As a result of a recent, comprehensive Request for Proposal (RFP) process, our pharmacy benefits manager (PBM) will be changing from Express Scripts, Inc. (ESI) to ProAct effective October 4, 2016.
ProAct is a New York-based, employee-owned company which provides PBM services to a number of other public sector employers, including the City of Schenectady. An added feature of their program is a collaborative arrangement with CanaRx that integrates claims data for patient safety while maximizing both member and County savings.
Your plan design will not change; however, some aspects of your drug benefit administration may change:
• Domestic Mail Order Service Pharmacy (for long-term medications)
For domestic mail order claims (i.e., maintenance medications that are not available through CanaRx), you’ll now use the ProAct Mail Service pharmacy to fill your long-term prescriptions.
If you currently have mail order prescriptions on file with ESI and those prescriptions have refills remaining (aka "open refills"), information about those scripts will be transferred electronically to the ProAct Mail Service pharmacy.
Under existing New York State law, only one refill per medication can be filled by ProAct Mail Service pharmacy, even if you have more than one refill remaining on that medication(s). Under that same law, that one refill per medication cannot be dispensed automatically by ProAct Mail. You will need to contact ProAct Mail and request your refill(s). When you contact ProAct Mail to request your refill(s), they will also verify your address and contact information and ask you to provide a method of payment (e.g., credit card information). For security reasons, the payment information that is on file with ESI are not transferred to ProAct Mail Pharmacy Services. Please allow adequate time for the processing of the refill(s) to ensure you receive it in time.
Once you have established your account with ProAct Mail, the refill process will be much easier in the future -- ProAct will be able to communicate directly with your prescribing physician(s) for future refill requests.
• Local Pharmacy Option (retail network)
The ProAct national network includes more than 67,000 pharmacies nationwide, including all major chains and 20,000 independents, including many locally-owned pharmacies. If you and/or any of your family members have used a non-participating pharmacy, you will receive a detailed, personalized letter from ProAct in mid-September.
Information about your existing retail scripts will not be transferred from ESI to ProAct. However, if you have open refills at a retail pharmacy that is in the ProAct pharmacy network, you will not need to get a new prescription. All you have to do is show the pharmacy your new ProAct ID card.
• Domestic Formulary (scripts filled at retail pharmacies and ProAct Mail services)
ESI and ProAct have different formularies. As a result, a limited number of brand name drugs may change copay tiers (for those in the 3-tier copay plan, aka "Schenectady Meds 2"), or coverage. If you and/or any of your family members are impacted by the change in formularies, you will receive a personalized letter from ProAct explaining your options.
You can review the ProAct formulary now at www.proactrx.com, by going to the website and registering. The formulary will be under the "Forms to Print" section. Copies of the formulary will also be available at the upcoming informational meetings (see below for schedule).
• CanaRx Formulary
Effective October 4th, we’ll also be changing the CanaRx formulary. Starting on Tuesday, September 20th, you’ll be able to view the new formulary on the CanaRx website (www.SchenectadyMeds.com/New), and copies will be available at the informational meetings.
• Specialty Drugs
These are medications designed for individuals with rare, complex or genetic conditions. Effective October 4th, these medications can be ordered through Noble Health Services, a fully-owned subsidiary of ProAct. If you and/or any of your covered family members are currently taking a specialty medication, you will receive further information about Noble Health Services, and a specialty drug list, in mid-September.
In addition to the member-specific Formulary and Specialty letters described earlier, ProAct will be also sending welcome letters and ID cards in mid-September.