Your Highmark Blue Shield PPOBlue plan includes prescription drug coverage. The Pharmacy Benefit Manager for Highmark Blue Shield is Medco. Information regarding your prescription drug coverage was included in the Highmark material that was mailed to your home.
A feature of the plan that will be new to employees, other than those who were enrolled in the Penn State Choice PPO, is the $1,000 out-of-pocket maximum that applies for prescription drug coverage. When an individual's combined out-of-pocket expense for prescription drugs reaches $1,000, his or her prescription drugs will be covered at 100% for the remainder of the calendar year.
As in the past, prescription drug coverage is designated as:
• Retail – Drugs that are purchased at your local participating pharmacy. The maximum supply available is 31 days. You pay 50% of the cost of the prescription at the counter. Generally, the retail method is used for short-term prescriptions, such as an anti-biotic. While maintenance drugs can be purchased on a retail basis, the maintenance prescription drug plan is more cost effective.
• Mail Order Maintenance – Drugs that are prescribed for the long-term treatment of a condition, such as high blood pressure, cholesterol, or diabetes. The maximum supply available is 90 days. You pay 20% of the cost of the prescription. Maintenance drugs are available from Medco by Mail and from the University Health Services Pharmacy.
Highmark Blue Shield maintains the formulary, or list of covered drugs, and the formulary applies for both retail and maintenance programs. Prescriptions included on the formulary receive the highest level of coverage. However, your drug plan allows you the freedom to choose to receive a medication that is not included on the formulary. You will pay 70% of the cost of a non-formulary medication.
It is important to note that this is a new formulary. While many of the same drugs that appeared on your previous plan's formulary also are on the Highmark formulary, you should verify that information. Online access to the Highmark formulary online allows you to see if your particular drug is on the formulary, to estimate the price of that drug, as well as to determine what alternative medications are available.
If you have established a log-in for the Highmark Blue Shield web site and have received your PIN number by mail, you can access the Medco formulary through the Highmark site. Registration on the Highmark Blue Shield web site will also provide you with access to other details of your coverage, such as the preventative care schedule and your claims expense summary.
Alternatively, you can view the formulary as well as research the cost of medications directly from the MedcoHealth [www.medcohealth.com] web page. You will need information from your Highmark Blue Shield PPOBlue ID card to establish a log-in on both web sites.
New prescriptions are required to use the Medco by Mail program for maintenance drugs as well as any new maintenance drugs that you purchase from the University Health Services Pharmacy. You will be able to order refills online and by phone. Your maintenance drug prescriptions from Medco by mail will be delivered to your home address. Drugs purchased from the University Health Services Pharmacy are delivered by campus mail to your work site at no cost or by US Mail to your home for a $3.00 fee.
If you previously were enrolled in the HealthAmerica HMO and were receiving your maintenance drugs from Walgreen's AND you had refills remaining on your prescription, those open refills were transferred to the University Health Services Pharmacy and will be available to you.
The PPOBlue Benefit Summary provides an overview of the plan benefits, including prescription drugs. All questions regarding your Highmark Blue Shield PPOBlue plan should be directed to Highmark Blue Shield at 1-800-914-4384. This is a dedicated line for Penn State faculty and staff.
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