Prescription Drug 90 Day Maintenance Program FAQs
2020 and 2021 Plan Year Information
Why does the Firm’s Medical Plan have a 90 day requirement for maintenance drugs?
In order to continue offering employees and their families comprehensive, high-quality benefits, we continually look for ways to control the increasing costs of health care. A 90 day requirement for maintenance drugs not only saves on costs for you and for the Firm; it’s also convenient and helps ensure your treatment is not interrupted.
Am I required to fill all my prescription drugs for 90 days?
No. Only prescription drugs that are considered maintenance medications are required to be filled for 90 days. Maintenance medications are those you may take on an ongoing basis for conditions such as diabetes, high blood pressure or high cholesterol, as well as birth control and certain behavioral health medications. Your first three 30-day fills of a maintenance medication may be filled at a retail pharmacy, though you’ll likely pay more than if you use a 90 day pharmacy.
Prescriptions that are excluded from mandatory 90 day supply include controlled medications, antibiotics and medications used on a short-term basis for the treatment of specific medical conditions. Contact OptumRx or Cigna Home Delivery Pharmacy to determine whether your drug is a maintenance medication.
|Cigna Home Delivery Pharmacy
(Medical Plan Option C through Cigna)800-CIGNA24 (244-6224)
Group # 3327984
How much will I pay if I choose not to fill a maintenance medication prescription by mail or at Cigna 90 day retail pharmacy?
If you choose to refill your prescription more than 3 times at a retail pharmacy, you will pay the full cost of the medication instead of a copay or coinsurance – and the cost will not be applied to you annual deductible. Note: if you are in Option C, you always pay the full cost of your prescription up to your annual deductible, unless the prescription is considered preventive care.
How do I determine whether my prescription is required to be filled for 90 days?
Contact OptumRx or Cigna Home Delivery Pharmacy and provide the name of your drug(s). You may also receive notifications from OptumRx or Cigna Home Delivery Pharmacy after a retail fill reminding you to use a 90 day pharmacy. You may speak with a pharmacist 24/7 if you have questions about any of your medications.
Are my covered dependents required to fill their prescription for 90 days, too?
Yes. The same rules that apply to you apply to any dependents you cover under the Firm’s Medical Plan.
Do I have to move to 90-day maintenance immediately?
No. The 90 day requirement for maintenance medications became effective
January 1, 2017, and the grace period to transition to 90 days began with your first fill of 2017. You will be required to move to 90 days after your third fill at a retail pharmacy.
To avoid paying the full cost of your medication at your fourth retail fill and to avoid a gap in receiving medication, we encourage you to proactively fill your medication for 90 days as soon as possible.
What happens on my fourth retail pharmacy fill?
If you don’t move to home delivery or a participating retail 90 pharmacy for your fourth fill, you will be required to pay the full cost of the medication and the cost will not apply to your annual deductible. You will continue to pay 100% of the cost of subsequent fills until you switch to 90 day maintenance. OptumRx participating retail pharmacies include CVS and Target. The Cigna Retail 90 network includes CVS, Target, Walmart and Kroger along with other retail pharmacies.
Do I have OptumRx or Cigna Home Delivery Pharmacy?
It is based on the Medial Plan option you elected.
You have OptumRx if you are enrolled in Option A or B through Cigna or UnitedHealthcare OR Option C through UnitedHealthcare.
You have Cigna Home Delivery Pharmacy if you are enrolled in Option C through Cigna.
Will OptumRx and Cigna Home Delivery Pharmacy assist with the transition?
Yes. Call OptumRx or Cigna Home Delivery Pharmacy to have an advocate contact your doctor for a 90 day maintenance prescription. OptumRx or Cigna Home Delivery Pharmacy will notify you if your doctor does not respond to the request. You can expedite the process by asking your doctor to send electronic prescriptions for your maintenance drugs to OptumRx, Cigna Home Delivery Pharmacy or your participating Cigna 90 Now Retail pharmacy directly.
