Some non-Medicare-eligible retirees will receive letters from OptumRx that were sent in error.

These letters indicate that:

• members will pay more for their medication;
• that quantity limits apply to their prescription; or
• that their medication requires prior authorization to determine if it will be covered under the plan.

These letters contain incorrect information. The retiree prescription drug benefits are not changing.

Beginning January 1, 2019, OptumRx will process AlaskaCare pharmacy claims, but you will continue to get the same medication you do today, for the same copays that you pay today.

If you have received a letter that contains one of the below statements, please disregard. These letters do not apply to the AlaskaCare retiree prescription drug plan.

• Beginning January 1, 2019, you will pay more for the medication(s) below.
  • This is inaccurate. You will continue to receive medications for $0, $4, and $8 copayments.
• Beginning January 1, 2019, you will need prior authorization (PA) for the medication listed below.
  • This is inaccurate for most members. Some Medicare-eligible members may require prior authorization to determine if their medication will be paid by the EGWP or the wrap benefit; however, the letters sent erroneously by OptumRx reference additional prior authorization or quantity limits that do not apply to the AlaskaCare retiree health plan. If you have questions about your prescriptions, you can call OptumRx toll-free at (855) 409-6999, TTY 711.
• Beginning January 1, 2019, there will be a new limit to the quantity or supply limit of the medication listed below that will be covered.
  • This is inaccurate for most members. Some Medicare-eligible members may require prior authorization to determine if their medication will be paid by the EGWP or the wrap benefit; however, the letters sent erroneously by OptumRx reference additional prior authorization or quantity limits that do not apply to the AlaskaCare retiree health plan. If you have questions about your prescriptions, you can call OptumRx toll-free at (855) 409-6999, TTY 711.
• Beginning January 1, 2019, prior authorization will be required for your medication to ensure appropriate use. Your doctor will also need to submit a request to OptumRx for any quantity of the medication that exceeds a set quantity limit.
  • This is inaccurate for most members. Some Medicare-eligible members may require prior authorization to determine if their medication will be paid by the EGWP or the wrap benefit; however, the letters sent erroneously by OptumRx reference additional prior authorization or quantity limits that do not apply to the AlaskaCare retiree health plan. If you have questions about your prescriptions, you can call OptumRx toll-free at (855) 409-6999, TTY 711.

OptumRx will send out a corrective notice to affected individuals. We apologize for any confusion this may cause.

Beginning January 1, 2019, OptumRx will become the Pharmacy Benefits Manager (PBM) for all AlaskaCare plans. OptumRx will manage the pharmacy benefit for our members, including retail, mail order and specialty prescription drugs, claims processing, and prior authorization requests for prescription medications. Currently these claims are processed by Aetna and CVS/Caremark. This does not impact medical, vision, or dental benefits. Those will continue to be administered by Aetna and Moda, respectively.

New Pharmacy Benefit Manager, Same Benefits

Your pharmacy benefits, including copays and covered medications, will remain the same, but you may notice some small administrative changes, including the list of medications requiring prior authorization. The Division is working to ensure members will be contacted ahead of time if they are impacted by these changes, but members can look up their medication online any time on our OptumRx information web page, or call OptumRx toll-free at (855) 409-6999, TTY 711.

Important Information and ID Cards Are Available in Your Welcome Kit

AlaskaCare members received information in the mail in October (specifically, in the Fall 2018 HealthMatters newsletter) about this transition. Members were also mailed a welcome kit from OptumRx this month, including new ID cards, and everything you need to know about your pharmacy plan. If you have not received your welcome kit and new ID card by January 1, please contact OptumRx toll-free at (855) 409-6999, TTY 711.

Do You Have Questions? Check Out Our FAQs to Help You Navigate This Transition!

As we shared in previous newsletters, we know you will have questions about this transition and may need to take action regarding your current prescriptions. The OptumRx concierge service can help with your individual account needs and make sure you are ready for the transition on January 1, 2019. You can reach OptumRx Member Services at (855) 409-6999. Representatives are available from 8 a.m. to 8 p.m. Alaska time until December 31, 2018. After January 1, 2019, OptumRx member services will be open 24 hours a day, 7 days a week.

• OptumRx Transition Frequently Asked Questions
• Enhanced Employer Group Waiver Plan (EGWP) Frequently Asked Questions

We are updating the FAQs regularly, please keep checking back for new information! Here are some recent additions:

What if I or my spouse are currently enrolled in a Medicare Advantage plan?

You cannot be enrolled in Medicare Advantage plan that includes 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 that includes 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. If you are disenrolled from the AlaskaCare EGWP, you will continue to receive pharmacy benefits through the standard AlaskaCare pharmacy benefit

Can I opt-out of the pharmacy benefit transition to OptumRx and stay with Aetna?

You cannot opt-out of the transition from Aetna to OptumRx for pharmacy claims administration. All AlaskaCare members are making that transition effective January 1, 2019.

Why did I receive more than one ID card with different ID numbers?

