Human Resources
Prescription Drugs
Across the nation, health care costs continue on a steady incline, in part due to the steadily rising costs of prescription drugs. Advancements in healthcare may improve your quality of life; however, they also have a direct impact on your out-of-pocket expenses. The following information and resources are presented to assist you in making informed healthcare decisions about prescription drugs.
Employee Prescription Drug Benefits
| All of the State of Iowa's health plans provide prescription drug coverage. All of the plans, except Deductible 3 Plus, provide benefits through a three-tier program and include a mail order option. More information about the State of Iowa's health plan prescription drug benefits can be found at DAS benefits prescription drug Web site. |
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Generic Prescription Drugs
| One of the ways you can save money is choosing generic. Generic drugs can be as effective as brand-name drugs, and they cost less. Generic drugs are held to the same Food and Drug Administration (FDA) standards for safety and performance as brand-name drugs. |
Wellmark has developed information on why why you should ask your physician about generic prescription drugs. Also, Wellmark has prepared the following frequently asked questions and answers on the differences between brand name and generic prescription drugs.
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$4 Generic Prescription Drugs
Many pharmacies now offer $4 generic prescriptionsSome large retail chain pharmacies are now offering their customers a variety of generic prescriptions for only $4 per prescription. State of Iowa employees/retirees can also use these programs. Always show your Wellmark ID card at the pharmacy; if your prescription is a generic listed on the pharmacy’s $4 list, you will only be charged $4 even if your copay should be $5. |
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he $4 copay will go towards your prescription drugs out-of-pocket for Program 3 Plus and Iowa Select or the medical out-of-pocket in the case of Deductible 3 Plus.
Learn more about $4 generic prescription drugs.
Here are some companies that offer $4 generic prescription drugs |
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Mail Order Prescription
All of the State of Iowa's health insurance plans, EXCEPT for Deductible 3 Plus, offer a mail order prescription drug benefit.
The mail order drug benefit allows you to order maintenance prescriptions drugs through the mail. You can receive a 90-day supply for just the cost of two copays instead of the 30-day supply and three copays that you would receive by ordering the prescription from a retail site.
The advantages of ordering prescription drugs through the mail are:
- Saving the cost of a copay
- Convenience of the prescription drug mailed to your home
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Walgreens Mail Service is Wellmark's mail order provider. To start using mail order, you will need to print the mail order form. Information and the mail order form can be found at Wellmark's Web site. Once registered, visit the Walgreens Mail Order Service Web site to refill mail service prescriptions online and to determine when your prescriptions have been shipped. |
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Vaccines at the Pharmacy
You now have the convenience of going to a pharmacy to receive certain vaccines as part of your pharmacy benefits. Wellmark Blue Cross and Blue Shield now provides pharmacy benefits when you receive certain vaccines at the pharmacy. (Vaccines at the pharmacy benefit does not apply to employees enrolled in the State Police Officers Council (SPOC) Alliance Select plan.)
The vaccines that can be administered at the pharmacy and be covered by Wellmark are:
| Diphtheria, Tetanus, Pertussis (DT&P) Haemophilus influenzae type b (Hib) Hepatitis A (HepA) Hepatitis B (HepB) Human Papillomavirus (HPV) Inactivated Poliovirus (IPV) Influenza Measles, Mumps, Rubella (MMR) Meningococcal (MPSV4) Pneumococcal Rotavirus (Rota) Varicella Zoster (over age 60) |
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For some vaccines, you may need a prescription from your doctor. Check with your pharmacy to determine if a prescription is needed.
Not all pharmacies provide vaccines. Only pharmacists, certified to give vaccines, can offer this service. Wellmark has a list of pharmacies that participate in the vaccine program. Also, the hours that vaccines are available may be different than the normal pharmacy operating hours. If your pharmacy is on the list of participating pharmacies, check with your pharmacy regarding the hours the service is available. If your pharmacy is not listed, let them know you are interested in this service.
You can still go to your doctor’s office to receive a vaccine.
Your cost share will be different depending on where you receive the vaccine. Your health benefit will apply if you receive the vaccine in your doctor’s office. If you receive the vaccine at a pharmacy, your cost share will be equal to the preferred brand name drug cost.
If you use a pharmacy that belongs to the Wellmark network, your claim will be filed electronically. If you use a pharmacy that does not belong to the Wellmark network, you will have to pay for the entire cost of the vaccine, submit a paper claim and wait for reimbursement.
The DAS group insurance staff prepared a benefit news with additional information on receiving vaccines at the pharmacy. Wellmark prepared the following frequently asked questions and answers about vaccines at the pharmacy.
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Specialty Prescription Drugs
Specialty drugs are high-cost, injectable, infused, oral or inhaled drugs for the ongoing treatment of a chronic condition. These drugs generally require close supervision and monitoring of the patient’s drug therapy.
Specialty drugs:
- Require special handling and administration
- Require temperature controlled shipping
- Require careful adherence to treatment protocols
- Require special monitoring or testing
- Are used for chronic illness or rare medical condition
- Are high-priced drugs ($1,500 -- $100,000 annually)
Effective January 1, 2009, self-administered specialty drugs will be covered under the prescription drug plan instead of the health plan. This new benefit design will apply to all Wellmark plans offered except Deductible 3 Plus. (This self-administered specialty drugs change does not apply to employees enrolled in the State Police Officers Council (SPOC) Alliance Select plan.)
