Empire Plan to launch specialty pharmacy program for certain drugs

By DEBORAH STAYMAN
Do you or a covered dependent take one or more high-cost prescription medicines requiring special handling, lab tests and nursing services for illnesses such as rheumatoid arthritis, cancer, psoriasis, multiple sclerosis or hemophilia?

If you do and you’re covered by the Empire Plan, then you likely will participate in the new Specialty Pharmacy Program starting April 1.

In fact, if you get your specialty medications from a retail pharmacy you will be enrolled automatically in the Specialty Pharmacy Program.

The program, which is administered by Medco subsidiary Accredo, will coordinate care between a doctor and patient by making available pharmacists who specialize in specific diseases, nurses to assist with side-effect and compliance management, around-the-clock call centers, and coordination of infusion and home health services.

Empire Plan enrollees who use one or more of these drugs were notified by letter of the program in February. New enrollees will be identified via weekly pharmacy claims.

Each enrollee may fill a targeted drug once at a retail pharmacy. The enrollee will then receive a letter explaining the Specialty Pharmacy Program and a follow-up phone call. When the enrollee needs a new prescription, Accredo will be notified and it will contact the patient to schedule delivery of the drug to the home or the doctor’s office via express courier.

By March, a list of the medications included in the program, will be posted online at www.cs.state.ny.us. On the site, select Benefit Programs, then select NYSHIP Online and, if prompted, choose your group, The Empire Plan, and then Health Benefits.

If you have questions about the Specialty Pharmacy Program, call the Empire Plan Prescription Drug Program at 1-877-7-NYSHIP (1-877-769-7447) and select option 4.

’09 Empire Plan claims due 3/31
By LORRAINE SIMPKINS
March 31 is the last day to submit your Empire Plan claims for covered medical services and items received in 2009. Send them to:

• United HealthCare for the Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP), and for non-network physical medicine services;

• OptumHealth Behavioral Solutions for non-network mental health and substance abuse services; and

• Medco for prescriptions filled at non-participating pharmacies or without using your Empire Plan Benefit Card.

If the Empire Plan is your secondary insurer, you must submit claims by March 31, or within 90 days after your primary health insurance plan processes your claim. If you are covered under the Empire Plan as both an enrollee and as a dependent, you may submit secondary claims to the Empire Plan for expenses not reimbursed under your primary coverage.

Claims submitted after the deadline will be rejected.The carriers will reconsider their denial of these claims only if you provide documentation indicating it was not reasonably possible for you to meet the deadline.

Ask your agency health benefits administrator for claim forms, or call (877) 769-7447.

You may download the forms through www.cs.state.ny.us. Select “Benefit Programs” and follow the prompts to access NYSHIP Online. Then, select “Using Your Benefits.”

Mail the completed claim forms with supporting bills, receipts and, if applicable, a Medicare Summary Notice or statement from your other primary insurer to:

• United HealthCare
PO Box 1600
Kingston, NY 12402-1600

• OptumHealth Behavioral Solutions
PO Box 5190
Kingston, NY 12402-5190

• Empire Plan Prescription Drug Program
c/o Medco Health Solutions
PO Box 14711
Lexington, KY 40512