Quick Reminders: 1095-C and Medicare Part D Out-of-Pocket Maximum

1095-C Reminder

Form 1095-C for the 2020 tax year is available electronically in Workday at https://sso.tamus.edu.  Once in Workday, click the Benefits Worklet. Select “My ACA Forms” in the View column. Please see our ACA Help page for more information. 

Medicare Part D Out-Of-Pocket Maximum

If you are enrolled in the A&M Care 65 Plus plan and the Medicare Part D Prescription Drug plan, your out-of-pocket maximum restarted on January 1, 2021. Please contact your Benefits Office if you have any questions.

Prescription Programs and your A&M System Prescription Drug Benefits

There are many prescription programs in place to ensure you are getting the best use of your prescription benefits. Sometimes, there is a generic alternative that might save you money on your prescription, there may be a therapeutic alternative to treat the same condition for a lower cost, or manufacturers may offer rebates on certain brands.

Express Scripts and Blue Cross and Blue Shield of Texas (BCBSTX) – How They Work Together

Express Scripts administers the prescription drug part of the BCBSTX A&M Care plans. When you receive a prescription and fill it at a participating pharmacy, the pharmacy knows to bill Express Scripts when you provide your BCBS insurance card or Express Scripts ID card. The plan includes a $50-per-person annual deductible (with a 3-person maximum). This deductible applies to the first $50 in prescription drugs that each covered person buys, whether at a retail pharmacy or through mail order. After you meet the deductible, you pay the applicable copayments for any remaining eligible drug purchases through the end of the plan year. Some of the prescription programs listed below assist with the amount of those copayments.

Express Scripts has a mandatory drug substitution policy. This means, when you are prescribed a brand name drug by your physician, and a generic substitute is available, you’ll automatically be given the generic version. You may choose to request the brand-name drug, but you will pay the difference in cost between the generic and brand-name drug as well was the brand-name formulary or non-formulary copayment. If you cannot take the generic drug for a documented medical reason, your doctor can call Express Scripts to request a medical override for the brand-name drug. If this is approved, you will receive the brand-name drug and will pay only the formulary or non-formulary brand-name copayment. This must be done in advance of the prescription being ordered and filled.

Prescription Care Management (PCM)

In addition to our prescription benefit plan, the Prescription Savings Program by PCM is a program that works with employees/retirees and covered dependents, their doctors and pharmacies to save the member money on prescription drugs. PCM offers you a choice to switch from higher cost drugs to a lower cost, equally-effective therapeutic alternatives. As a plan participant, no action is required unless PCM contacts you. PCM will contact your physician first to ask if the alternative will work with your medical history and for approval to make the change. If approved, then PCM will contact you for your permission to change medications. PCM will answer your questions and take care of the work involved to change your prescription at the pharmacy. This program does not change the pharmacy benefits offered by the A&M System and administered by Express Scripts. Should you receive a call from PCM, contact their member services department at 1-800-281-7050 with any questions or concerns.

SaveOn SP

SaveOn SP is an Express Scripts program that lowers the cost of a number of specialty drugs for both the members and the plan by taking advantage of manufacturer assistance programs. The specialty drugs are in specific medication categories such as Hepatitis C, Multiple Sclerosis, Oncology, Rheumatoid Arthritis, and a few others. If you participate in this program, you will have a zero cost for certain specialty medications. Your prescriptions will still be filled through Accredo, your existing specialty mail pharmacy.

  • The cost of these drugs will not count towards the annual out-of-pocket maximum, and
  • All plan members must use the Accredo specialty pharmacy for all specialty fills.

SaveOn is not available to the 65 Plus plan. If you have any questions or concerns, please contact SaveonSP at 1-800-683-1074 Monday – Thursday 7:00 a.m. – 7:00 p.m. Central and Friday 7:00 a.m. – 5:00 p.m. Central.

First Things First: New Fiscal Year Benefits Checkpoints

Check your deductions

Your new benefits plan year began September 1, 2020. It is important to log into Workday through Single Sign On (https://sso.tamus.edu/) and verify the accuracy of the benefits you elected for FY21 by clicking on the Benefits worklet, then “Benefit Elections” in the View column. If you find an error in your benefit elections, contact your human resources office before October 15, 2020.

Dependent SSN Reminders

As part of compliance with the Affordable Care Act (ACA), the A&M System Benefits Administration Office is required to request Social Security Numbers (SSNs) for covered dependents. This information will remain confidential. If you have dependents covered through your A&M System health plan for whom you have not provided an SSN or if you are unsure as to whether you have previously provided your dependent’s SSN(s), go online to Workday (http:// sso.tamus.edu/) to check and enter an SSN. After logging into Workday, click on the Benefits worklet. On the Benefits screen, select “Dependents” in the Change column. Click on the Dependent record you would like to edit. Visit the Workday Help website for assistance.

FY20 Flexible Spending Account Deadlines

If you have remaining funds in your FY20 healthcare or dependent daycare Flexible Spending Account (FSA), the grace period has been extended due to COVID-19. You may file eligible claims with a date of service of September 1, 2019 through December 31, 2020 to use your remaining FY20 FSA funds. All claims related to your FY20 FSA must be filed by December 31, 2020.

