the Drug Plan Changes

Medication Talk
Your employees’ drug plan is changing. We’ll explain the
changes and how we’re helping your employees get the
medications they need to stay healthy.
Why are HMSA drug plans changing?
These changes are necessary to manage the cost of
your employees’ drug plan. Every year, more brandname drugs become available. These drugs treat
many serious illnesses, such as cancer, hepatitis C,
and multiple sclerosis. But they come with a high
price tag because of their research, development,
and marketing costs. These expensive brand-name
drugs drive up overall health plan costs.
Your employees’ drug plan changes will help curb
rising costs and continue to give your employees
access to medications they need.
Drug plan changes
The cost of doing business continues to challenge all of us. We’re working to help your
employees get safe, effective medications at an affordable price. That’s why we regularly
adjust the list of medications, or the “formulary,” for your employees’ prescription drug plan.
In some cases, their medication costs may change or they may have to switch medications.
Your employees may be able to take less expensive alternatives that do the job just as well.
We want you to be aware of these changes.
Non-formulary. These medications will no longer be in HMSA’s drug
plan because there are equally effective alternatives that cost less. We’re
asking your employees to talk to their doctors about these alternatives
before refilling current presecriptions. This change affects less than
1 percent of your employees.
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Finding solutions
Tier changes. These medications will move to a higher-costing drug
plan level because there are lower-cost alternatives. We’re asking your
employees to talk to their doctor about taking a lower-cost alternative. If
they continue taking their existing medication, they may have to pay more.
Patient safety. There will be quantity limits on these drug doses to comply
with U.S. Food and Drug Administration guidelines. The FDA says that
taking a higher-than-recommended dose isn’t always effective and could
risk the health and safety of your employees who take these drugs.
Prior authorization. Your employees will need approval before taking
these drugs to make sure that they’re necessary for their condition. Their
doctor can help them determine what’s best for them.
Step therapy. Your employees will be prescribed a less-costly alternative
before they can take these medications. Their doctor may determine
that the alternative works just as well as the brand-name drug to treat
their condition.
Specialty medication. There are lower-cost specialty medications for
your employees. We’re asking your employees to choose the preferred
specialty medication if it’s appropriate to help them save money.
Your impacted employees will receive letters and information packets
from us with details. We’re asking them to talk to their doctor or
pharmacist about alternative medications for their condition. In some
cases, a doctor may request an exception to have them stay on their
current medication or dose.
If your employees have questions, they can call 1 (855) 298-2491 tollfree to talk to a medication specialist at CVS/Caremark, our pharmacy
benefits manager.
1300-2353E 4.15 LE
If you have any questions, please contact your HMSA representative.