Page 17 - Work Force December 2018

2019 Empire Plan Formulary released
Important options to consider for the 2019 plan year:
• Changing your New York State
Health Insurance Program (NYSHIP) option during the Option Transfer Period.*
• Enrolling in the Opt-Out Program*(if eligible)
*Option transfer dates were not available as this article went to press. During the Option Transfer Period,
you may change your New York State Health Insurance Program (NYSHIP) health insurance option for the next plan year to one of the following:
• The Opt-Out Program (if eligible)
In 2019, NYSHIP will continue
to offer the Opt-Out Program,
which allows eligible CSEA active employees who have other employer- sponsored group health insurance to opt out of their NYSHIP coverage in exchange for an incentive payment.
If you currently participate in
the Opt-Out Program and wish
to continue receiving incentive payments in 2019, you must re-elect the Opt-Out Program during the Option Transfer Period.
Please see your agency health benefits administrator for specific details, plan requirements and deadlines.
New York State has recently released the 2019 Empire Plan Advanced Flexible Formulary drug list for CSEA active State and Court System Empire Plan enrollees.
The creation of the Empire Plan Formulary is an administrative responsibility held by the New York State Department of Civil Service and the Empire Plan Prescription Drug Administrator, CVS Caremark. During the creation of the formulary, all medications on the formulary (including generics) are evaluated for effectiveness and safety.
Generics should be considered the first line of prescribing. If there is no generic available, there may be more than one brand-name drug
to treat a condition.
Preferred brand-name
drugs are listed within
the formulary to help
identify products that are
clinically appropriate. Please
note that the 2019 Empire Plan Advanced Flexible Formulary is not an all-inclusive list; the formulary includes a list of commonly prescribed drugs covered by therapeutic class, a Quick Reference Drug List with commonly prescribed covered drugs in alphabetic order,
a listing of commonly prescribed non-preferred (Level 3) covered drugs and covered preferred
drug alternatives, and a listing of excluded drugs along with covered alternatives. Brand-name drugs in this list are in CAPS and generic drugs in lowercase italics.
During the annual review, drugs can change co-payment tiers
December 2018
(resulting in either an increased or decreased co-payment) or drugs can be excluded from coverage or re-introduced to coverage if they were previously excluded.
Empire Plan enrollees who may be negatively impacted by any changes to the Advanced Flexible Formulary will receive a letter with a list of alternative medications from CVS Caremark.
The Empire Plan offers a medical exception process for non- formulary drugs that are excluded from coverage. To request a
medical exception, you and your physician must first
evaluate whether covered drugs on the Advanced
Flexible Formulary are appropriate
alternatives to your treatment. After an appropriate trial of
formulary alternatives, your physician may
submit a letter of medical necessity to CVS Caremark that
details the formulary alternative trials and any other clinical documentation supporting medical necessity. The physician can fax the exception request to CVS Caremark at 1-888-487-9257. If an exception is approved, the Level 1 co-payment will apply for generic drugs and the Level 3 co-payment (and ancillary charge, if applicable) will apply for brand-name drugs.
For specific information regarding your prescription benefit coverage and co-payment information, please visit empireplanrxprogram.com or call 1-877-7-NYSHIP (1-877-769-7447) and select option 4 for the Empire Plan Prescription Drug Program.
• •
The Empire Plan
A NYSHIP Health Maintenance Organization (HMO)
BRINGS A
Changing your health insurance option for 2019?
BRINGS A
COLLEGE
COLLEGE
DEGREE WITHIN
DEGREE WITHIN
YOUR REACH.
YOUR REACH.
Who is eligible?
Who is eligible?
AFSCME Members
Retired AFSCME Members
Family of AFSCME Members*
*Family of AFSCME members are defined as parents, siblings, children (or stepchildren), grandchildren (or step-grandchildren), spouses, domestic partners, and financial dependents.
AFSCME Members Retired AFSCME Family of AFSCME
AFSCME and Eastern Gateway Community College are offering the chance
Members Members*
to earn an online degree from an accredited school with no out-of-pocket
*Family of AFSCME members are defined as parents, siblings, children (or stepchildren), exgpreandscehi.ldArenc(olrlsetegpe-gdraendgcrheilderecna),nspboueseyso, duormpesatitchpwaratnyertso, andefiwnaoncpiapl doerptuendietnietss. ,
greater responsibility, and more earning power.
AFSCME and Eastern Gateway Community College are offering the chance
to earn an online degree from an accredited school with no out-of-pocket expense. A college degree can be your pathway to new opportunities,
greater responsibility, and more earning power. The Work Force 17
Learn More at
Learn More at
freecollege.afscme.org
freecollege.afscme.org
or call 888-590-9009
or call 888-590-9009