Prescription Management Change to become effective January 1, 2018 for those in the NJ School Employees Health Benefit Plan

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For members (all Retirees and some Active) in the School Employees health Plan and who get their prescriptions through the State plan, you should have been notified of a change in the management provider of the prescription plan from Express Scripts to OptumRx beginning January 1, 2018.  In an effort to help our members understand this change, we have put together this guide. Should you have additional questions, you can call Bob Murphy, Director of Retirement and Benefits at NJPSA 609-860-1200 or either the State Pension Number 609-292-7524 or the OptumRx Numbers that are contained in this guide.

Why is the change taking place?

In 2016, the union representatives on the Plan Design Committees won the cooperation of the State to utilize an on-line auction process to competitively compare drug costs during the bidding process for the new prescription manager for the State Health Plans.  Through this process the State was able to award a bid that is projected to save the state taxpayers an estimated $1.6 billion dollars over the next three years. Retired members must keep in mind that your health care providers are subject to change.

Beginning January 1, 2018, OptumRx will manage your State of New Jersey pharmacy benefit.

BEFORE JANUARY 1, 2018                                               AFTER JANUARY 1, 2018

Online:                           Online:

Member Phone: 1-844-368-8740                                      Member Phone: 1-844-368-8740

Monday through Friday, 8am-8pm, CST                         24 hours a day, seven days a week

App for your smartphone: OptumRx                                App for your smartphone: OptumRx

OptumRx and the School Employees Health Benefit Plan are committed to a smooth transition for members from Express Scripts to OptumRx.  By now you should have received a letter from OptumRx with information regarding the transition and a Q&A section anticipating the questions you may be asking.  This guide highlights some of these points.

  • You should receive your OptumRx card during the month of December. You will continue to use your Express Scripts card until January 1, 2018. Your OptumRx card becomes effective on January 1, 2018.
  • Look for OptumRx information regarding prescriptions that have automatically transferred from Express Scripts to OptumRx. You may need to contact your doctor for a new prescription. OptumRx will be sending you notification regarding any action you might have to take in this regard.
  • Most medications that were filled under Express Scripts will be covered under OptumRx. Off-label medications that were filled by Express Scripts may be flagged by OptumRx. This may require a step therapy process with your doctor. However, any medications that were ‘pre-approved by Express Scripts will also be honored by OptumRx.
  • The appeal process will remain a three-step process with step 3 being an independent review.
  • Your pharmacy will fill your prescription with a generic unless otherwise directed by your doctor (brand medication).
  • You will not be required to utilize mail order to fill your prescription unless that drug must be filled by a Specialty Pharmacy. However, if you do use mail order, you will need to update your credit card information on either the OptumRx web page or in the OptumRx mobile app.  Your financial information will not be transferred from Express Scripts to OptumRx.
  • OptumRx has a Hassel Free program for automatic refills that you must ‘turned on’ or after January 1, 2018 by going on-line to your account or by contacting member services.
  • Home Delivery should work the same with OptumRx as it did with Express Scripts. Most of your prescriptions with remaining refills will transfer from Express Scripts to OptumRx.  Some prescriptions may not transfer in which case you will need to contact your doctor. Remember you will need to update your payment information it will not be automatically transferred.

Will my medications cost the same?

Possibly.  Your medications are subject to the OptumRx formulary and therefore might fall into a different coverage tier, require pre-approval for coverage, require a step therapy or be limited to a certain quantity over a specific time period.

Specialty Pharmacy medications will be filled through the OptumRx specialty pharmacy –BriovaRx. You can contact them at 1-888-341-8579 to ensure that your medications have been transferred.

The Formulary used by OptumRx is different from Express Scripts.  The formulary is a list of the approved drugs, lists any medication exclusions and indicates if any prior authorization or step therapy is needed.  You can find the OptumRx Formulary at the following link.