The new features and changes described below are effective January 1, 2020.
There are no changes to the plan’s deductibles, coinsurance, copayments (UC Care) or annual out-of-pocket limits.
Prescription Formulary Changes
To help keep prescription drug costs and premiums affordable, effective January 1, 2020, the UC Care, UC Health Savings Plan (HSP) and CORE PPO plans will transition from the current Anthem National Drug List to the Anthem Essential Drug List. The Essential Drug List focuses on less costly medications with the same effectiveness as more expensive—and often brand name—medications. The University has a responsibility to faculty and staff to manage costs on their behalf without sacrificing quality or access. This change reflects the University’s focus on increasing the value of the health benefits that faculty, staff and retirees receive.
The majority of members currently taking medications will notice no difference as a result of this change. However, a small number will experience a change in how their medications are covered. In mid- to late October, Anthem Blue Cross will send affected members a letter with specific information about how each medication that they are taking will be impacted.
To minimize the impact on members, any current medications will be grandfathered (in current form and dosage), meaning you can continue taking them without disruption for as long as the medication is prescribed in its current form and dosage. However, grandfathering will end if the prescription is changed in the future (e.g., a different formulation or dosage is prescribed). New prescriptions written on or after January 1, 2020, will be subject to the coverage guidelines and policies of the new Essential Drug List.
Key Things You Need to Know
Your costs may change. The plan copayments and coinsurance are not changing, and the formulary will continue to have four tiers (typically generic, preferred brand, non-preferred brand and specialty). However, the Essential Drug List may classify drugs in a different tier than the National Drug List, which could affect your out-of-pocket costs. For example, the current National Drug List might classify a medication in Tier 1, but the new Essential Drug List classifies it in Tier 2. So you could pay more, or less, for your prescriptions than you do today. Anthem will notify you directly if your current medications will change tiers or are available over the counter.
Prior authorizations and approvals will continue. Prior authorizations and approvals for exceptions to benefit rules and regulations (e.g., quantity limits or step therapy) that are still active on December 31, 2019, will be honored by Anthem for as long as you are taking that specific medication, in the current dosage until the expiration of the prior authorization occurs.
You will not receive a new ID card. Continue to use your current Anthem PPO plan ID card in 2020 for prescription drugs and for medical and behavioral health services. (If you switch to a different PPO plan during enrollment, you will receive a new ID card for 2020.)
Questions? Contact Pharmacy Member Services at (833) 261-2463, available 24/7.
New Supplemental Health Insurance Options
New for 2020, you can purchase supplemental health insurance to complement your primary health insurance. This coverage pays cash benefits to you if you have a covered accident, illness or hospitalization. The supplemental plans have a premium that is separate from and in addition to your health insurance contributions. To learn more about the supplemental plans, what you pay and to enroll (if interested), go to ucplus.com.