Catalyst Rx is a full-service pharmacy benefit management (PBM) company that has been providing PBM services to employers since 1994. They currently serve over four million lives in all 50 states, with total managed drug expenditures for 2007 of $4 billion. They are the fourth largest publicly traded PBM. They contract with Walgreens Mail Service to provide mail order services, which is located in Phoenix, Arizona. The Catalyst Rx Customer Service Department for Sandia is located in Las Vegas, Nevada.
Why were CIGNA member carved out to Catalyst Rx?
Catalyst Rx brings very competitive pricing. In addition, with the new on-site pharmacy the administration of the pharmacy benefit under one vendor will allow the same formulary for all, the same plan design, and the same prior authorization processes, etc. creating much less confusion. With the Lovelace pharmacies in the Catalyst Rx network, this was a natural progression, much like the way we carved out UnitedHealthcare members to a pharmacy benefit manager years ago. Catalyst Rx provides the highest level of customer service among the top ten pharmacy benefit managers in the industry (according to a recent industry survey of employer groups). Certified pharmacy technicians are available to assist you 24 hours a day, seven days a week, when you call customer service.
I have heard we will be receiving a "welcome kit." What will this "kit" include?
If you are new to Catalyst Rx, you can anticipate receiving your welcome kit in mid-December. The Welcome Kit will contain new ID cards to use at the pharmacy; a welcome letter providing an overview of your prescription drug program through Catalyst Rx; a mail order transition letter for CIGNA members; a Walgreens Mail Service Registration and Prescription Order form; a 2009 Preferred Drug Pocket Formulary; and a listing of the retail network chain pharmacies.
Are my copays changing?
For non-represented employees in the UHC Premier PPO, the UHC Standard PPO and the CIGNA In-Network Plan, the copay/coinsurance structure for 2009 is changing. Refer to the information on the Open Enrollment website for changes. For represented employees in the UHC Premier PPO, the UHC Standard PPO, the CIGNA In-Network and the CIGNA Premier PPO plans, the copay/coinsurance structure is staying the same. For those who are in the CIGNA plans your cost may change based upon a different preferred drug list. The preferred drug list identifies which brand name drugs will be dispensed at the lower copay. To find out whether your drug is preferred or not, go to www.catalystrx.com and log in with SNL as the user id and password under Clients.
What drugs under Catalyst Rx are subject to a Prior Authorization?
A Prior Authorization, or PA, is a clinical program that ensures appropriate use of prescription medications. Typically, these medications have potential for misuse or are sometimes prescribed for uses not recommended by expert guidelines. Medications subject to a PA require pre-approval from the Catalyst Rx Prior Authorization Team before they can qualify for coverage. If you are prescribed a medication which is subject to Prior Authorization, you, your pharmacist, or your provider can initiate a PA by contacting Catalyst Rx at 1-866-854-8851. Catalyst Rx will contact your provider and request the information necessary for medication coverage. The following drugs are subject to a Prior Authorization:
Acne products for members 26 and older (e.g. Retin A/Differen/Avita)
Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder (ADHD) agents (e.g. Ritalin) for members 18 or older
Prescription vitamins (other than pediatric and prenatal)
Rebetron
Renova for members 26 and older
Synagis
Synvisc
Thyrogen
Zyvox
I have a Prior Authorization (PA) on a drug with CIGNA – what happens to this?
The PA will carry over for 12 months from the date the PA was entered into the system by CIGNA. For example, if CIGNA entered the PA on 8/19/07 it will be good through 8/18/08. Information on individual member Prior Authorizations will be transferred from CIGNA to Catalyst Rx.
What drugs under Catalyst Rx are subject to a Quantity Limit (QL)?
A Quantity Limit is a limitation on the number (or amount) of a prescription medication covered within a certain time period. Quantity Limits are established to confirm that prescribed quantities are in compliance with clinical guidelines, to ensure appropriate utilization, and to avoid the potential misuse and abuse of medications. Prescriptions written for quantities in excess of the established limits will require a Prior Authorization before the prescription can be filled.
