Public Employee Press

DC 37 Health & Security Plan news
Update on prescription drug benefit

Members who get medications through the OptumRx mail-order service should register a credit card with Optum, which manages the union's Prescription Drug Benefit for the DC 37 Health & Security Plan.

Under a new policy, Optum will no longer fill the prescriptions of members who have outstanding bills of $100 or more. Optum says it was forced to adopt this policy because many DC 37 members have an excessive amount of uncollected co-payments.

Members who don't have a credit card will be asked to send Optum a check for the co-pay before their medications are shipped.

Under an agreement with the DC 37 Health & Security Plan, OptumRx cannot refuse to fill prescriptions for members with outstanding balances under $100, even if they don't have a credit card on file or do not want to send a check in advance. If an order goes unfilled, members should contact the DC 37 Health & Security Plan's Inquiry Unit at 212-815-1234.

Should you use the mail-order service?

OptumRx's mail-order service for medications - except specialty drugs - is optional.

Mail order is cheaper than filling prescriptions at a neighborhood pharmacy. With the mail-order service, members pay only two co-pays instead of three for a 90-day supply of drugs.

New 30-day limit on specialty drug orders

Members who take specialty medications will now only be able to fill 30-day prescriptions under a change adopted by Optum Rx, which administers the DC 37 Health and Security Plan's drug benefit.

This change does not apply to Medicare-eligible retirees, who are covered by UnitedHealthcare.

Specialty medications are very costly or complex drugs used for treating difficult, chronic and rare conditions, such as HIV/AIDS, anemia, infertility, hepatitis and multiple sclerosis.

The Optum Rx specialty pharmacy used to cover 90-day prescriptions. But Optum is restricting coverage to ensure that newly prescribed drugs don't have adverse reactions and to avoid waste.

Specialty pharmacies offer patients comprehensive support for using these expensive or complex drugs, including help from health-care professionalso to ensure that they are using their medications properly and safely.

Any member facing special circumstances that preclude him or her from using the specialty pharmacy should contact the DC 37 Health & Security Plan's drug unit at 212-815-1608 so that alternative arrangements can be explored.

New drug cards and booklet

OptumRx recently sent members new drug cards and a booklet on the union's prescription drug benefit. The booklet provides a plan description, including co-pays for medications and coverage restrictions.

Some retirees who are Medicare-eligible and covered by the UnitedHealthcare drug plan instead of Optum have reported that they received the OptumRx drug card.

Unfortunately, the erroneous mailing has generated confusion, and it has led some retirees to throw out their UnitedHealthcare card or to be uncertain about which plan - OptumRx or UnitedHealthcare - should be providing their medication.

Medicare eligible retirees who received the OptumRx card and do not have a non-Medicare eligible spouse or dependent should discard the OptumRx card and keep their UnitedHealthcare card. Anyone who discarded his or her UnitedHealthcare card after getting the mailing should call 877-792-4096 for a replacement card.

— Gregory N. Heires