Maintenance Choice

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Across
  1. 3. This program does not block 30 Day refills, but rather increases the copay for each additional 30 day refill past the refill limit.
  2. 6. A letter is generated when an opportunity is identified for a plan member who is currently filling a maintenance medication at a retail pharmacy other than ours.
  3. 8. if the Opt Out ____ needs to be backdated we would warm transfer to Senior Team.
  4. 11. We should always do this to verify opt out working correctly to process a 30-day supply.
  5. 12. Members may also use the self-service Rx Transfer tool at Caremark.com/_____
  6. 15. The link we click in PeopleSafe to see the Maintenance Choice description.
  7. 18. Plan members may also elect to receive Home Delivery of their medication from their local CVS pharmacy. Delivery cost may vary. Member should speak with Retail pharmacy for details.
  8. 19. In most cases, 90 Day supplies offer a cost savings over filling 30 Days at a time. Compare pricing via Test Claims to illustrate savings.
  9. 21. A prescription on hold cannot be transferred unless it has been filled at least once.
  10. 22. The member no longer wants to be enrolled in MChoice.
  11. 23. Transform Diabetes Care Opt Out program
  12. 24. If the member has called in because they previously Opted Out (Example: They wish to continue to fill prescriptions at other retail pharmacies at the plan’s designated retail copay and day supply), but their transactions are being rejected at retail because of Mandatory Maintenance Choice or Mandatory Mail requirement
  13. 26. One place we always check to see if plan has Mchoice.
  14. 28. The tab in PeopleSafe we can click to see participating pharmacies, they are indicated by “MCHOICE” in the column “Network Level.”
  15. 29. Members are limited to a certain number of 30 Day retail refills (varies per Client) at in-network retail pharmacies. After this limit is reached, maintenance medications are only covered via Mail Order in 90 Day supplies.
  16. 30. A letter is generated when an opportunity is identified for a Plan Member who is currently filling a maintenance medication at our CVS Retail Pharmacy.
  17. 32. When member would like to opt out one medication.
  18. 33. How many Opt Out types are there?
Down
  1. 1. A program that helps manage drug costs by offering Members the option of filling (long-term) medications in 90 Day supplies, either at a CVS Retail Pharmacy or via CVS Caremark Mail Order, for the same mail rate and copay.
  2. 2. No more monthly pharmacy trips. In addition, with mail service, your medicine is delivered right to you. That means fewer trips to the pharmacy and the gas pump.
  3. 4. When a prescription is transferred between pharmacies, the ____ Rx is transferred, not a single refill.
  4. 5. Health Engagement Engine
  5. 7. 30 Day refills are still covered under this program, but ensure the Member is getting the lowest price by comparing 30 and 90 Day supplies via Test Claims.
  6. 9. CVS Caremark programs may be offered in combination with any MChoice or other plan designs.
  7. 10. When member would like to opt out all medications.
  8. 13. 90 day supplies under this program are often the same copay, or even less, than the 30 day supply.
  9. 14. Certain drugs, such as some pre-packaged medications, are counted by the week instead of by the month and are dispensed in 28 or 84 Day supplies instead of 30 or 90. 28/30 Days and 84/90 Days count the same under MChoice.
  10. 16. Members may only Opt Out for themselves and any minor children on their account. Otherwise, each member needs to contact us to authorize the change.
  11. 17. This program incentivizes the use of Mail Order for maintenance medications by ensuring lower cost shares/copays for Mail, whereas Retail refills may either reject or experience an increase in cost/copay.
  12. 20. We will contact your doctor for you for a 90 Day prescription of your current medicine.
  13. 25. are not subject to Maintenance Choice, or available at CVS Retail. View CIF to confirm Specialty coverage and pharmacy details.
  14. 27. refills are available via CVS Caremark Mail Order, as well as at all CVS Retail pharmacies, including those inside of Target stores.
  15. 31. only allows one refill of a prescription to be transferred.