between pharmacies. You may see a difference if you or your employer recently selected a new benefit plan. Additionally, if you haven t yet met your deductible and you re paying out-of-pocket for your medication, you may see a cost increase or decrease between refills. Benefit Changes 5. Will my benefits change as a result of the transition to OptumRx? We anticipate there will be no change to your benefit coverage as a result of the transition to OptumRx. Your employer may choose to update benefit plans during open enrollment. Additionally, as part of your pharmacy benefit plan, Prescription Drug List (PDL) updates generally occur once or twice a year, depending on the plan. Any PDL or health and pharmacy benefit changes made during open enrollment are separate and not related to the transition to OptumRx. Precertification Requirements 6. My medication requires precertification. Will I need to go through this process again? As long as coverage of your medication is still in effect, you will not need to go through the process again now that you ve transitioned to OptumRx. Before your precertification approval expires, please ask your doctor to contact OptumRx to renew your precertification. You can find the expiration date in your original precertification approval letter. Website 7. Will I be able to see my prescription information online? Yes, you can still access your prescription and mail service information online. Go to the Pharmacies & Prescriptions section of oxfordhealth.com, click on Online Pharmacy and log in to the OptumRx site. You can view your prescriptions by clicking on the My Medicine Cabinet link under the My Prescriptions tab. You can quickly view your medications, check status and refill mail service prescriptions. You will also see transferred mail service prescriptions that may be eligible for refills. Placing an online refill order is easy. You simply need to provide a payment method during the checkout process. You can also set up refill reminders to send to your mobile telephone. Please note you will need to complete a one-time registration to view your prescription information and log in each time you enter the OptumRx site.
8. How can I view my dependent(s) or spouse s pharmacy benefit online? Go to the Pharmacies & Prescriptions section of oxfordhealth.com, click on Online Pharmacy, and log in to the OptumRx site to view and manage all your dependents information under the age of 13. Click on the My Prescriptions tab. On the left side of the page, you can select your dependent s account by using the View Accounts drop-down box. In order to protect the privacy and personal health information of our members, OptumRx has adopted a process for you to request permission to access your dependent(s) (age 13 and older) or spouse s prescription information. To set up access, your covered dependent(s) or spouse will need to go to the Pharmacies & Prescriptions section of oxfordhealth.com, click on Online Pharmacy, and log in to the OptumRx site. Then, click on the My Account tab, and follow the steps under Household/Caregiver Access. Mail Service 9. Will my mail service prescription(s) transfer to OptumRx? Most mail service prescriptions with remaining refills will automatically transfer. Based on guidelines from the National Council of Prescription Drug Programs, prescriptions for certain medications will not transfer or be refilled. Examples include compound drugs and some controlled substances, including certain pain medications and stimulants. In this case, you ll receive a letter from us. Prescriptions that do not transfer, including expired prescriptions, will require a new prescription from your doctor. OptumRx will contact you when it s time to process your refill order. 10. What if there are no more refills for my medication? You ll need a new prescription if there are no more refills for your medication. You can contact your doctor for a new prescription. Or, we can work directly with your doctor. 11. Once I place a mail service order, how quickly will I get my medication? New and transferred prescription orders will arrive around 10 business days from the date OptumRx receives the order. Refills normally arrive within seven business days of OptumRx receiving your order. If you have an email address on file, you can expect to receive an email when your prescription ships. If you don t have an email address on file, you ll receive a telephone call. 12. Will my medication look different? Brand medications will look the same as your current prescription. Generics may look different, as OptumRx may use a different manufacturer for some medications. You can rest assured that U.S. Food and Drug Administration (FDA) approved generic medications are required to be the same strength and follow the same quality standards. If you have questions about your medications, OptumRx registered