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Humana Pharmacy Solutions: Pinellas County Schools 2013 Plan Benefits. Understanding Your Pharmacy Benefits. Contents. Your pharmacy benefit Pages 3-4 For your safety Pages 5-8 Filling your prescriptions Pages 9-15 Maximizing your pharmacy benefits Pages 16-17
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Humana Pharmacy Solutions: Pinellas County Schools 2013 Plan Benefits Understanding Your Pharmacy Benefits
Contents • Your pharmacy benefit Pages 3-4 • For your safety Pages 5-8 • Filling your prescriptions Pages 9-15 • Maximizing your pharmacy benefits Pages 16-17 • Humana web and mobile tools Pages 18-25 • Questions to ask your doctor Pages 26-27
Understanding your Rx3 Plan • Your Rx3 Plan assigns prescription drugs into three levels of coverage. • Level 1: generic drugs • Level 2: preferred brand-name drugs • Level 3: non-preferred brand-name drugs and specialty drugs
How levels are assigned • A committee of Humana pharmacists and doctors evaluate each drug after the U.S. Food and Drug Administration has approved them. This is also done once a year for maintenance. • The committee looks at medical research and literature to decide how the drug compares to similar products on the market in such areas as: • Effectiveness • Safety • Side effects • Drug interactions • Cost • This helps to ensure you get medicines that are safe, effective, and at an affordable cost.
For your safety- Prior Authorization • Certain medications require your doctor to ask for and receive approval before they are covered. • This is called a Prior Authorization (PA). • This process helps make sure you receive the right medication in the right dose for the right reason. • Prior Authorization helps keep you safe. • Medications requiring authorizations are: • Typically expensive • Only appropriate for specific diseases • Require frequent monitoring *See page 22 to find out how to verify if your medication requires a PA.
For your safety- Quantity Limits • A quantity limit is the maximum amount of medication you can receive for a certain price and for a set period of time, usually 30 days. • Quantity limits help you get the right dose for your condition and help make sure you're safe when you take your medicine. • Quantity limits are based on: • FDA guidelines • Abuse potential • Cost/Waste *See page 22 to find out how to verify if your medication has a quantity limit.
For your safety- Step Therapy • Step therapy (ST) is when you are required to try a generic, or lower-cost brand-name medicine, before your benefit will cover the higher-priced brand-name medicine. • Before moving to the higher-priced brand-name medicine, try a generic medicine first. *See page 22 to find out how to verify if your medication require Step Therapy (ST) or has a generic available.
Why Generics? • Because they’re the same: • Dosage • Safety • Strength • Quality • Performance • They save you money • They contain the same active ingredient as the brand-name drug but are usually 30 to 80 percent less than their brand name counterparts.
Filling your prescriptions • Always use a pharmacy that is in the Pinellas County Public Schools pharmacy network. Those pharmacies are Walmart, Sam’s Club, CVS, RightSource and RightSource Specialty. • Networks are groups of pharmacies that agree to give discounted prices to members of certain pharmacy plans. *Don’t forget to show your Humana member ID card!
RightSource & RightSource Specialty Humana's Mail Order and Specialty Pharmacies
RightSource & RightSource Specialty • RightSource is Humana’s Mail-Order pharmacy. • RightSource fills prescriptions for maintenance medications. • Maintenance medications are taken regularly and long-term for conditions such as: asthma, high cholesterol, and high blood. • RightSource Specialty is Humana’s Specialty pharmacy. • RightSource Specialty fills prescriptions for specialty medications. • Specialty medications are used to treat chronic, complex illnesses and are typically high-priced injectable drugs. But can also include expensive tablets, capsules or inhaled medications. These are separate pharmacies that fill different types of prescriptions and operate out of different locations. • If you use both pharmacies, you’ll receive individual invoices and shipments will arrive separately.
Your RightSource experience • RightSource receives the prescription order. • Doctors can send new prescriptions by fax, phone, or electronically. • You can send new prescriptions by mail with an order form or visit your claims page on MyHumana to transfer an existing prescription. • RightSource technicians • Check the Humana pharmacy benefits coverage • Add the profile to a secure database • Scan the order • Create a unique shipment number • Doctor’s instructions and prescription orders are loaded into RightSource computers. • A RightSource pharmacist reviews the prescription order for accuracy and possible drug interactions. If there are concerns or questions, a RightSource pharmacist contacts the doctor for clarification.
Your RightSource experience • Approved orders go through the payment process. • If for some reason your benefit doesn’t cover the medication, a technician will review the rejected claim. • RightSource will resolve the issue or return the written prescription with an explanation about why they couldn’t process it. • An automated system dispenses the medication and a RightSource pharmacist makes sure the product matches the label before it’s sealed. • RightSource mails the order to your home, along with an invoice, and all of the necessary medication information.
RightSource Specialty • RightSource Specialty pharmacists are available 24 hours a day, seven days a week to answer questions and listen to concerns. • Members receive a 30-day supply delivered to their home or doctor’s office, along with any required administrative supplies such as needles or syringes. • Every new patient is contacted by a nurse. • Nurses specialize in the patient’s condition and medications. • The patient’s condition is assessed and a follow-up outreach is determined. • Patients are provided with nurse contact information and may call as often as needed. • Learn more online at RightSourceRx.com/Specialty
Want cheaper or free medications? • Publix Not a network pharmacy, so no need to show your Humana card, but you can still get these medications for FREE • Lisinopril (blood pressure medication) • Metformin (diabetes medication) • Certain Antibiotics such as: • Amoxicillin • Ampicillin • Cephalexin (capsules and suspension only) • Sulfamethoxazole/trimethoprim (SMZ-TMP) • Ciprofloxacin (excluding Ciprofloxacin XR) • Penicillin VK • Doxycycline Hyclate (capsules only) For more information including limitations please visit http://www.publix.com/pharmacy/Free-Medications.do • Walmart • $4 prescriptions: (on a 30 day supply) • Always show your Humana card at Walmart, and when you choose medications from this list your generic copay is only $4 instead of your regular $15 generic copay! For a full list of these medications please visit: http://www.walmart.com/cp/PI-4-Prescriptions/1078664
24- Hour online pharmacy resources What is MyHumana? It’s Humana’s secure website that gives you access to your information anytime you want it. If you haven’t registered for MyHumana: • Visit www.MyHumana.com • Have your Humana ID card handy • Go to Humana.com • Click “Register for MyHumana” • Follow the easy steps to register
Pharmacy locator • Select the Wal-Mart or CVS pharmacy locations based on address and/or zip code. • View pharmacy information (24 hour location, drive-thru, 90 days at retail, etc.).
Drug pricing tool on MyHumana • Locate drug level and copay amount. • Find generic or lower cost alternatives. • Please find the coverage information on your drug in the highlighted areas below.
MyHumana Mobile • You can: • Determine if plan covers prescriptions • Find prices at RightSource and retail pharmacies • Identify alternatives • Sign up for text message refill reminders • Available in: • Android Store • iTunes • Mobile device browser at m.humana.com • Future enhancements: • Medication adherence alerts • Biometric monitoring • Order RightSource refills at the click of a button
Questions • How will this medication help me? • How long should I stay on this medicine? • Is there anything I shouldn’t take while I’m on this medication? • What side effects can I expect? • Is there a generic available?
