Schedule M - 2019 MPSERS Pharmacy Summary of Benefits_Non Medicare.pdf
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- Attached to
- HMO Services for MPSERS
- Solicitation number
- RFP 171 190000002803 2
- Issued by
- Michigan
About this file
This document is a 2018 Plan Highlights summary for the Michigan Public School Employees' Retirement System (MPSERS) prescription drug program, administered by OptumRx for non-Medicare eligible members. The document outlines the pharmacy benefits structure, including cost-sharing arrangements for different medication types and fill quantities. Member cost shares are set at 20% coinsurance for generics and preferred brand medications (with minimums of $10 for 30-day fills and $25 for 90-day home delivery fills), while non-preferred drugs carry 40% coinsurance. An additional 10% coinsurance applies to maintenance drugs beginning with the fourth fill. The annual coinsurance maximum is established at $1,500, resetting on January 1, 2019.
The plan encourages cost containment through a tiered formulary approach, promoting generic drug utilization with average savings of 85% compared to brand-name alternatives. Members have access to retail pharmacy services for short-term prescriptions, mail-order home delivery for 90-day supplies of maintenance medications, and specialty pharmacy services through BriovaRx for complex conditions including multiple sclerosis, rheumatoid arthritis, and cancer. OptumRx provides 24-hour member services support at 1-866-288-5209 for non-Medicare members, along with online resources through Optumrx.com and a mobile application available on Apple and Android platforms for benefit review, formulary searches, and prescription management.
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Michigan Public School Employees’ Retirement System – Non-Medicare Eligible 2018 Plan Highlights
Welcome to the Michigan Public School Employees’ Retirement System prescription drug program administered by OptumRx®. OptumRx is committed to keeping you informed about your retirement system’s prescription drug plan. This is a summary of your 2018 plan benefits. Please refer to your annual mailing for a full benefit explanation. Or, call OptumRx member services with any questions.
2018 Member Cost Share
30-Day Fill
90-Day Fill via Home Delivery
(Medicare members may also use an in-network
90-day retail) pharmacy)
Generics and Preferred Brands
20%*
$10 Min / $40 Max
20%
$25 Min / $100 Max
Non-Preferred Drugs
40%*
$10 Min / No Max
40%
$25 Min / No Max *Additional 10% coinsurance starting with the fourth fill of a maintenance drug
Your annual coinsurance maximum resets on January 1, 2019.
Your 2018 annual coinsurance maximum is $1,500.
Maximizing value through your formulary:
GO GENERIC – Generic medications use the same active ingredients as brand-name medications, offering members average savings of
85% when compared to brand-name counterparts. All Generic
Medications will charge the lowest member cost share.
Stay Preferred – A preferred brand-name medication is lower cost or more clinically effective than a non-preferred brand-name medication.
While generally more costly than generics, they are a good value if a generic is not available.
Retail pharmacy prescriptions
Retail pharmacies are best utilized for short term medications (one-month fills). To find a pharmacy in your area, visit Optumrx.com or call member services at the phone number listed on your pharmacy ID card before filling your prescription.
Save money and time with home delivery
Fill a 90-day supply of your long-term or maintenance medications through the mail. Get more information about home delivery at Optumrx.com.
Specialty pharmacy prescriptions
If your treatment plan calls for specialty medications, fill your prescription exclusively through BriovaRx® Specialty Pharmacy. BriovaRx offers highly personalized service for chronic and complex conditions such as multiple sclerosis, rheumatoid arthritis, cancer, and others. Call BriovaRx at 1-855-427-
4682 or visit BriovaRx.com for more information.
Online and mobile resources
Use our website, Optumrx.com or our mobile app, available on Apple© and
Android© by searching for OptumRx at the Apple App Store
SM
or Google Play
TM
With these tools, you can review your plan’s benefits, search for preferred brand and generic alternatives, and keep track of your prescription history. And with the mobile app, you can set medication dosage and refill reminders, have an electronic pharmacy ID card, and more.
Member services
OptumRx is here to assist you day and night. Our member services department is open 24 hours a day, every day of the year. Please contact member services at the appropriate phone number below with any questions regarding your prescription drug benefits.
All Optum
TM
trademarks and logos are owned by Optum, Inc. All other brand or product names are trademarks or registered marks of their respective owners. © 2018 Optum, Inc. All rights reserved. 0625.08b.01.090115
Non-Medicare members call: 1-866-288-5209
Manage your account online at: www.Optumrx.com http://www.optumrx.com/
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