pharmacists are available 24 hours a day, seven days a week. 13. How do I refill an existing mail service prescription that was transferred to OptumRx? You can refill an existing mail service prescription in one of the following ways: Online: Go to the Pharmacies & Prescriptions section of oxfordhealth.com, click on Online Pharmacy, and log in to the OptumRx site. Click on the Renew Prescriptions link under the My Prescriptions tab. Mail: Mail in your prescription with a completed order form. This form can be found by visiting oxfordhealth.com and clicking on the Download Forms link on the Tools & Resources tab. Phone: Call the member telephone number listed on the back of your health plan ID card for the OptumRx Mail Service Pharmacy. You will need to confirm your new payment method with OptumRx. You can do this when OptumRx contacts you via telephone or mail prior to your first fill. Or, go to the Pharmacies & Prescriptions section of oxfordhealth.com, click on Online Pharmacy, log in to the OptumRx site and follow the steps outlined in Question No. 7. Also, please note that pharmacists by law must validate prescriptions transferring from Express Scripts (formerly Medco) to OptumRx. Both of these actions will take place before the prescription is filled. 14. How do I order a new prescription through mail service? There are several ways you can place a new mail service order: Online: Go to the Pharmacies & Prescriptions section of oxfordhealth.com, click on Online Pharmacy, and log in to the OptumRx site. Click on the Fill New Prescriptions link under the My Prescriptions tab. Mail: Mail in your prescription with a completed order form. This form can be found by visiting oxfordhealth.com, and clicking on the Download Forms link on the Tools & Resources tab. Phone: Call the member telephone number listed on the back of your health plan ID card for the OptumRx Mail Service Pharmacy. Your doctor can also fax, speak to a pharmacist or e-prescribe a new order for you.
15. What are the advantages of using mail service? Many members use mail service for the convenience, safety and savings. Medications are delivered directly to your home, as a three-month supply, which means fewer trips to the pharmacy. Registered pharmacists are available 24 hours a day, seven days a week to answer questions. And you can feel confident in OptumRx s 99.99 percent mail service accuracy rate. All prescriptions go through multiple checks by licensed pharmacists and technicians, and are screened for potential harmful interactions with other medications on file 2. To learn more about mail service, visit the Pharmacies & Prescriptions section of oxfordhealth.com, click on Online Pharmacy, and log in to the OptumRx site. 16. What happens if I currently use Medco s Extended Payment Plan for mail service? You are responsible for any outstanding payments to Medco. Payments will be billed to the credit card on file with Medco in the same 30-day increments until they are paid in full. Your balance will not transfer. Specialty 18. I receive a specialty medication through the OptumRx Specialty Pharmacy. How does this impact me? Do I need to take any action? No, you do not need to take action. There are no changes to your benefits or services as a result of the transition to OptumRx. Please continue to order your specialty prescriptions from OptumRx by calling 1-888-739-5820. Customer Service 19. What happens if my question is not answered here? You can now use one telephone number for both your medical and pharmacy questions. Call Customer Service at the member telephone number listed on the back of your health plan ID card. If you are hearing impaired and require assistance, please call our TTY/TDD line at 1-800-201-4875. Please call 1-800-303-6719 for assistance in Chinese, 1-888-201-4746 for assistance in Korean, or the telephone number on your health plan ID card for assistance in English and other languages. 17. I use Medco s Worry Free Fill program (automatic refill) for my mail service prescriptions. What will happen to these prescriptions? To continue receiving automatic refills, you will need to enroll all your eligible mail service prescriptions in the Hassle-Free Fill SM program with OptumRx. You can enroll in two ways: 1. Call the telephone number on the back of your health plan ID card. 2. Wait for OptumRx to contact you via telephone or mail two to three weeks prior to your first refill date and enroll at that time. 1 Network Report, December 2012. 2 Based on OptumRx Mail Service reporting 2012. Oxford HMO products are underwritten by Oxford Health Plans (NY), Inc., Oxford Health Plans (NJ), Inc. and Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. All brand medications are trademarks or registered trademarks of their respective owners. M53202-B MIG_Oxford_100113 8/13 2013 Oxford Health Plans LLC. All rights reserved. MS-13-495