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There are approximately 70 drugs that Wellmark has identified as self-administered specialty drugs. The Wellmark Specialty Drug List is available on Wellmark's Web site. Also, you can contact Wellmark’s customer service about specialty drugs. Wellmark’s customer service phone numbers are listed above. |
Specialty drugs on the list under the “Self Administered” category will only be available at the pharmacy as a pharmacy benefit. Drugs on the list under “Self and/or Office Administered” category will be available either at the doctor’s office (where they will be processed as a health benefit) or at the pharmacy (where they will processed as a drug benefit.) Finally, specialty drugs on the list under the “Office Administered” category will be only available at the doctor’s office and will be processed as a health benefit.
Depending on the specialty drug, your cost share will be either the copay of the preferred brand name drug (tier 2) or the non-preferred brand name drug (tier 3). The following are the prescription drug copays or coinsurance amounts for the Wellmark plans affected by this benefit design change. The majority of self-administered specialty drugs are on the non-preferred brand name drug (tier 3).
Wellmark Plan |
Tier 2 Preferred Brand Name Drug |
Tier 3 Non-Preferred Brand Name Drug |
| Blue Access | $15 copay |
$30 copay* |
| Blue Advantage | $15 copay |
$30 copay* |
| Iowa Select | $15 copay if you have not reached your maximum out-of-pocket | $30 copay if you have not reached your maximum out-of-pocket |
| Program 3 Plus | $15 copay if you have not reached your maximum out-of-pocket | $30 copay if you have not reached your maximum out-of-pocket |
* For Blue Access or Blue Advantage, the cost share for non-preferred brand name self-administered specialty drugs is only the $30 copay. The coinsurance of 25% does not apply to self-administered specialty drugs. The lack of coinsurance only applies to self-administered specialty drugs. It does not affect other drugs at the 3rd tier.
If you receive a self-administered specialty drug from a doctor or other health care provider, the claim under the health plan will be denied and you will be responsible for the cost of the drug. The doctor’s office cannot file a pharmacy claim.
Self-administered specialty drugs cannot be ordered through mail order and the drugs are limited to a 30-day supply.
Caremark Specialty Pharmacy
In addition to a retail pharmacy, you can choose to receive self-administered specialty drugs through Caremark Specialty Pharmacy. The Caremark Specialty Pharmacy is a full-service specialty pharmacy dedicated to servicing individuals using specialty drugs through mail.
By using Caremark Specialty Pharmacy for your specialty drugs, you will receive the following value-added services at no extra cost:
- Education and wellness programs that provide information, materials, and ongoing support to help you manage your health
- Complete insurance billing, including coordination of benefits for lower out-of-pocket costs, and virtually no paperwork
- Timely, accurate and free courier delivery of medications, often with next day delivery
- Supplies, including syringes, alcohol swabs, and sharps kits, if required
Getting started with Caremark Specialty Pharmacy services is easy with two simple options:
- Call CaremarkConnect at 1-800-237-2767 and identify yourself as a Wellmark Blue Cross and Blue Shield member. Hours are Monday through Friday, 6:30 a.m. – 8 p.m. CST. A representative will collect your information and contact your physician to obtain a new prescription.
- Ask your provider to fax a completed CaremarkConnect enrollment form to 1-800-323-2445. (A CaremarkConnect enrollment form can be found at the Wellmark Web site.) A CaremarkConnect representative will then contact you to obtain any information needed to complete the ordering process.
Specialty Drugs Frequently Asked Questions
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Additional Pharmacy Information
You can register at Wellmark's Web site and register at myhealth@wellmark to use their BlueConnection Pharmacy Tools. This allows you 24/7 access to your pharmacy information.Additional information on prescription drugs can be found at the Wellmark Web site.
Wellmark's Formulary
Medication Adherence Card (printable card to list all the prescriptions you are taking)
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The Consumer Report Best Buys Drug Web site can provide you:
- Free, unbiased analysis of the prescription drugs you take each day.
- Recommended Best Buys that could save you thousands of dollars a year.
- Detailed reports to help you and your doctor discuss which medicines are right for you.
Additional Information from Consumer Reports Best Buy Drugs.
Holiday Heartburn (10/30/09)
Off-Label Drug Use ( 09/29/2009)
Consumer Drug Alert: Avoid weight-loss drugs Alli and Xenical (Orlistant) (09/02/09) Antipsychotics to Treat Schizophrenia (09/02/09)
Antidepressants: Effective for Some, Side Effects for Many (07/2009)
Parents: Don't Rush to Adderall XR, Concerta, Strattera (07/2009)
Keep High Blood Pressure Well-Controlled with Low-Cost Generics (06/2009)
Enlarges Prostate Best Treated with Older Generic Drug (04/2009)
Diabetes Type 2 Patients: Save hundreds of dollars by using Best Buy selections (02/2009)
Menopause: New Advise on Hormone Treatments
Medicines Older Adults May Want to Avoid
Insomnia Report (08/2008)
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Questions
For questions regarding Blue Access's or Blue Advantage's prescription drug benefits, call Wellmark's customer service at 800-553-7801.
For questions regarding Deductible 3 Plus', Iowa Select's or Program 3 Plus' prescription drug benefits, call Wellmark's customer service at 800-622-0043.
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Site updated 11/13/2009