There’s a New Prescription Provider for the State Employee Health Benefit
The state quietly underwent a major transition this month with the switch to Express Scripts as the pharmacy provider for the Executive and Judicial Branch employees’ and retirees’ Health Benefit plan. As with any major transition, there have been some hiccups, of course. For those members who have been having problems, the SEA’s benefits specialist Chris Porter is and has been available to help.
We’ve seen a few problems crop up repeatedly, but before we get into that, it might be helpful to explain how we ended up with the new provider. Last year, the state put the pharmacy benefit provider contract out to bid, and Express Scripts scored the highest (CVS/Caremark, the previous provider was the runner-up). While the pharmacy benefit is collectively bargained, the state has autonomy in deciding who provides the benefit. With the Department of Administrative Services’ recommendation, the Executive Council approved the contract in September. Express Scripts took over on Jan. 1.
The state provided a checklist late last year to help beneficiaries prepare for the transition to the new provider, and promised welcome letters and cards would be sent out. Porter said the welcome letters and other materials were mailed out a bit later than we’d been told.
“Letters telling some that their prescriptions are non-preferred have just gone out in the last week,” Porter said. “Things that should probably have gone out in December are arriving now, so we’re seeing a handful of issues just come to light.”
Porter noted a problem he’s seen is that some drugs that CVS/Caremark covered are deemed non-preferred by Express Scripts. This means you could end up paying more or perhaps not even be able to get a prescription you had been using. One prescription, Porter noted, was priced as a generic under CVS/Caremark ($1 for a 90-day supply) but is priced at the highest rate under Express Scripts ($70 for a 90-day supply). Porter also noted that because Express Scripts’ exclusions of non-preferred prescriptions are different, some are seeing their options dwindle.
“Express Scripts offers substitutes, but in some cases that means going from five choices to just one,” Porter said. “Unless you just happen to have been prescribed with that one, you’re faced with having to make a change.”
In investigating that problem, Porter did find out, though, that Express Scripts will allow exceptions with a doctor’s approval. You could probably have found that bit out yourself, but it illustrates an important benefit to members: as the SEA’s benefits specialist, Chris Porter is here to help navigate the often confusing, frustrating world of health benefits. Even if the answer isn’t always what you want it to be, it helps to have someone with expertise in your corner.
If you have any health or prescription benefit related questions, you can call Chris at 271-3411, ext. 134 or email him at firstname.lastname@example.org.