What happens if my doctor changes my maintenance prescription dosage or prescribes a new maintenance drug?
If your doctor prescribes a new dosage or new drug – you have a new prescription. You will have three grace fills for each adjusted or new prescription at a retail pharmacy before you are required to switch to 90 day supply. However, it is usually more cost effective to use your 90 day benefit right away.
Are my out-of-pocket costs for prescriptions considered an eligible expense for my Health Care Flexible Spending Account (FSA) or Health Savings Account (HSA)?
Yes. You may use your Health Care FSA or HSA to pay for your cost of medications covered by the Medical Plan. For a full list of eligible expenses, see IRS Publication 502.
How do I use Mail Order for a new prescription?
Online registration: Go to the web address on the back of your medical plan ID card and register for the mail order program, following the step-by-step instructions.
Once enrolled, you may manage your medications online, including filling or auto-filling prescriptions and transferring other prescriptions to mail order. You may also set up text message reminders. Be sure to have your medical plan ID card and medication bottles on hand.
By phone: Call the member phone number on the back of your medical plan ID card to talk with a customer service representative. Have your medical plan ID card and medication bottle available. Ask the representative to contact your doctor directly if you need to transfer an existing prescription to mail order or to request a refill for a drug you are taking.
By mail: Ask your doctor for a new prescription for up to a three-month supply, plus refills for up to one year. Then go to the web address on the back of your medical plan ID card and download the new prescription order form. Complete the form and mail it to the address at the bottom of the form.
By fax or electronic prescription: Ask your doctor to call OptumRx or Cigna Home Delivery Pharmacy at the numbers below for instructions on how to fax or email your prescription.
- OptumRx: 1-800-791-7658
- Cigna Home Delivery Pharmacy:1-800-835-3784
What could cause a delay in prescription processing?
Your prescription may be delayed if:
- Your doctor has not responded to OptumRx or Cigna Home Delivery Pharmacy for a prescription.
- There is a manufacturer back order for the drug.
- Your medication requires prior authorization and your doctor has not completed the needed paperwork.
- A valid credit card is not on file with OptumRx or Cigna Home Delivery Pharmacy to pay for the cost of your medication.
OptumRx or Cigna Home Delivery Pharmacy will notify you of any delays. If you have multiple medications, your prescriptions may ship in separate packages, if necessary.
How do I check on the status of my order?
Visit the web address or call the phone number on the back of your medical plan ID card.
Am I charged for shipping
Standard shipping is free. Rush shipping is available for a fee.
Will my coupon/copay card apply to mail order or retail 90?
Coupon/copay cards do not apply to drugs ordered through mail order but will apply at retail pharmacies that participate in the retail 90 network. However, if you continue to fill your maintenance prescriptions at a retail pharmacy outside the retail 90 network, you will lose the benefit of any Plan coverage or pricing discounts and will pay the full cash price at the retail pharmacy after your third fill, less the amount of any coupon/copay credit that your pharmacy will accept. Before purchasing at a non-participating retail pharmacy, we encourage you to compare prices by calling OptumRx or Cigna and your retail pharmacy. Often the mail order cost is less than the retail pharmacy’s cost, even after subtracting the coupon or copay discount.
Can I use my coupon or copay card at home delivery with OptumRx?
Coupons and copay cards are not accepted by the OptumRx. Cigna provides a limited exception for certain specialty drugs, and a few drug manufacturers will honor coupons for mail order purchases directly. Call the number on your coupon or copay card to find out about your drug maker’s policy. Remember that coupons and copay cards are generally only available on high priced drugs and for a limited time.
My doctor/pharmacist gave me a coupon/copay card for my drug. What is this?
Drug coupons and copay cards are discounts offered by drug companies for certain brand named drugs. They work much like “cents off” coupons for groceries, and they usually are available only for select high priced drugs when a lower cost or generic option is available. Coupons typically are limited time offers, so you go back to paying high retail prices when your coupons run out. They usually only apply at retail pharmacies.