Pharmacy coverage – what’s changing for 2018?

Prescription drug costs continue to rise, and Mission is working to make sure both you and your health plan are better able to manage these costs. Here’s an overview of changes for 2018:

Generic and preferred brand drugs

Copays for these drugs will remain the same as 2017. However, if you choose the MCP and use a non-preferred brand drug, you’ll have an added deductible. After the deductible, you’ll be responsible for more of the cost than in the past, and this amount will vary depending on whether you use a Mission pharmacy or an OptumRX pharmacy.  You’ll find all these details in your Annual Enrollment magazine or at Mission&Me.com.

Over-the-counter products

New for 2018, if there is an over-the-counter alternative to a prescription drug, those prescription medications now will be covered only for patients younger than 18 years old.  This includes some commonly prescribed medications like nasal steroids, proton pump inhibitors (PPIs), acid reducers, oral antihistamines and others. This means that you could be responsible for the full retail price of the medication at the pharmacy if you choose to continue with it instead of an over-the-counter alternative.

Mission recognizes the impact this change might have on your drug therapy and is dedicated to offering the most price-competitive over-the-counter products possible. Mission’s retail pharmacies and eCommerce (shopmissionhealth.org) are committed to offering the lowest competitive price for patients on these medications. Simply ask your Mission retail pharmacist or browse at shopmissionhealth.org to find these valuable offers.

Patients using these prescription medications are not required to change to an over-the-counter alternative. However, if you or your dependents (ages 18 and over) continue using the prescription version, you will pay more.

Chronic Condition Clinic

Beginning January 1, 2018, specific diabetic medications must be prescribed by the Chronic Condition Clinic  and filled at a Mission pharmacy, for coverage under Mission’s health plans.  A full list of drugs that require consultation with the Chronic Condition Clinic is available at Mission&Me.com. Note that additional drugs may be identified to move to the Chronic Condition Clinic during the plan year.

Formulary and other changes

There will be additional changes for the Chronic Condition Management Program and the overall OptumRx Formulary. When these occur, you’ll be notified by mail from OptumRx.  The 2018 Rx Formulary and Exclusions will be posted on MissionAndMe before January 1, 2018.

Remember, you’ll find all these details in the Annual Enrollment resources mailed to your home, or available on Mission&Me.com.

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