Thursday, July 8, 2010

UHC expands Select Designated Pharmacy program to additional fully insured groups effective August 1

In an effort to better manage prescription drug costs and help members save money while providing affordable access to medications, UnitedHealthcare (UHC) is expanding their Select Designated Pharmacy program. As of August 1, 2010, the program will be implemented in CO, GA, ID, KS, MA*, MO, MS, NC*, SD, TN, TX* and VT (*2007 rider business only).

The program has not been expanded to fully insured customers in AR, CT, LA, MD, NY and NY. Additionally, customers with in-network only pharmacy coverage in AR, DE, GA, IA, ID, IN, MO, MS, MT, NC, ME, OK, RI, TN, TX, UT, VT, WV and WY will not be participating at this time.

About the program
The Select Designated Pharmacy program encourages members on select high cost Tier 3 medications to make lower cost medication and pharmacy decisions. It also requires members to use mail order pharmacy or switch to a lower cost medication for continuation of in-network benefits.

By switching to mail-order pharmacy, lower-tier medications, or both, members can save a significant amount of money. Since the program began, the average member savings is $25 per month, or $300 annually.

Select medications
The program targets 18 Tier 3 medications, representing just 1% of all retail prescriptions. Most medications in the program have multiple, lower-cost alternatives. Medications in the program may change as part of the semi-annual Prescription Drug List (PDL) schedule on January 1 and July 1. To view the current medication list as of May 1, 2010, click to access the UHC Select Designated Pharmacy Program Summary.

Member Outreach and Impact
Members taking affected drugs are allowed two prescription refills ('grace fills') at their retail pharmacy before they must select a new option to receive network coverage. After the first grace fill, members will receive a letter and a phone call explaining their options. During both grace fills, point-of-sale messaging at retail pharmacies will encourage pharmacists to engage with members about their coverage options. At any time, members can call member services to help facilitate this change.

Members on affected drugs who have non-network benefit coverage and choose to make no change will pay the full cost of the drug, and can file a paper claim for reimbursement as a non-network benefit. Effective August 1, 2010, in states where allowed, members who have in-network only pharmacy coverage and make no change will pay the full cost of the drug and cannot file a paper claim for reimbursement.

The Select Designated Pharmacy program is not available in all states or for all in-network only customers. For more information, please view the UHC Select Designated Pharmacy Program Summary.

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