Please find the scenario that best describes you:

I am covered under a single AlaskaCare plan, and…

• I am a retiree that is not eligible for Medicare:

ID cards are issued in packs of two to retirees that are not eligible for Medicare. If you have an eligible dependent, you can share the extra card with your dependent. If you have more than one eligible dependent, you can request additional cards through OptumRx at (855) 409-6999. Starting January 1, 2019, you can also print a temporary card from the OptumRx portal, or use the OptumRx mobile app.

• I am a Medicare-eligible retiree who is not covered under the enhanced Employer Group Waiver Program (EGWP):

ID cards are issued in packs of two to retirees that are not enrolled in the AlaskaCare enhanced Employer Group Waiver Program (EGWP). If you have an eligible dependent, you can share the extra card with your dependent. If you have more than one eligible dependent, you can request additional cards through OptumRx at (855) 409-6999. Starting January 1, 2019, you can also print a temporary card from the OptumRx portal, or use the OptumRx mobile app.

• I am a retiree covered under the enhanced Employer Group Waiver Program (EGWP):

You should have received only a single ID card with the MedicareRx logo in the lower right corner (see example below). Please contact the Division or OptumRx for additional information on why you may have received a second card.

I am covered under my own plan and under my spouse’s AlaskaCare plan and…

• Both my spouse and I are either an active employee or a retiree not yet eligible for Medicare:

You will both receive a two-pack of ID cards with your own name and ID number. You may share one copy of your ID card with your spouse, however, you or your dependents only need to present one of these ID cards to the pharmacy. OptumRx coordinates your coverage behind the scenes.

• Both my spouse and I are retirees and eligible for Medicare:

If you are both eligible for Medicare and are enrolled in the enhanced Employer Group Waiver Program (EGWP), you should each receive a single ID card that has the MedicareRx logo in the lower right (see example below). Each card will have an individual name and ID number. Although you receive only one card, when you present the card at the pharmacy you will receive the benefit of your double coverage under the plan. This means you will not be required to pay a copay at the pharmacy counter.

• One of us is a Medicare-eligible retiree enrolled in the enhanced Employer Group Waiver Program (EGWP) and the other is either an active employee or a retiree not enrolled in EGWP:

The retiree who is Medicare-eligible and is enrolled in the enhanced Employer Group Waiver Program (EGWP) will receive a single ID card that has the MedicareRx logo in the lower right (see example below). The card will have their individual name and ID number. Although they receive only one card, when they present the card at the pharmacy, they will receive the benefit of having double coverage under the plan. This means they will not be required to pay a copay at the pharmacy counter.

The spouse who is not enrolled in the EGWP will receive an ID card two-pack in their own name for each layer of coverage they have (their own coverage and their dependent coverage as the spouse of a Medicare-eligible retiree). The only difference between the two packs of ID cards will be the ID number. The ID number that matches the Medicare-eligible retiree’s MedicareRx ID card will be the dependent coverage card. However, the spouse or other non-Medicare-eligible dependents only need to present one of these ID cards to the pharmacy. OptumRx coordinates the coverage behind the scenes.

I am covered under more than one of my own AlaskaCare plans, and…

• I am eligible for Medicare:

If you are eligible for Medicare and are enrolled in the enhanced Employer Group Waiver Program (EGWP), you should receive a single ID card that has the MedicareRx logo in the lower right (see example below). Although you receive only one card, when you present the card at the pharmacy you will receive the benefit of your double coverage under the plan. This means you will not be required to pay a copay at the pharmacy counter.

• I am not eligible for Medicare:

You will receive an ID card two-pack for each layer of coverage you have. The only difference between the different packs of ID cards will be the ID number. However, you only need to present one of these ID cards to the pharmacy. OptumRx coordinates the coverage behind the scenes.

Thank you to everyone who submitted comments on the changes to the retiree health plan booklet! The new plan booklet will take effect on January 1, 2019, with the transition of the pharmacy benefit manager and adoption of the enhanced EGWP pharmacy plan for Medicare-eligible retirees and dependents.

The new booklet includes important changes that take effect on January 1, 2019, including:

• Information about pharmacy benefits have changed to reflect implementation of an enhanced EGWP for Medicare-eligible retirees and Medicare-eligible dependents.
• The AlaskaCare enhanced EGWP is a Medicare Part D group pharmacy plan and represents an administrative change to how the health plan receives federal subsidies for Medicare-eligible retirees and dependents. Read more about the enhanced EGWP on our EGWP FAQ web page.
• AlaskaCare is expanding habilitative services for pervasive developmental delays such as Autism Spectrum Disorder (ASD). Habilitative services can include occupational therapy, speech therapy, and other services, including early intensive behavioral interventions, such as applied behavioral analysis for treatment of ASD.
• The booklets are updated to reflect the change from Aetna/CVS Caremark to OptumRx as the pharmacy benefit manager (PBM).

The new booklet will be available on the AlaskaCare website, by January 1, 2019.