Public Employee Press

Drug plan changes go into effect July 1

As the DC 37 Health and Security Plan switches to a new prescription benefit administrator July 1, the mail-order program for maintenance drugs will become optional and a new program will let members and retirees buy 90-day supplies of those medications at certain participating pharmacies.

Under the new Retail 90 Rx program, participants will be able to get 90-day supplies for three monthly co-payments at chains like CVS, Duane Reade, Eckerd, Rite Aid and Walgreens.

The mail-order program — which costs two monthly co-pays for a 90-day supply — will now be voluntary.

Eliminating the mandatory mail program and launching Retail 90 Rx are among the changes the plan adopted recently as it reached a contract with Innoviant Inc., which is replacing Express Scripts Inc.

“As we considered bids and negotiated a new contract, the trustees wanted to make the benefit more ‘user friendly’ and control costs,” said Local 983 President Mark Rosenthal, chair of the plan’s board of trustees.

While the trustees decided to make the program voluntary, they didn’t eliminate the mail-order option, because while many participants wanted to buy medications at their neighborhood pharmacy, others preferred the convenience of mail-order and the one-third discount off the regular co-pay that the program offers for 90-day supplies.

In June, the DC 37 plan will send out a comprehensive “Welcoming Package” describing the changes in the drug plan. “We are working very closely with Innoviant and ESI to try to make the transition as smooth as possible,” said Rosa R. Esperon, administrator of the union plan. Participants should call the plan’s Inquiry Unit at 212-815-1234 with any questions or concerns.

Until July 1, members and retirees using the mail-order program should continue to order refills from ESI. After July 1, Innoviant will fill outstanding prescriptions. To order refills from Innoviant, call 1-800-207-1561.

With the welcoming packet, members and retirees will also receive a new DC 37 Innoviant drug card.

Half Tab Rx tablet splitting program
Because of concerns with identity theft, the plan has replaced the Social Security numbers on its drug card with the six-digit personal identification number (PID) that DC 37 relies on for other programs.

On July 1, the plan will also introduce Half Tab Rx. This new voluntary program will let participants cut their co-pay for certain medications by as much as half. Since some medications cost about the same regardless of dose, participants can buy higher dosage pills and use a free tablet-splitting device to “create” their own pills with the lower dosage. Call Innoviant at 1-800-207-1561 to participate.

The switchover to Innoviant will affect participants in the city’s PICA program, who have used their DC 37 drug card to obtain injectable and chemotherapy medications through ESI. Since DC 37 no longer has a contract with ESI, the city will issue ESI PICA cards to DC 37 members and retirees in the program.

The 27-page welcoming packet will inform participants about the Rx Instep program, which used to be called “step therapy.” This program — designed to cut drug costs — requires participants with certain medical conditions to initiate treatment with generic programs before taking more expensive “second step” medication.

The packet also explains the plan’s “Quantity Limits on Medication” program. In certain instances, physicians prescribe more medication than the monthly dosage recommended by the federal Food and Drug Administration, whose guidelines the DC 37 benefit follows.

The packet also contains partial listings of preferred medications and medications that require prior approval.

The basic co-payment structure of the plan is unchanged, with the addition of the 90-day option at retail pharmacies. Participants pay $5 for a 30-day supply of generic drugs, $15 for preferred brands and $35 for non-preferred brands.

In the mail-order program, the co-pays are $10 for a 90-day supply of generic drugs, $30 for preferred drugs and $70 for non-preferred drugs. The co-pays for the new Retail 90 Rx program are $15 for a 90-day supply of generics at a participating pharmacy, $45 for preferred drugs and $105 for non-preferred drugs.