Significant Changes to Empire Blue Cross Rx Options on November 1

Empire’s Small Group prescription cost share options are changing

Pending NYS DOI Approval

“Rising prescription drug costs can impact premium rates. So to help keep premiums and, in most cases, member out-of-pocket expenses more affordable, we’ve adjusted our prescription drug cost share options for our new and renewing small group business effective starting November 1, 2011.”

Starting on November 1, all current small group drug cost shre options will be discontinued on renewal.  Three new pharmacy options will be available, and employees will have to pay percentage-based coinsurance (NOT COPAYS) for certain tiers of formulary drugs.

Here are the new plans:  Most plans will move to the $10/$35/35% plan.  If you have a $15 generic plan, you will move to a $10 generic plan. 

I will be participating in a webinar next week and will report more once I know it.

Starting on November 1st, we plan to discontinue all current small group drug cost share options upon renewal.1 (This change does notshare options for new and renewing small group business.  Under this new structure, members will pay percentage-based coinsurance instead of a flat copayment for certain tiers of formulary drugs.   

MARK YOUR CALENDARS and RSVP TODAY!
Join us for a live webinar, Small Group Prescription Plan Options are Changing
 July 13th from 2:00 p.m. – 3:00 p.m.
The webinar will present these Rx changes in detail and address questions you may have.

Click here to register for the downstate webinar.

Click here to register for the upstate webinar.

(Note:  These changes apply to small group prescription plan options.  They do not affect large group prescription plan options).

How is this going to impact renewing business?

When small groups renew on or after November 1, 2011, they’ll move to one of the following prescription structures based on which plan they currently have:

  • Most Small Groups with a copay-based drug benefit will move to our $10/$35/35% prescription drug plan requiring payment of 35% coinsurance for Tier 3 drugs.
  • Small Groups with the $15 Generic drug benefit will move to our $10 Generic drug benefit.
  • Small Groups with HMO 3 Tier Rx will move to our $10/35%/50% prescription drug plan requiring payment of 35% coinsurance for Tier 2 drugs and 50% coinsurance for Tier 3 drugs. 

Note:

  • Renewing groups have a choice of moving to another plan currently being offered to the Small Group market at the time of their renewal. Just let us know at renewal time.
  • Pharmacy benefits themselves will not change.  These changes affect Rx cost sharing only.

Please check out a flyer that has been created to provide an overview of Empire’s Small Group Pharmacy Options.

Click here for the downstate version.

Click here for the upstate version.