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Please
Note: Not all NCPPO plan participants who
have access to a NCPPO program are enrolled in the
WellPoint NextRx as their Prescription Benefit
Management program. Please check with your benefit administrator
for information on your specific PBM.
Employers and labor organizations
that offer access to NCPPO networks as part of their
group medical plan may provide pharmacy management services
through WellPoint NextRx.
Three
Levels of Benefits: Generic, Formulary (Preferred) or Brand
Name. If an employer-sponsored health plan includes
access to WellPoint NextRx, plan participants
are charged a minimal copayment for generic drugs and a
higher copayment for brand name drugs that are included
on WellPoint's Formulary list of preferred medications.
The program also covers brand name drugs that are not on
the Formulary, but at a higher copayment.
Two
Ways to Fill Prescriptions. WellPoint NextRx offers plan participants two ways to fill prescriptions
- at local pharmacies through the National Retail Network,
and through PrecisionRx - the Mail Service program.
National
Retail Network. The pharmacy program includes a
national network of more than 40,000 pharmacies, as well
as a Retail Maintenance Network that allows plan participants
to purchase up to a 90-day supply of medications at local
pharmacies. The Retail Program is a convenient way to fill
short-term prescriptions of 30 days or less. Plan participants
who use a retail network pharmacy pay a set dollar amount
for brand name drugs and a lesser amount for generic drugs.
Plan participants who fill prescriptions at a non-network
pharmacy must pay the full amount charged at the time of
purchase, and submit a claim form to WellPoint NextRx for reimbursement.
PrecisionRx
Mail Service Program. The Mail Service Program is
a convenient, cost-effective way to order up to a 90-day
supply of maintenance medication for home delivery. Prescriptions
are delivered via UPS, or First Class U.S. Mail within
7 to 10 days after the order is received. Service representatives
accept prescription reorders by phone Monday through Friday
from 7:00 a.m. to 9:00 p.m. CST. The toll-free number is
1-888-820-0287.
Formulary
List of Preferred Medications. WellPoint NextRx offers plan participants a Formulary
incentive program. The Formulary is a select list of preferred
medications. Plan participants who purchase prescription
drugs listed on the Formulary pay less out-of-pocket than
they would for brand name medications not on the Formulary.
The Formulary is periodically reviewed and revised by WellPoint's
Pharmacy and Therapeutics Committee, which consists primarily
of physicians and pharmacists.
Drug
Utilization Management. Every retail and mail order
prescription is screened to detect potential problems from
the perspectives of prescribing physicians, pharmacists
and plan participants.
Responsive
Customer Service. We build our programs around the
needs of our clients and we support the programs with efficient,
informed accessible service. Plan participants may call
the WellPoint NextRx Customer Service
line Monday through Friday from 7:00 a.m. to 12:00 a.m.
(midnight) CST,
and Saturday and Sunday from 8:00 a.m. to 5:00 p.m. CST.
The toll-free number is 1-888-820-0287.
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