New Pharmacy Corporate Standards for Medical Mutual of Ohio Small Group Grandmothered Plans Effectiv

10-05-2022

Medical Mutual is introducing two new pharmacy standards, SaveOnSP and Active Choice, to our small group grandmothered book of business effective at renewal beginning with Jan. 1, 2023 renewals.

Medical plans with drug cards will receive SaveOnSP and the Home Delivery Incentive program, and medical plans with Major Medical drug benefits will receive SaveOnSP Exclusive and Select Home Delivery Active Choice.

 Groups with a drug card benefit plan will receive:

The SaveOnSP program, which saves members money by maximizing prescription drug copay assistance from pharmaceutical manufacturers for specialty drugs. On the specialty drugs in the SaveOnSP program, the members’ out-of-pocket cost goes to $0 with participation. The SaveOnSP program targets more than 200 drugs across several therapy classes. Program materials can be found below.

The Home Delivery Incentive program is also being added to all small group grandmothered plans. With this program, after three fills at a retail pharmacy for a maintenance medication, we’re asking members to transition to a 90-day supply through home delivery instead. If members do not transition, they will be charged twice the normal retail copayment as a penalty. Any group in a current drug plan that allows a 90-day supply of medications from a retail pharmacy will also be transitioned to a maximum 30-day supply at retail pharmacies as part of this program.

Groups with a Major Medical drug benefit plan will receive:

The SaveOnSP Exclusive program, which saves members money by maximizing prescription drug copay assistance from pharmaceutical manufacturers for specialty drugs. On the specialty drugs included in the program, SaveOnSP Exclusive reduces members’ out-of-pocket costs to $0 with participation. The SaveOnSP Exclusive list targets a smaller number of drugs than the SaveOnSP program for groups with a drug card, but the member cost share is still reduced to $0. Program materials can be found below.

Select Home Delivery Active Choice, is a home delivery incentive program being added to groups with Major Medical drug coverage. The program guides members who are prescribed long-term medications to use home delivery for refills unless they actively opt out. Members must contact Express Scripts to indicate they wish to continue to use a retail pharmacy past three refills without penalty. Express Scripts can be contacted by phone at 1-800-417-1961. If members fail to contact Express Scripts and continue to use a retail pharmacy, after three fills they will pay 100% of the allowed amount with no accumulation to deductible or maximum out of pocket.

Any groups that allow a 90-day supply of medications from a retail pharmacy will also be transitioned to a maximum 30-day supply at retail pharmacies as part of this program. Members utilizing a 90-day supply at retail pharmacies will be notified of this change at least 60 days in advance.