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New Rx Administrator in 2018: Information Coming to You

As you may be aware, effective January 1, 2018, UC will transition the pharmacy benefits administration for the UC Care Plan from OptumRx to Anthem Blue Cross. We are working with Anthem to make the transition as smooth as possible and to keep you informed about any changes in medication coverage or costs that will affect you.

The table below lists the types of communications you may receive based on how you are affected by the transition. If you are not affected, you will receive only your new ID card and none of the other communications listed below.

As always, if you have any questions, call Anthem Health Guide at (844) 437-0486 Monday through Friday, 5:00 a.m. to 8:00 p.m. (Pacific).

Mid-November 2017–late January 2018

Communication Who It Applies To Why You Might Receive It
Change in formulary or coverage Members taking medication(s) not on the Anthem National Drug List OptumRx and Anthem have a different list of covered drugs, also called a formulary. If you’re taking a medication that’s not on the Anthem list of covered drugs, you’ll receive information about how your situation will be handled during the transition.
Prior authorization, step-therapy, or quantity limit exceptions Members who have received prior authorization from OptumRx

If OptumRx has authorized use of a medication and has:

  • Noted that you have an existing prior-authorization;
  • Noted that you’ve met step-therapy requirements; and/or
  • Authorized you to receive a higher quantity of medication at one time;

You’ll receive information about how your situation will be handled during the transition.

Cost increase of one or more medications Members affected by cost increases The Anthem drug list has four tiers of medications. This is different from the way OptumRx classifies drugs. If you’re taking a medication that will be more expensive through Anthem (i.e., a drug is on a different tier), you’ll receive information about how your situation will be handled during the transition, including recommendations on lower-cost alternatives.
Change in how medications are categorized and covered Members affected by medical vs. pharmacy coverage determination If you’re currently filling a prescription under the pharmacy benefit that should instead be covered under the medical benefit, you’ll receive a letter with more information explaining the change and, where appropriate, how to transition the prescription.
Current opioid medication(s) will require new prescription Members currently taking an opioid By law, these prescriptions cannot be automatically transferred from OptumRx to Anthem. You’ll get information about actions needed to get a new prescription.
Pharmacy network disruption Members currently using a retail or specialty pharmacy that is not in the Anthem network OptumRx and Anthem use a different pharmacy network. If you are currently using a pharmacy not within Anthem’s network, you’ll receive information about in-network alternatives and steps to transfer your prescriptions.

By late December 2017

Communication Who It Applies To Why You Might Receive It
Anthem medical plan ID card All members Each covered family member will receive his/her own ID card. Beginning January 1, 2018, use this card for medical, prescription drug and behavioral health services.