As of September 1, 2009, Oxford and UnitedHealthcare pharmacy benefit coverage will be updated.

WHAT THIS MEANS TO YOU AS AN EMPLOYER?
It is important to understand any new changes that affect your current pharmacy benefit coverage in order to effectively communicate this to your employees. Please make sure to review your plan as some prescription drugs may have changed tiers.

A summary of the tier structure is listed below.

Tier 1 – Your Lowest-Cost Option
This is the lowest co-payment option. For the lowest out-of-pocket expense, one should always consider Tier 1 medications when it is decided by the individual and his or her physician that it is right for his or her treatment.

Tier 2 – Your Midrange-Cost Option
This is the middle co-payment option. Tier 2 medications should be considered when an individual and his or her physician decide that a Tier 2 medication is right for his or her treatment.

Tier 3 – Your Highest-Cost Option
This is the highest co-payment option. Sometimes there are alternatives available in Tier 1 or Tier 2 that may be appropriate to treat a condition. If one is currently taking a medication in Tier 3, they can ask his or her doctor whether there are Tier 1 or Tier 2 alternatives that may be right for his or her treatment. Compounded medications, medications with one or more ingredients that are prepared “on-site” by a pharmacist, are classified at the Tier 3 level.

Please note: Some plans have a two-tier pharmacy benefit rather than a three-tier pharmacy benefit. Generally, a two-tier closed pharmacy benefit plan does not cover medications classified in Tier 3 of this PDL. A two-tier open pharmacy benefit plan covers one tier at the lower co-payment and covers a second tier at a higher co-payment. In addition, some plans have a four-tier prescription plan.

WHAT SHOULD I DO NEXT?
Please communicate this important information to your enrolled employees. For more information, CLICK HERE for the 2009 Three-Tier Prescription Drug List Reference Guide.

If you have any additional questions regarding the information within this eCommunication, please contact Corporate Synergies at 1.866.CSG.1719 or click here to contact us today.