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December 15, 2020

To improve member experience, operational excellence and overall affordability, we will transition our preferred specialty and home delivery vendors away from AllianceRx Walgreens Prime. Our PBM, Prime Therapeutics, has signed an agreement with Express Scripts International (ESI) to provide specialty and home delivery pharmacy network options through Accredo and Express Scripts Pharmacy®, respectively. Accredo is a wholly owned subsidiary of ESI. This agreement does not change our relationship with Prime as our PBM.

These changes apply only to specialty and home delivery pharmacy services. They take effect April 1, 2021, and apply to all groups in lines of business that have Specialty Select (except Medicare plans). Express Scripts Pharmacy and Accredo will be in-network for members of Medicare plans. These members will retain the option to change their pharmacy; however, we will not automatically transfer their prescriptions. Our retail network will remain the same.

Key changes you should be aware of:

Specialty drugs: Effective April 1, 2021, Accredo will be our preferred specialty pharmacy. Members of plans that have Specialty Select (specialty force-fill list) must fill their specialty drugs at Accredo to be covered by the health plan. About 1,000 health plan members (excluding Medicare) will be transitioned to Accredo. The implementation and transition will be carefully orchestrated between us, AllianceRx Walgreens Prime and Accredo to ensure each member’s treatment is not interrupted.

Home delivery: Effective April 1, 2021, Express Scripts Pharmacy will be our preferred home delivery pharmacy. Express Scripts Pharmacy has been serving members with prescription delivery for more than 30 years, with multiple locations across the United States, allowing prescriptions to be routed for fast processing and dispensing. About 2,000 members currently use AllianceRx Walgreens Prime home delivery. Members will receive notice of the change by late February with instructions on how to register with Express Scripts Pharmacy.

The coming new year gives us the opportunity to review our formulary and ensure we offer our members the highest-quality, best-value medication options. Formulary changes that positively affect our members or employer groups are made throughout the year. Our annual review is a more comprehensive evaluation to align our formulary with market changes, new products and regulatory requirements.

In 2021, formulary updates will include cost-share and tier changes, new pre-authorization requirements and exclusions for certain drugs. Changes that will lower costs and improve access for members include moving drugs to lower-cost tiers and adding medications to the Optimum Value List (OVL) for common conditions, such as asthma, seizures and mental health.

In early November, we notified by mail members directly affected by these changes. Our letters always include options available to members and contact information if they have any questions.

A few changes of note are listed below:

• We’re limiting coverage of prenatal vitamins to those under $25. Expensive new-to-market prenatal vitamins provide no additional benefit to our members.
• We’re adding pre-authorization to ProAir brand (to prefer generic albuterol inhalers) and removing ProAir from the OVL. Generic albuterol inhalers will remain on the OVL and offer a better value to our members.
• We’re adding generic Truvada to PPACA coverage and removing the brand version.

• We’re moving Synthroid to a non-preferred brand tier. Options include comparable generic thyroid products.

Amazon’s recently announced Amazon Pharmacy will function as a mail-order pharmacy. It’s considered an in-network option for our health plan members, following members’ retail benefits. It’s preferred for Medicare members who have the retail preferred network.

The company says Amazon Prime members will be able to save money on medications and benefit from free two-day delivery on generic and brand drugs. Amazon Prime customers can also get a prescription savings card to use at up to 50,000 pharmacies including CVS, Walmart, Rite Aid, and Walgreens in case they can’t wait two days for medication delivery.

If you have any questions about these changes, please contact your account executive.