Medco Presciption Advisory

The purpose of this advisory is to clarify information being provided by recent correspondence from Medco Health Solutions, Inc. (Medco) to Medicare eligible retirees. Here is a copy of the latest correspondence.

As previously reported, the School Employees’ Health Benefits Commission (SEHBC) has made a change to the Retiree Prescription Drug Program administered by Medco as of January 1, 2012. As of this date, all Medicare-eligible retirees will be automatically enrolled in the Medco Medicare Prescription Plan. This program includes the Medicare eligible retiree being automatically enrolled in Medicare Part D. This will allow Medco to first submit prescription drug claims to the federal government. After the prescription is submitted to the federal government, the state will pick up any additional cost, leaving the retiree liable only for their copayment. It is important to keep in mind that retirees will continue to pay only their copayment at the time they fill a prescription.

Since retirees will be automatically enrolled in Medicare Part D by Medco, there is certain information that is required by the Center for Medicare and Medicaid Services (CMS) to be distributed to these affected retirees. This information discusses such things as pharmacies, formulary lists and prior authorization. While it is important to understand how these issues will affect you, the SEHBC has repeatedly assured the NJEA/NJREA that for most retirees it will be a seamless transition and therefore most of the issues raised in the Medco letter will not impact you.

It is important to understand that while the correspondence from Medco indicates that members are not obligated to join the Medco Medicare Prescription Plan, if a retiree decides not to join, they will lose their prescription drug coverage with the School Employees’ Health Benefits Program (SEHBP).

If you have any questions about the correspondence from Medco, contact the Division of Pension and Benefits at 609-292-7524, Medco at 1-866-544-9703, or NJEA at 609-599-4561 and ask for the Pensions and Benefits Unit.