Page 8 - 2019 Fontbonne
P. 8
2019 Benefits Guide
PHARMACY
Fontbonne continues to partner with Cigna to implement strategies for
curing the rising cost of pharmacy medications. The programs below are
Mail Order intended to drive better decision making and support healthier outcomes.
Program—“3 months
for 2” Copays Essential Package
Prescription plan participants
can use the mail order program To remain good stewards of the health plan, Fontbonne is implementing
to obtain valuable savings when Cigna’s full Essential Package program. Essential Package protects the
ordering up to 90-day supplies
of maintenance medications. plan and its participants against potentially harmful, ineffective, and
Under this program, you pay an unnecessary drug treatments and rising costs. The program includes prior
amount equal to two times the authorizations, quantity limitations, and step therapy.
retail copay for a 90-day supply
of your prescription. Not all drugs z Prior Authorizations (continued for 2019): some medications
will qualify for the mail order drug
program. require prior approval before your prescription will be covered
z Quantity Limitations (continued for 2019): quantity limits
may apply to certain medications according to clinically approved
Premium HSA Plan prescribing guidelines
Plan
In-Network In-Network z Step Therapy (new for 2019): you must try a generic drug irst
Deductible, before your plan will cover certain brand drugs. Antipsychotic and
then the Antidepressant classes are grandfathered under the member’s current
following medications
copays: no
deductible on
maintenance Cigna 90 Day Now
medications
Generic $10 copay $10 copay The Cigna 90 Now Program requires you to ill maintenance medications
Preferred $40 copay $30 copay at a 90-day supply. You can ill these medications at certain Cigna retail
brand pharmacy locations or through home delivery (excludes Walgreens for
Non- $60 copay $50 copay 90-day ills). By illing at a 90-day supply, members pay the reduced
preferred 90-day supply copay rather than illing at the 30-day retail copay each
brand time. Currently, members can only ill a 90-day maintenance medication
Mail 2 times 2 times
order above above copays through home delivery.
copays for for 90-day
90-day supply
supply 30-day Supply for Specialty Medications
Note: If you purchase a prescription drug In an effort to reduce unnecessary spending and help control waste on
from a non-network pharmacy, you are costly specialty medications (which make up over 30% of Fontbonne’s
responsible for any diference between what
the non-network pharmacy charges and the overall plan cost), this program reduces the ill quantity on all specialty
amount which would have been paid for medications to a 30-day supply. A 90-day ill option will no longer be
the same prescription drug dispensed by a
network pharmacy. available.
* Impacted members will receive a letter explaining the changes and their alternatives.
8
PHARMACY
Fontbonne continues to partner with Cigna to implement strategies for
curing the rising cost of pharmacy medications. The programs below are
Mail Order intended to drive better decision making and support healthier outcomes.
Program—“3 months
for 2” Copays Essential Package
Prescription plan participants
can use the mail order program To remain good stewards of the health plan, Fontbonne is implementing
to obtain valuable savings when Cigna’s full Essential Package program. Essential Package protects the
ordering up to 90-day supplies
of maintenance medications. plan and its participants against potentially harmful, ineffective, and
Under this program, you pay an unnecessary drug treatments and rising costs. The program includes prior
amount equal to two times the authorizations, quantity limitations, and step therapy.
retail copay for a 90-day supply
of your prescription. Not all drugs z Prior Authorizations (continued for 2019): some medications
will qualify for the mail order drug
program. require prior approval before your prescription will be covered
z Quantity Limitations (continued for 2019): quantity limits
may apply to certain medications according to clinically approved
Premium HSA Plan prescribing guidelines
Plan
In-Network In-Network z Step Therapy (new for 2019): you must try a generic drug irst
Deductible, before your plan will cover certain brand drugs. Antipsychotic and
then the Antidepressant classes are grandfathered under the member’s current
following medications
copays: no
deductible on
maintenance Cigna 90 Day Now
medications
Generic $10 copay $10 copay The Cigna 90 Now Program requires you to ill maintenance medications
Preferred $40 copay $30 copay at a 90-day supply. You can ill these medications at certain Cigna retail
brand pharmacy locations or through home delivery (excludes Walgreens for
Non- $60 copay $50 copay 90-day ills). By illing at a 90-day supply, members pay the reduced
preferred 90-day supply copay rather than illing at the 30-day retail copay each
brand time. Currently, members can only ill a 90-day maintenance medication
Mail 2 times 2 times
order above above copays through home delivery.
copays for for 90-day
90-day supply
supply 30-day Supply for Specialty Medications
Note: If you purchase a prescription drug In an effort to reduce unnecessary spending and help control waste on
from a non-network pharmacy, you are costly specialty medications (which make up over 30% of Fontbonne’s
responsible for any diference between what
the non-network pharmacy charges and the overall plan cost), this program reduces the ill quantity on all specialty
amount which would have been paid for medications to a 30-day supply. A 90-day ill option will no longer be
the same prescription drug dispensed by a
network pharmacy. available.
* Impacted members will receive a letter explaining the changes and their alternatives.
8
