Division of Retirem ent and Benefits Retire Public Employee - PowerPoint PPT Presentation

Alaska Departm ent of Adm inistration Division of Retirem ent and Benefits Retire Public Employee Association South Central Chapter December 11, 2018

What is AlaskaCare? • AlaskaCare is a term used to describe the State of Alaska self-insured health plans managed by the Division of Retirement & Benefits. o AlaskaCare Retiree Plans including:  Defined Benefit Medical and Pharmacy Plan  Defined Contribution Retiree Medical and Pharmacy Plan  Dental, Vision, and Audio Plan  Long Term Care Plan (not referred to as AlaskaCare) Division of Retirement and Benefits 2

Key Staff • John Quick - Commissioner • Ajay Desai – Director: – Michele Michaud – Chief Health Official – Emily Ricci – Chief Health Policy Administrator – Kathy Lea – Chief Pension Officer – Vacant – Chief Financial Officer Division of Retirement and Benefits 3

Retiree Health Plan Advisory Board • Created in 2017 through Administrative Order • Purpose to facilitate policy engagement & coordination with retirement system members • Seven-member board includes: Judy Salo (chair), Cammie Taylor, Mauri Long, Nan Thompson, Gayle Harbo, Dallas Hargrave, Joelle Hall, and John Quick (non-voting) • All meetings available online at alaskacare.gov 4

Contracting & Procurements • Division hires contractors to administer claims, also known as Third Party Administrator (TPA) • For pharmacy benefits, they are called Pharmacy Benefit Managers (PBM) • Division competitively procured and awarded PBM contract to OptumRx beginning 1/1/2019 • Medical, dental, & vision contract being procured now to take effect 1/1/2020. 5

EGWP • Division also implementing an enhanced Medicare Part D Employer Group Waiver Plan (EGWP). • Administrative change to increase federal subsidies without changes to benefits. • Estimated $20 million in savings to health trust and reduction in unfunded liability and associated state payments. • Analysis documents available online at AlaskaCare.gov through retiree advisory board 6

AlaskaCare enhanced EGWP • Only applies to Medicare eligible members. • Members will be enrolled automatically. • Will still cover same medications today at same cost through a supplemental benefit called a wrap. • May require prior authorization to determine if covered by Medicare Part B, Part D, or wrap. • No step therapy. 7

What this means for members Beginning January 1, 2019 members will transition to OptumRx and the AlaskaCare enhanced EGWP will be implemented. LOTS OF COMMUNICATIONS! 8

Transition Information • Aetna CVS/Caremark is the current PBM. • OptumRx will be the new PBM beginning 1/1/19 • NEW! Members will have a separate card for pharmacy (OptumRx) and medical (Aetna) • Welcome kit with new ID cards in mail last week. • OptumRx phone lines are open for members at (855) 409-6999 • You can also call the Division at (800) 821-2251 9

Find a pharmacy • Is my pharmacy in network? • Probably, but you can find out for sure by visiting the AlaskaCare-specific locator tool at: https://www.optumrx.com/oe_alskeert/phar macy-locator • You can also call OptumRx at (855) 409-6999, TTY 711 10

Mail Order FAQs • Most mail order prescriptions should transfer automatically; EXCEPT • Opioids or controlled substances cannot be transferred • Prescriptions that have no more refills will not automatically transfer • If you have questions about your prescription you can call OptumRx at (855) 409-6999 11

Specialty Medications • BriovaRx is the exclusive mail order specialty medication pharmacy for AlaskaCare members. • Prescriptions filled at other specialty pharmacies will be subject to normal retail copay. • Specialty medications will automatically transfer over to OptumRx for non-EGWP members. • EGWP members may be contacted by BriovaRx to transfer their medications. • Members can contact BriovaRX at 855-4BRIOVA 12

Open Formulary • Will my medications be covered? • If your medication is covered by the plan today, that coverage should not change. • Some medications may require prior authorization, or have quantity limits for safety. • Find out if your medication has these requirements by visiting http://doa.alaska.gov/drb/alaskacare/optumrx.html • You can also call OptumRx at (855) 409-6999 13

Prior Authorizations • Most members will not require prior authorizations for medications. • Two types of prior authorizations required for the AlaskaCare enhanced EGWP: – Will the medications be paid by Part B or Part D? – Will the medications be paid by Medicare or the wrap? • The formulary is available online to check. • Typical prior authorizations returned in 72 hours; expedited in 24. 14

