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Posted November 1, 2017

Prescription Drug Plan Changes

for Albuquerque Public Schools employees and their covered family members

Prescription

Important notification regarding changes to the prescription drug plan for Albuquerque Public Schools employees and their covered family members

Effective January 1, 2018, Albuquerque Public Schools (APS) has made the following changes to the prescription drug plan administered for APS by Express Scripts. 

 1. All Specialty Medications must be filled through Accredo, the Express Scripts specialty pharmacy. 

  • This is a change from previous years, where APS medical/prescription drug plan enrollees and their covered family members were allowed two fills of prescribed specialty drugs at a retail pharmacy.
  • Employees and covered family members who are taking a specialty drug or who are prescribed a specialty drug after January 1, 2018 will need to fill those prescription(s) through Accredo.
  • Most APS employees and their family members who are enrolled on our medical/ prescription drug plan will not be impacted by this change, because most of our enrolled members are not taking prescription drugs that are classified as specialty drugs.  
    • Specialty medications are used to treat complex medical conditions, such as cancer, growth hormone deficiency, hemophilia, hepatitis C, immune deficiency, multiple sclerosis and rheumatoid arthritis. If you have questions as to whether the prescription drug you or a family member are taking is classified as a specialty drug, please contact Express Scripts at 866-563-9297.  

 2. APS is implementing a specialty pharmacy copay assistance program.

  • To save on certain high priced prescription medications, we have partnered with SaveonSP for a copay assistance program. 
  •  List of specialty drugs impacted by this change
    • Most APS employees and their family members who are enrolled on our medical/prescription drug plan will not be impacted by this change, because most of our enrolled members are not taking prescription drugs that fall into the select group of specialty drugs that qualify for the SaveonSP program.
      • There are approximately 64 specialty medications in 13 therapy classes that are part of the SaveonSP program. 
  • Employees and their family members who are taking one of the specialty drugs that are part of this program will receive a letter (and possibly a phone call) from SaveonSP to explain the program and assist with enrollment into the program.
  • Members who enroll in the SaveonSP program will have their select specialty medications covered at 100% (no copay or cost to the enrolled member). 
  • Specialty medications are not one of the ten Essential Health Benefits under the Affordable Care Act (ACA) and are therefore considered non-essential health benefits.  (Under the Affordable Care Act (ACA), there are ten categories of services that must be covered under a health plan; these are referred to as Essential Health Benefits.  Services that fall outside of these ten categories are considered non-essential health benefits under the ACA.)
  • As non-essential health benefits, the cost of such specialty drugs will not be applied toward satisfying the member’s out-of-pocket maximum on the prescription drug plan.
    • Although the cost of the drugs under the SaveonSP program will not be applied towards satisfying the member’s out-of-pocket maximum, the cost of these drugs will be reimbursed by the manufacturer and result in no cost to the member.
    • By implementing this copay assistance program with SaveonSP, the self-insured Albuquerque Public Schools prescription drug plan will also save significant money, allowing APS to continue to offer a high quality medical and prescription drug plan. 
  • Copays for the specialty medications that fall under the SaveonSP program may be set to the maximum of the current plan design ($150) or the amount of any available manufacturer-funded copay assistance amount.
    • Should you or your covered family member qualify for the SaveonSP program (because a prescription drug that you take is part of the list of specialty drugs covered under this program), and you decline to sign up with the SaveonSP program, your prescription drug copay will be the amount stated on the SaveonSP program drug list, which will represent a significant increase in cost to you. (Often these drugs cost thousands of dollars per month; if you or a covered family member are taking one of these medications, we encourage you to participate in the SaveonSP program.)
    • In addition, if you are eligible for, but choose not to enroll with, the SaveonSP program, your costs for the specialty drug(s) covered under this program will not apply to either your medical plan deductible or to your medical or prescription drug plan out-of-pocket maximums. 

 

 

 

 

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