Medicare Part D Updates – Annual Communications

If you are enrolled in the A&M Care 65 Plus plan, you will be receiving an annual communication from Express Scripts regarding Medicare Part D in early October. Express Scripts is required to send these details to you on a yearly basis. You do not need to take action at this time and there will be no changes to your prescription drug plan. The annual enrollment period for our group differs from that of the general Medicare population. Your Medicare Part D Prescription Drug Out-of-Pocket Maximum will restart on January 1, 2021. Please contact your Benefits Office if you have any questions.

Need a New ID Card?

Misplacing your insurance ID cards can be a pain when trying to go to an appointment or get a prescription! You can follow the steps for each insurance plan below to get a new ID card, and then keep them all in one place. MyEvive also has the ability to save images of multiple ID cards, so all you need is your phone and the MyEvive app the next time you need your card. 

Blue Cross and Blue Shield of Texas
1. Log in to your Blue Access for Members account at https://bcbstx.com/tamus
2. From your dashboard, click the image of the ID card on the left hand side.
3. You can print a paper copy of your ID card, or order one from this page!
4. If ordered, a new ID card will be mailed to the address on file within two weeks.

Express Scripts
Retirees on the 65 plus plan and their spouse will have separate ID Cards.
1. Log into your Express Scripts account.
2. Select the Account tab from the main menu.
3. Click Member ID Card.
4. Download your card from this screen.

Superior Vision
Although you are not always required to present your vision ID card, it is good to keep for your records.
1. Go to Superiorvision.com and select “Member Log in” in the top right.
2. Log in using your username and password.
3. From the home page, select Print ID Card from the menu.

All of these accounts can also be linked to MyEvive with single-sign-on capability! This means, once you log in through MyEvive once, you can go straight into your vendor account from the MyEvive app.

 

Using Express Scripts Mail Order

Express Scripts mail-order is a convenient way to get your prescription drugs delivered to your home and ensure you stay adherent to your medication by planning in advance. You will also receive reduced copays for getting a 90-day supply via mail-order rather than purchasing a 60-day supply at retail for eligible drugs.

Benefits of Using Mail-Order Services

One of the greatest problems associated with maintenance medications is adherence. Maintenance drugs are medications prescribed for chronic, long-term conditions that are taken on a regular, recurring basis. Using a mail-order service to refill your maintenance prescriptions is a convenient way to ensure you have enough of the medication delivered directly to your home. Express Scripts mail-order service provides the following benefits:

  • Get up to a 90-day supply of each covered medication for a lower co-payment – two copays rather than three (subject to plan limitations, rules, and state regulations, such as controlled substances).
  • Registered pharmacists are available 24 hours a day, 7 days a week.
  • Order refills online, by mail, or by phone – anytime day or night. To order online, register at www.express-scripts.com. Refills are usually delivered within 8 days after Express Scripts receives your order.
  • Choose a convenient payment option – check, money order, credit card, or Express Scripts automatic payment program
  • Automatic Refills
  • Standard shipping is free

Submitting a Prescription through Mail Order

Your 90-day mail-order prescription should be sent to:

Express Scripts, Inc. P.O. Box 650322 Dallas, Texas 75265-0322

Or, you may ask your doctor to call 1-888-327-9791 for instructions on how to fax the prescription to Express Scripts (ESI). Your doctor will need to use your social security number or ESI member ID number to complete the transaction. (Only doctors can fax prescriptions to ESI.)

Order Delivery Times

First-time orders arrive within 8 to 11 days. Refills usually arrive in less time – 7 to 9 days, however, you can call to request expedited delivery. At www.express-scipts.com you can review detailed order status information. The best time to reorder is when you have about a 14-day supply of your medication remaining. This will help ensure that the medication is received when it is needed.

Express Scripts Value-Added Programs

Express Scripts, the prescription drug provider for the A&M Care plans, has several value-added programs. These, and other Express Scripts programs, can be found on the System Benefits Administration website at https://www.tamus.edu/business/benefits-administration/prescriptions-express-scripts/.

Pulmonary Care Value Program

Express Scripts (ESI) created the Pulmonary Care Value (PCV) program to improve adherence since a large majority of asthma patients fail to take their medication as directed.

  • Patients must fill all pulmonary care maintenance medications as 90-day prescriptions from Walgreens, home delivery, or certain other local pharmacies. Express Scripts provides access to one-on-one support from a team of extensively trained clinicians through their Pulmonary Therapeutic Resource CenterSM (TRC).
  • High-risk patients will be offered remote monitoring devices to help optimize medication use and maximize their health. When monitoring shows that patients overuse their rescue inhalers or are not adherent to controller medications, pulmonary TRC pharmacists will reach out with individualized support.
  • Some members will also be offered the Mango Health app – a patient engagement solution that gamifies health and rewards patients for making healthy decisions

 

Diabetes Care Value Program

The Diabetes Care Value Program combines a quality-based pharmacy network and a holistic approach to diabetes patient care. The program applies to all A&M Care health plan members who purchase oral and injectable diabetes drugs as well as the diabetes blood glucose test strips. The program requires that:

  • diabetes-related prescriptions be filled with a 90-day supply rather than a 30-day supply, and
  • diabetes-related prescriptions be filled through Express Scripts Home Delivery (mail-order) or a Walgreens pharmacy (retail).

The two main goals of the program are better patient adherence to diabetes medications and control of rapidly increasing costs. Aside from specialty medications used to treat debilitating diseases such as multiple sclerosis or HIV, spending on diabetic medications is the next highest spend. Controlling health plan costs helps offset premium increases and benefit reductions.