Express Scripts will manage prescription drug benefits July 1

Starting July 1, Rice employees’ prescription drug benefits will be administered by Express Scripts (ESI) instead of Envision. It is anticipated that this change, which was reviewed and endorsed by the University Benefits Committee, will improve service to members and will support Rice’s efforts to provide a comprehensive, well-managed pharmacy benefit. During June, faculty and staff who are enrolled in Rice’s medical plan will be mailed a new Aetna ID card that has ESI information on the back, which is all the pharmacist will need to process claims. The new card should not be used until July 1.

“While the service provider is changing, and we expect an enhanced level of service and ease of use, changes to Rice’s pharmacy benefits plan will be minimal,” said Sue Prochazka, director of benefits.

For fiscal year 2018, copays will remain the same. Tier levels for medications will also remain the same, but due to differences in the formulary (a list of which manufacturers’ drugs in the same class are preferred), certain drugs are preferred or excluded by Express Scripts, so some drugs currently on tier 2 may move to tier 3 or vice versa. There may be some differences in which medications require prior authorization or are excluded from coverage. The retail network where drugs can be purchased will be very similar to the current options, with all the major stores being in-network.

Like the current plan, Express Scripts will require members to use generics drugs if they are available unless a member’s physician requires the use of a brand-name drug. “We will continue to require members to purchase maintenance prescriptions at 90-day quantities, and they will still be available at retail or by mail order,” Prochazka said.

The new specialty pharmacy is Accredo. More information will be available this month on that transition.

Prochazka said that the first time employees use their new Aetna ID card in July or later, they should inform their pharmacist about the new prescription drug plan through ESI.

To inquire about the prescriptions drugs that members currently take, faculty and staff can call Express Scripts at 1-800-363-9019. They should tell the service representative that they are a Rice employee and give the name and dosage of any medications they want to know about, and the representative will tell them how the drugs will be covered.

“Rice will be doing all we can to ensure a smooth transition from Envision to ESI,” Prochazka said. “We plan to transition prior authorizations and claims history as thoroughly as possible. This may require some assistance from employees. We ask that members open all mail received from ESI so that if action is needed on their part, such as getting a new prescription from their doctor, they will have time to do so prior to the July 1 go-live date. We think that this is particularly important this year, when we are bringing on a new pharmacy vendor with the new fiscal year, which coincides this year with a long Independence Day weekend.”

ESI, headquartered in St. Louis, is a Fortune 22 company that serves over 75 million Americans. The company prides itself on innovation and has appeared two years in a row on Forbes’ list of “World’s Most Innovative Companies.”