TRB: Retiree Prescription Drug Benefit Changes Effective January 1, 2015

Retiree Prescription Drug Benefit Changes Effective January 1, 2015

The Teachers’ Retirement Board prescription drug plan will change effective January 1, 2015, to an Employee Group Waiver Plan which is an enhanced group-sponsored Medicare Plan D prescription drug plan.  This will increase our Federal funding and provide discounts on the cost of name brand drugs.

To help you understand the changes we have placed the information in this Frequently Asked Questions format.  We hope that the FAQs below will provide you with the most relevant changes that impact your prescription benefits. 

Who will be the Pharmacy Benefits Administrator?
Effective January 1, 2015, Express Scripts will replace CVS Caremark as our Pharmacy Benefits Administrator. 

How will the change to Express Scripts impact me?
  • The change will broaden your network of pharmacies allowing you to fill prescriptions at more locations. 
  • The number of preferred covered drugs is larger with Express Scripts reducing the cost on some prescriptions.
  • Within the next year or two, your annual premium is expected to decrease. 
Is there a change to my copayment?
There will be no cost for generic drugs after the deductible is satisfied.  All other copayment percentages will remain the same.

What will my annual calendar year deductible and maximum out-of-pocket cost be for prescriptions, effective January 1, 2015?
  • Deductible: 
$320 (Effective 1/1/2015) 
  • Copayment:
  • Maximum Out-of-Pocket cost:    
$1,070 (Annual Calendar Year Maximum)  
Why has the deductible increased from $250 to $320?
The $320 deductible is consistent with the Medicare Part D deductible of $320.  This should be offset by the lower premium costs and the elimination of copayments on generic drugs.

How will maintenance drugs be handled?
You can have your 90-day maintenance drugs filled by Express Scripts mail order or at many network retail pharmacies with the same copayment percentage as mail order.  Most pharmacies are in the network.  We recommend you call your pharmacy to confirm that they participate in the network 

What do I need to do to enroll in the new prescription program?
If you are currently enrolled in the TRB prescription benefit plan, you will be automatically enrolled with Express Scripts.   

What do I need to watch for as we move to Express Scripts?
  • September ....................
A plan change notification. 
  • October 1st ...................
Express Script dedicated telephone line opens. The telephone
number will be released later. 
  • October .........................
A Benefit Overview and “Opt out” form. 
  • November/December ...    
A Welcome Kit - approximately 100 pages 
Per federal law, your welcome kit will include the following:
  • Member ID Card 
  • Quick Reference Guide 
  • Welcome letter 
  • Benefit Overview 
  • Pharmacy Directory 
  • Low Income “Extra Help” assistance information 
  • Privacy Notice
  • Evidence of Coverage Document 
  • Formulary list 
  • Mail Service Order Form 
It is crucial that you watch for, read and retain all the information in your welcome kit.  The above Teachers’ Retirement Board logo and the Express Scripts logo will appear on the outside of the Welcome Kit envelope to identify the mail as legitimate. 

I use maintenance drugs and currently use mail order.  If I want to continue using mail order, will I need a new prescription?
Yes, you will need to have your physician provide a new prescription for mail order to Express Scripts on or after January 1, 2015.  You will receive information in your welcome kit.

How do I find participating pharmacies?
Participating pharmacies will be included in your welcome kit that you receive along with your new id card.  You should find that the number of participating pharmacies has actually increased.

Content Last Modified on 9/5/2014 8:38:31 AM