Humana Pharmacy Solutions:
Pinellas County Schools
2013 Plan Benefits
Understanding Your Pharmacy Benefits
Contents

Your pharmacy benefit
Pages 3-4

For your safety
Pages 5-8

Filling your prescriptions
Pages 9-15

Maximizing your pharmacy benefits
Pages 16-17

Humana web and mobile tools
Pages 18-25

Questions to ask your doctor
Pages 26-27
2
Understanding your Rx3 Plan

Your Rx3 Plan assigns prescription drugs into three levels of coverage.
Level 1: generic drugs
 Level 2: preferred brand-name drugs
 Level 3: non-preferred brand-name drugs and specialty drugs

Prescription
Drug Level
Prescription
Deductible
Wal-Mart or CVS
RightSource
Mail Order
Deductible only
on Tiers 2 & 3
30 day
supply
90 day
supply
90 day
supply
Tier 1
N/A
$15 copay
$30 copay
$30 copay
Tier 2
$250 per
individual/$500
per family
$35 copay
$70 copay
$70 copay
$60 copay
$120 copay
$120 copay
Tier 3
3
How levels are assigned

A committee of Humana pharmacists and doctors evaluate each drug after
the U.S. Food and Drug Administration has approved them. This is also done
once a year for maintenance.
–

The committee looks at medical research and literature to decide how the drug
compares to similar products on the market in such areas as:
• Effectiveness
•
Safety
•
Side effects
•
Drug interactions
•
Cost
This helps to ensure you get medicines that are safe, effective, and at an
affordable cost.
4
For your safety- Prior Authorization

Certain medications require your
doctor to ask for and receive approval
before they are covered.
–
This is called a Prior Authorization (PA).

This process helps make sure you
receive the right medication in the
right dose for the right reason.

Prior Authorization helps keep you
safe.

Medications requiring authorizations
are:
Typically expensive
– Only appropriate for specific diseases
– Require frequent monitoring
–
*See page 22 to find out how to verify if your
medication requires a PA.
5
For your safety- Quantity Limits

A quantity limit is the maximum
amount of medication you can receive
for a certain price and for a set period
of time, usually 30 days.

Quantity limits help you get the right
dose for your condition and help make
sure you're safe when you take your
medicine.

Quantity limits are based on:
–
–
–
FDA guidelines
Abuse potential
Cost/Waste
*See page 22 to find out how to verify if your
medication has a quantity limit.
6
For your safety- Step Therapy

Step therapy (ST) is when you are
required to try a generic, or lower-cost
brand-name medicine, before your
benefit will cover the higher-priced
brand-name medicine.

Before moving to the higher-priced
brand-name medicine, try a generic
medicine first.
*See page 22 to find out how to verify if your
medication require Step Therapy (ST) or has a generic
available.
7
Why Generics?


Because they’re the same:

Dosage

Safety

Strength

Quality

Performance
They save you money

They contain the same active ingredient as the
brand-name drug but are usually 30 to 80 percent
less than their brand name counterparts.
8
Filling your prescriptions

Always use a pharmacy that is in the
Pinellas County Public Schools pharmacy
network. Those pharmacies are
Walmart, Sam’s Club, CVS, RightSource
and RightSource Specialty.

Networks are groups of pharmacies that
agree to give discounted prices to
members of certain pharmacy plans.
*Don’t forget to show your Humana
member ID card!
9
RightSource & RightSource
Specialty
Humana's
Mail Order and
Specialty
Pharmacies
10
RightSource & RightSource Specialty

RightSource is Humana’s Mail-Order pharmacy.
‒
RightSource fills prescriptions for maintenance medications.
•

Maintenance medications are taken regularly and long-term for conditions such as: asthma,
high cholesterol, and high blood.
RightSource Specialty is Humana’s Specialty pharmacy.
–
RightSource Specialty fills prescriptions for specialty medications.
•
Specialty medications are used to treat chronic, complex illnesses and are typically highpriced injectable drugs. But can also include expensive tablets, capsules or inhaled
medications.
These are separate pharmacies that fill different types of prescriptions and
operate out of different locations.
–
If you use both pharmacies, you’ll receive individual invoices and shipments will
arrive separately.
11
Why RightSource?
It’s
convenient
Cost savings
Safety
Easy to use
• There's no need to drive to the pharmacy. You can get up to a three-month
supply delivered right to your door and make just four orders per year.
• You only pay 2 copays for a 3 month supply of your maintenance
prescription.
• All new prescriptions are checked by 2 pharmacists.
• RightSource foil seals containers to provide safety and security.
• You can convert your retail medications to RightSource by visiting your
claims page on MyHumana at www.MyHumana.com.
12
Your RightSource experience

RightSource receives the prescription order.
Doctors can send new prescriptions by fax, phone, or electronically.
– You can send new prescriptions by mail with an order form or visit your
claims page on MyHumana to transfer an existing prescription.
–

RightSource technicians
Check the Humana pharmacy benefits coverage
– Add the profile to a secure database
– Scan the order
– Create a unique shipment number
–

Doctor’s instructions and prescription orders are loaded into
RightSource computers.

