{"id":4856,"date":"2019-09-27T15:23:13","date_gmt":"2019-09-27T15:23:13","guid":{"rendered":"http:\/\/hnetalk.com\/provider\/?p=4856"},"modified":"2019-09-27T15:26:21","modified_gmt":"2019-09-27T15:26:21","slug":"our-medicare-advantage-product-line-is-changing-our-pbm","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/our-medicare-advantage-product-line-is-changing-our-pbm\/","title":{"rendered":"Our Medicare Advantage Product Line is Changing our PBM"},"content":{"rendered":"

As part of Health New England\u2019s commitment to provide ways on keeping health care costs down for our members, our Medicare Advantage product line is changing our pharmacy benefits manager from Castia Rx to OptumRx\u00ae<\/sup>. Beginning January 1, 2020, OptumRx will administer prescription drug benefits for our Medicare Advantage members.<\/p>\n

New ID Card Issued to all members with new Rx information<\/h3>\n

A new Health New England Medicare Advantage member ID card will be issued to all members with a pharmacy plan. This new card will have the RxBIN and PCN, and Group numbers for the pharmacy to reference. We have asked our members to destroy their existing card and begin using this new card effective January 1, 2020. As their provider, you will want to ask to see a copy of their new ID card.<\/p>\n

Lists of covered drugs prescribed to your patients<\/h3>\n

Health New England is required to maintain up-to-date information on covered drugs. Therefore, the process of informing about covered drugs in our formularies will remain the same. Beginning October 1, 2019, our members will have an opportunity to review the list of 2020 covered drugs and should be having the conversation with their doctors on any concerns with prescribed medications.<\/p>\n

Transition period if coverage changes for a prescribed medication<\/h3>\n

For most drugs eligible for Medicare Part D, our members can get up to a 30-day supply from January 1, 2020 through March 31, 2020. If coverage has changed from the prior formulary, our members receive a notice at the time of filling the prescription, and they are to follow the directions given on the notice to avoid any interruption with drug therapy.<\/p>\n

If a drug is no longer covered, we encourage our members to talk with their doctors on finding an alternative drug in our formulary. If you believe that none of the drugs covered are right for your patient, follow the process to request an exception to our formulary.<\/p>\n

Prior Authorization<\/h3>\n

For any prior authorizations in place today for prescribed medications, those will transfer to OptumRx.<\/p>\n

For any questions or new prior authorizations after January 1, 2020, please call toll\u2013free at (800) 393-0395 (TTY 711) or fax (844) 403-1028. They will be available 24 hours a day, 7 days a week. You may also write OptumRx, Prior Authorization Department, P.O. Box 25183, Santa Ana, CA 92799<\/p>\n

As part of this transition, a communication was sent to our Medicare Advantage members providing them similar guidance and at times, asking for them to talk with their doctor. For any other questions about this transition, please call Health New England\u2019s Pharmacy Department at (800) 310-2835 or send an email to our Provider Relations Department at ProviderRelations@hne.com<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

As part of Health New England\u2019s commitment to provide ways on keeping health care costs down for our members, our Medicare Advantage product line is changing our pharmacy benefits manager from Castia Rx to OptumRx\u00ae. Beginning January 1, 2020, OptumRx will administer prescription drug benefits for our Medicare Advantage members. New ID Card Issued to […]<\/p>\n","protected":false},"author":1,"featured_media":4858,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[8],"tags":[],"class_list":["post-4856","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-updates"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/hnetalk.com\/provider\/wp-content\/uploads\/2019\/09\/optum-hne-hero-e1569597782931.jpg?fit=800%2C282","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZHB-1gk","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/4856","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/comments?post=4856"}],"version-history":[{"count":3,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/4856\/revisions"}],"predecessor-version":[{"id":4861,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/4856\/revisions\/4861"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media\/4858"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=4856"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=4856"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=4856"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}