Beginning January 1, 2020, VSTRS, in collaboration with VEHI and BCBSVT, will be implementing changes to its health benefit plans for retired teachers and their families. They are explained briefly below. Most retirees will not be directly impacted by them. Just the same, it is important you know what they are.
The Trustees of VSTRS approved these changes because they will substantially lower costs for the retirement system while continuing to ensure access to high-quality, affordable care for retirees and their dependents.
If you have questions about the information below, please contact a retirement specialist by dialing (802) 828-2305, or Mark Hage (mhage@vtnea.org), Vermont-NEA’s Director of Benefit Programs and a VEHI Trust Administrator.
For Non-Medicare Retirees Only: NPF & Accredo
National Preferred Formulary
On January 1, 2020, for retirees not yet enrolled in Medicare, VEHI will be transitioning to Express Script’s (ESI) National Preferred Formulary (NPF) to provide prescription medications. ESI is VEHI’s and BCBSVT’s pharmacy benefit manager.
NPF is the same prescription formulary used by Vermont’s state employees, active and retired, by thousands of Vermonters on the state’s health care exchange, and by several large businesses in Vermont. VEHI made this decision after researching NPF thoroughly with guidance from BCBSVT and independent pharmacy consultants at Remedy Analytics.
NPF offers a comprehensive list of effective prescriptions and, because of how this formulary is managed annually, the costs of prescriptions are more affordable for VEHI and VSTRS.
Further, NPF removes high-priced drugs annually from the formulary that medical research proves don’t deliver better clinical value than other drugs in the same class but that are less costly – sometimes significantly less expensive.
The great majority of retirees will NOT be affected by the switch to NPF, and this formulary change, as noted above, will only affect retirees not enrolled in Medicare.
Accredo Specialty Network
Effective January 1, 2020, non-Medicare retirees prescribed specialty medicines must purchase them directly through Accredo or from a select number of Vermont pharmacies in the Accredo network. Accredo, like NPF, is managed by Express Scripts and will deliver significant cost savings to VEHI without compromising the health of our subscribers.
Specialty medicines are drugs that are used to treat complex conditions such as cancer, growth hormone deficiency, hemophilia, hepatitis C, immune deficiency, multiple sclerosis and rheumatoid arthritis.
It delivers medications directly to people’s homes or other preferred sites. Many VEHI members switched voluntarily to Accredo in recent years. Accredo also offers drug supplies, drug safety monitoring, and24/7 personalized care for patients with complex and chronic conditions.
Medicare retirees will continue to access their specialty medications through a different formulary (CareMark).
NOTE: Employees and their families affected by the NPF and Accredo changes explained above will be contacted in writing with more detailed information prior to the changes taking effect, and their physicians are being directly assisted by BCBSVT’s pharmacy experts. All employees and their families will be assured access to medications they need.
New for All Medicare Retirees: OTC Medications
Over-the-Counter Medications
Also, on January 1, 2020, if medications are available over the counter – Claritin, Prevacid or Flonase, for example – you will no longer be able to purchase them with a co-payment and a prescription.
You will pay the OTC price charged by a pharmacy or store.
GoodRx (https://support.goodrx.com/hc/en-us/articles/360000677866-Does-GoodRx-have-prices-for-over-the-counter-medications-and-medical-supplies) also offers guidance on where you can find the best prices for OTC medications and how you might benefit financially from OTC discount coupons.
This change went into effect for non-Medicare retirees in VSTRS on January 1, 2018; it is new in 2020 only to VSTRS’ retirees enrolled in Medicare.
For All Retirees in Medicare and Non-Medicare Plans: ED Medications
Erectile Dysfunction Medications
VEHI benefit plans for retirees, Medicare and non-Medicare eligible, will no longer include ED medications in its Rx formulary. This change went into effect for active employees on January 1, 2018. VSTRS is implementing it for retirees on January 1, 2020.
The most popular drug in this category is Viagra. Fortunately, it has been available since 2018 as a low-priced generic.
You can find information about the costs of the generic (Sildenafil/Revatio) and the cost differences per prescription at different pharmacies, plus advice about financial assistance programs, on the GoodRx website: https://www.goodrx.com/sildenafil. (GoodRx collects and compares prices from more than 60,000 U.S. pharmacies.)