A RightSource pharmacist reviews the prescription order for accuracy
and possible drug interactions. If there are concerns or questions, a
RightSource pharmacist contacts the doctor for clarification.
13
Your RightSource experience

Approved orders go through the payment process.
–
If for some reason your benefit doesn’t cover the medication, a technician will
review the rejected claim.
–
RightSource will resolve the issue or return the written prescription with an
explanation about why they couldn’t process it.

An automated system dispenses the medication and a RightSource
pharmacist makes sure the product matches the label before it’s sealed.

RightSource mails the order to your home, along with an invoice, and all
of the necessary medication information.
14
RightSource Specialty

RightSource Specialty pharmacists are available 24 hours a day, seven days a
week to answer questions and listen to concerns.

Members receive a 30-day supply delivered to their home or doctor’s office,
along with any required administrative supplies such as needles or syringes.

Every new patient is contacted by a nurse.
Nurses specialize in the patient’s condition and medications.
– The patient’s condition is assessed and a follow-up outreach is determined.
– Patients are provided with nurse contact information and may call as often as
needed.
–

Learn more online at RightSourceRx.com/Specialty
15
Maximizing your pharmacy benefits
Choose Generics
• Generic drugs contain the same
active ingredients as the brandname drug.
• Generic drugs undergo rigorous
FDA review before they can be
approved.
• Generics may cost 30 - 80% less
than brand-name drugs.
Consider an over-thecounter (OTC) alternative
Apply for a Prescription
Drug Assistance Program
• OTCs are available for many
common conditions, including
allergies, heartburn, pain
management, and more. If
currently treating these
conditions with a prescription
drug, consider switching to an
OTC.
• OTCs are cost-effective and
convenient, often saving you
the time of meeting with your
doctor and the cost of your
office visit.
• Patient assistance programs are
run by pharmaceutical
companies to provide free
medications to people who
cannot afford to buy their
medicine.
• Visit the Patient Assistance for
Rx page located within the Rx
Resources on Humana.com for
more information.
16
Want cheaper or free medications?

Publix
Not a network pharmacy, so no need to
show your Humana card, but you can still
get these medications for FREE
Lisinopril (blood pressure medication)
 Metformin (diabetes medication)
 Certain Antibiotics such as:


Amoxicillin

Ampicillin

Cephalexin (capsules and suspension only)

Sulfamethoxazole/trimethoprim (SMZ-TMP)

Ciprofloxacin (excluding Ciprofloxacin XR)

Penicillin VK

Doxycycline Hyclate (capsules only)

Walmart

$4 prescriptions: (on a 30 day supply)

Always show your Humana card at Walmart, and
when you choose medications from this list your
generic copay is only $4 instead of your regular
$15 generic copay!
For a full list of these medications please visit:
http://www.walmart.com/cp/PI-4-Prescriptions/1078664
For more information including limitations please visit
http://www.publix.com/pharmacy/Free-Medications.do
17
Humana Web and Mobile
Tools
18
24- Hour online pharmacy resources
What is MyHumana? It’s Humana’s secure website that gives you access to your
information anytime you want it.
If you haven’t registered for MyHumana:
1.
Visit www.MyHumana.com
2.
Have your Humana ID card handy
3.
Go to Humana.com
4.
Click “Register for MyHumana”
5.
Follow the easy steps to register
19
MyHumana is Your Humana
20
Pharmacy locator

Select the Wal-Mart or CVS pharmacy locations based on address and/or zip code.

View pharmacy information (24 hour location, drive-thru, 90 days at retail, etc.).
21
Drug pricing tool on MyHumana

Locate drug level and copay amount.
 Find generic or lower cost alternatives.
 Please find the coverage information on your drug in the highlighted areas
below.
22
Pharmacy claims information
23
Switching to RightSource is easy
24
MyHumana Mobile
•
You can:
–
–
–
–
•
Available in:
–
–
–
•
Determine if plan covers prescriptions
Find prices at RightSource and retail
pharmacies
Identify alternatives
Sign up for text message refill reminders
Android Store
iTunes
Mobile device browser at m.humana.com
Future enhancements:
–
–
–
Medication adherence alerts
Biometric monitoring
Order RightSource refills at the click of a button
25
Questions to ask your
doctor or pharmacist
26
Questions
•
How will this medication help me?
•
How long should I stay on this medicine?
•
Is there anything I shouldn’t take while I’m on this medication?
•
What side effects can I expect?
•
Is there a generic available?
27
Humana Pharmacy Solutions
28