Prescription Drug Plan

Tier Zero for 2011

Tier Zero is the prescription drug tier for generic prescription drugs that treat congestive heart failure, diabetes, high blood pressure and high cholesterol. The co-pay for Tier Zero prescription drugs will be waived. That’s right, Emory pays 100% and plan participants will pay $0 for a 30- or 90-day prescription supply.

Some drugs that are included in Tier Zero are:

• Hydrochlorothiazide
• Furosemide
• Glyburide
• Simvastatin

Here is a complete list of all Tier Zero drugs.

Tier Changes

• Lipitor and Crestor moved from Tier 1 to Tier 2
• Pantoprozole and Lansoprozole moved from Tier 1 to Tier 3

Brand Exclusions

• Allergy, Nasal Steriods and Sleep Aid medications will no longer be covered at the BRAND name level.  Generic level medications for these drug categories will continue to be covered by the plan.
• Nexium will be the only brand proton pump inhibitor (PPI) covered under the plan (used to treat Acid Reflux, GERD, etc.)  Generic level medications will continue to be covered.

Clinical Review Programs

Prior Authorizations and quantity limits as part of Medco and Aetna's clinical review programs will be implemented for the 2011 - 2012 plan year for medications within certain drug categories PDF.  These clinical review programs will ensure patient safety by implementing quantity, dose and effectiveness reviews prior to medications being prescribed.

For a list of medications subject to the clinical review program for 2011 - 2012, click here PDF.

• Am I affected?
  • Yes, if you currently or may have a prescription for one of these medications in 2011 - 2012.
• What do I need to do?
  • For the most up-to-date information on what tier your medication is covered or if your medication will require prior authorization, contact:
  - Medco Health Solutions at 800-939-3758 (Aetna POS Plus and Value)
• Additional Information
  •  Prescription Drug Benefit - To learn more about Emory’s Prescription Drug benefit, refer to the 2011 - 2012 MHS Benefits Guide. Here you will find information about Emory’s five-tier structure and  Medco (the pharmacy vendor for the POS Plus and POS Value plans), as well as how you can save money with Tier Zero, Generic drugs and Mail Order.

Save Money and Time — Get Your Prescriptions in the Mail

If you take prescription medication on an ongoing basis, there are specific advantages associated with using mail order:

•   Cost savings — By receiving a 90-day supply, you won’t have to go to the pharmacy and you’ll incur fewer co-pays.

•   Free shipping — No extra charge for shipping when you receive your prescriptions through the mail.

•   Convenience — You don’t have to leave your home, stand in lines or wait at a drugstore for
your medication.

Here’s an example of your savings using mail order for a Tier One prescription:

Your Savings = $6 (per 90-day supply) or $24 for the year

Mmore information on Medco mail order prescriptions can be found at www.medco.com or by calling 800-939-3758.

 

(Please be aware Tier Zero will appear as Tier 5)

How to Fill Your Prescription

Use your Medco Pharmacy Card at a participating pharmacy when you have a prescription filled.

To begin using the Mail-In Prescription service:

• Step 1: Call Medco Prescription Service at (800) 473-3455. Customer Service will assist you in getting your prescription to Medco by mail or fax.
• Step 2: Mail your written prescription with the Medco Prescription Mail Order Form or have your doctor fax in your prescription with the Medco Prescription Fax Form. Make sure your information is on the forms.

Vendor Contacts

Medco
(800) 939-3758

How the Plan Works

Emory's prescription drug benefits for the Aetna POS Plans are provided by Medco and enable you and your covered dependents to have prescriptions filled at a participating pharmacy or to use the mail service program.

Prescription drugs are divided into five tiers which affect the cost of the drug. Having the prescription filled at a retail pharmacy versus using the mail service also affects the cost.

* Your plan documentation provides you with a booklet listing the most common drugs and their tier level. Your physician and pharmacist can also provide information on the tier level for specific drugs.

** Mail Order - Maintenance medications (taken daily) should be issued by your physician and remitted to Medco as a 90 day supply, refillable 3 times.

You can take advantage of Medco's mail order program to obtain up to a three-month supply of maintenance drugs for the cost of two retail co-pays. You should request two prescriptions from your doctor; the first, for a 30-day supply to fill immediately at a participating pharmacy and second, for a 90-day supply to be filled through the mail.

Note:

• If the cost of the drug is less than the co-pay, you pay the cost of the drug.
• At retail, when a generic drug is available, but the brand name is dispensed for any reason, you pay the brand co-pay plus the difference between the brand-name drug and the generic drug.

Plan Information Documents

Medco Pocket Formulary Guide	Tier Zero

Plan Forms

Medco Prescription Mail Order Form	Medco Prescription Fax Form
Medco Prescription Claim Form

Emory University Benefits

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1599 Clifton Road, NE
Atlanta, GA 30322
(404) 727-7613

Disclaimer

Emory reserves the right to terminate, suspend, withdraw, amend or modify the Plan in whole or in part at any time. Further, Emory reserves the right to terminate or modify coverage for any group of employees, active or retired and their dependents or a class of dependents at any time.