Switching from CIGNA/Express Scripts, Inc. to Empire BCBS/Caremark:

What You Need To Know

 

Q:        When will I receive more detailed information about the change in vendors from CIGNA/Express Scripts to Empire Blue Cross Blue Shield (BCBS)/Caremark?

A:         On 11/7/05 , the NYS Department of Civil Service began mailing an Empire Plan Special Report announcing the change in vendor and explaining its effect on enrollees.  The 2006 Empire Plan Preferred Drug List was included in the Report.  This Report should answer most of your questions regarding the change in vendors.

Q:        On what date will Empire BCBS/Caremark replace CIGNA/ESI?

A:         January 1, 2006

Q:        Will there be any change to the copayments for prescription drugs?

A:         No.  The 3-tier copayment design will remain the same, as shown below. 

Drug Category

30 Days Supply Retail Pharmacy or Mail Order

31-90 Days Supply  Mail Order

31-90 Days Supply Retail Pharmacy

Generic

$5

$5

$10

Preferred

$15

$20

$30

Non-preferred

$30

$55

$60

Q:        Will I receive a new Empire Plan identification card or Empire BCBS/Caremark identification card to use at a retail pharmacy?

A:         No. Enrollees should continue to use the card with the alternate identification number sent to them earlier this year.  The Empire Plan Special Report announcing the change in vendor will include additional information you should bring with you the first time you go to a retail pharmacy on or after 1/1/06 .

Q:        Will I still be able to use the local, retail pharmacy I have been using?

A:         Empire BCBS/Caremark is currently contracting with both chain and independent pharmacies to participate in the Empire Plan pharmacy network.  They expect to contract with most of the retail chain pharmacies and independent pharmacies currently in the Empire Plan pharmacy network.  If they are unable to reach an agreement with the local, retail pharmacy you currently use, you would still be able to use the pharmacy but your benefits would be significantly reduced.

Q:         I am currently using the Express Scripts mail service pharmacy.  What will I need to do in order to use the Caremark mail service pharmacy?

A:         Beginning on December 28, 2005 , you should send new prescriptions to Caremark, P.O. Box 3223 , ilkes-Barre , PA 18773-3223 .  If you have refills remaining on prescriptions sent to the Express Scripts mail service pharmacy, you will not have to get a new prescription unless it is for a compound drug (medications prepared by a pharmacist) or a controlled substance (such as sedatives, sleeping pills, narcotics or pain-control medications).  Except for compound drugs and controlled substances, all other prescriptions will be transferred to the Caremark mail service pharmacy.

Q:        Is the list of preferred drugs going to change?

A:         Empire Plan enrollees should be prepared for changes to the Preferred Drug List (PDL) every January 1st regardless of the vendor administering the Prescription Drug Program.  Even if Express Scripts had remained the vendor, there would have been changes to the PDL.  For example, Express Scripts is removing Lipitor, a popular drug used to treat high cholesterol, from its preferred drug list on 1/1/06 .  A condensed version of the PDL with the most commonly prescribed drugs was included in the Empire Plan Special Report sent to enrollees in early November 2005.  This condensed list will be posted on the PEF web site as soon as it is available.

Q:        Will I be notified if I am currently using a brand name drug that will not be on the 2006 Empire Plan Preferred Drug List?

A:         Enrollees using drugs that will become non-preferred brand name drugs as of 1/1/06 will receive a letter in the mail identifying lower cost alternatives.

Q:        Express Scripts approved my appeal of the Mandatory Generic Substitution requirement so that I donít have to pay the difference in cost between my brand-name drug and its generic equivalent. ill I have to submit another appeal to Empire BCBS/Caremark?

A:         If Express Scripts waived the generic substitution requirement for a specific prescription you are using, you will not need to re-appeal through Empire BCBS/Caremark until the date the waiver expires.

Q:        One of the drugs I use requires Prior Authorization.  Express Scripts authorized benefits for this drug through a date in year 2006.  W ill I have to request Prior Authorization from Empire BCBS/Caremark now that the vendor is changing?

A:         The Prior Authorization will continue to be valid until the date it expires.

Q:        What number should I call if I have a question about my medication?

A:         You should first call 1-877-7NYSHIP and select the prompt for the Prescription Drug Program.  W hen you press this prompt you will be given the option of speaking to the current vendor, Express Scripts, or the new vendor, Caremark.  Itís important that you listen to the message carefully before making your choice.  For information regarding your 2005 prescription drug coverage, the current PDL, or if you want to order a refill of a prescription before 12/28/05, you should select prompt #1 to be connected to Express Scripts.  If you want to know if a drug is on the 2006 Empire Plan PDL or you have questions regarding ordering prescriptions from the Mail Service Pharmacy after 12/28/05 , you should select prompt #2 to be connected to Caremark.

Q:        How soon can I send my prescriptions to the Caremark Mail Service pharmacy?

A:         Since the Caremark Mail Service pharmacy will not become the Empire Plan Mail Service pharmacy until 1/1/06 , you should not begin sending your prescriptions to Caremark until 12/28/05 .

Q:        I currently use a credit card to pay for my mail order prescriptions. Will my payment information be transferred to Caremark?

A:         No, you will need to make a payment arrangement with Caremark the first time you use their mail service pharmacy. If you are currently using the Empire Planís Mail Service pharmacy, you will receive additional information about using the Caremark Mail Service pharmacy before 1/1/06 .

11/14/05