EGWP Enrollment • Medicare eligible retirees and Medicare eligible dependents will be automatically enrolled by OptumRx. • Enrollment and opt-out are handled by OptumRx subcontractor, Convey, based in Sunrise, Florida. • Convey has separate call number (855) 235-1405. All other inquires should be directed to the AlaskaCare dedicated contact center in Salem, Oregon at (855) 409-6999. 15

Opt-Out • The Division is required to provide members the option to opt-out of the AlaskaCare enhanced EGWP. • Members have received a letter from OptumRx dated November 15th, stating they have 21 days to opt-out. • This is not a hard deadline. Members can opt-out at any time. • If you opt out of the enhanced EGWP you will be enrolled in a plan that is much different than the benefits offered today. 16

Opt-Out Plan Standard Plan Opt-Out Plan Days Supply at retail Up to 90-day for single copay Copay for each 30 days at retail (can still refill up to 90-day supply at one time) Days Supply at mail order Up to 90-day supply Up to 90-day supply Formulary Open 3-tier formulary: generic, preferred brand, non- preferred brand Mail order $0 copay for all medications $20 for generic, $50 for preferred brand name and $100 for non-preferred brand name medications Network retail $4 for generic, $8 for brand name Generic member pays 20% with minimum of medications $10/maximum of $50 Preferred brand name member pays 25% with minimum of $25/maximum of $75 Non-preferred brand name member pays 35% with minimum of $80/maximum of $150 Out of Network Same as in network Member responsible for 40% of the cost Out-of-Pocket Annual Not applicable $1,000 individual, $2,000 family Limit Coordination of Benefits Coordinates to provide up to Does not coordinate 100% coverage 17

IRMAA • Just like Medicare Part B, the Centers for Medicare & Medicaid Services (CMS) does require a premium payment of high-income individuals who are eligible for Medicare. • Applies to those with household income of $85,000/individual or $170,000/family. • You should receive a letter from Social Security. • Send a copy of the letter to the Division, and you will be reimbursed for the surcharge through a Health Reimbursement Arrangement. 18

Multiple EGWP Plans • You cannot be enrolled in more than one EGWP plan at a time. • If you are already covered under an EGWP through a non-AlaskaCare plan, please contact the Division to be dis-enrolled from the AlaskaCare EGWP. • You will receive a letter from AlaskaCare confirming that you have been removed that you can share with your other health plan. 19

EGWP & Medicare Advantage • You cannot be enrolled in a Medicare Advantage plan that has prescription drug coverage and a separate EGWP plan at the same time. • We anticipate that this situation will be rare, but if you are covered under a Medicare Advantage plan with prescription drug coverage, please provide the Division with a letter or copy of your Medicare Advantage card and we will disenroll you from the AlaskaCare EGWP. 20

EGWP Odds and Ends • LEP – Late Enrollment Penalty may apply to individuals who did not sign up for Medicare when they first became eligible. The Division will pay this on behalf of members. • LIS – Low Income Subsidy typically offers subsidies to Medicare eligible members. • Evidence of Coverage –letters that are required by Medicare to be distributed to EGWP members. • Donut hole, catastrophic coverage, initial coverage stage - are all terms for different stages of Medicare coverage that are not applicable for AlaskaCare members since they have enhanced benefits. 21

EGWP Odds and Ends • Foreign Travel – Prescriptions filled outside the United States will be covered under the wrap benefits. • Vacation overrides – members will still be able to receive vacation maximum refill overrides. • Federal Blue Cross/Blue Shield plan will move to secondary payer with AlaskaCare EGWP primary 22

Resources OptumRx Pharmacy Questions Division of Retirement & Benefits Phone: (855) 409-6999, TTY 711 Phone: (800) 821-2251 Email: doa.drb.benefits@alaska.gov Website: www.AlaskaCare.gov 23

Stay Informed! • Sign up for our new e-newsletter at http://doa.alaska.gov/drb/index.html 24

Call us out! • Join us every month our telephonic town hall and ask us your questions live! • NEXT TOWNHALL- Thursday, December 20 at 10:00am • Register at: https://vekeo.com/event/alaskacare- town-hall-43334/ • Listen to past townhalls at http://doa.alaska.gov/drb/headlines/2018/08/eqwp- tele-town-hall/#.XA2yU2hKhPY 25