Sleep aids (Ambien, Ambien CR, Ambien Pak, Lunesta, Sonesta, Rozerem, and Zolpidem Tartrate) (limit of 15 pills/30 days at retail or 45 pills/90 days at mail)
Note: Catalyst Rx will waive the QL if the provider ordering the prescription is a sleep specialist.
Sexual dysfunction (limit of 8 pills/30 days at retail or 24 pills/90 days at mail) for males only
Epi-Pen (limit of 3 per year)
Insulin-injecting devices (limit of 2 per year)
Glucagon (auto-injection) (limit of 2 per year)
Tamiflu (limit of 10 capsules per year)
Relenza diskhaler (limit of 1 diskhaler per year)
Lovenox (limit of 7 days/14 injections)
Nicotrol Nasal Spray (limit of 3 inhaler kits per 30 days with a maximum of 360 days per lifetime)
How often is the preferred drug list changed?
Catalyst Rx only changes the preferred drug list on January 1st of each year.
Will I have to switch to a different pharmacy?
You should not have to as the Lovelace pharmacies, as well as the major chains, are in the Catalyst RX retail network. If your pharmacy is not in-network and would like to be, have the pharmacy contact Catalyst RX at 1-866-854-8851.
I went to the pharmacy on January 10th and they told me I was not showing eligible in the system?
Most likely it is because you have not provided your new Catalyst RX ID card. If you are providing your new ID card and still being rejected as ineligible, you will need to contact Catalyst RX at 1-866-854-8851.
Where can I find out what pharmacies are in-network?
Can I get a 90 days supply for the mail order copay at a Walgreens retail network pharmacy?
No. Even though the mail order is through Walgreens Mail Service, the cost to Sandia will typically be lower for mail order purchases than through the Walgreens retail network pharmacy. This is because the mail order pharmacy is purchasing bulk quantities from manufacturers and can receive better pricing.
How do I know what to put in my Health Care Flexible Spending Account for my mail order prescriptions?
Contact Catalyst Rx at 866-854-8851 as they will be able to provide you with the cost based on the day you call which will give you an idea of what your cost will be for the year. As always, it is recommended that you be conservative with your Health Care FSA.
Mail Service Program FAQ's
Who provides mail order services for Catalyst Rx?
Catalyst Rx subcontracts the mail order program to Walgreens Mail Service located in Arizona.
I accidentally sent my mail order prescription to CIGNA after 1/1/09? What will happen?
CIGNA will forward any prescriptions they receive after 12/31/08 to Walgreens Mail Service for processing.
I had a prescription on file with CIGNA that I can refill in January. What is the process to refill a prescription through Walgreens?
If you have prescription refills remaining through CIGNA, these prescriptions will be transferred to Walgreens Mail Service for you. After you have registered as a Walgreen’s customer, you will need to call the Catalyst Rx Customer Service Department in order to initiate a refill of the transferred prescription. Your refill will not be mailed automatically. To speak with a Customer Care Representative to order a refill of a transferred prescription, please call 1-866-854-8851 and select Option 2. Note: For the initial refill, you must call Monday through Friday from 6:00 a.m. to 8:00 p.m. (MST) or Saturday and Sunday from 6:00 a.m. to 3:00 p.m. (MST) and speak with a Customer Care Representative. You cannot order your initial refill through the voice response system or via the internet as the CIGNA prescription numbers will not be the same in the Walgreen’s system. Please note that certain types of medications cannot be transferred and therefore require a new prescription. These include compound medications, controlled substances, and expired prescriptions, as well as prescriptions without remaining refills and future-fill prescriptions (e.g. prescriptions previously sent to and which are currently being held by your current mail order vendor until eligible for fulfillment). If your current prescription has run out of refills, please obtain a new prescription from your physician and then submit it to Walgreens Mail Service.
How do I register to use the Walgreens Mail Service?
To begin receiving prescriptions through Walgreens Mail Service, you will need to register as a first-time Walgreens customer. You can register one of three easy ways – in writing, via the internet or by telephone.
By Mail: IIn your welcome packet, you will receive the Walgreens Mail Service Registration & Prescription Order Form which will establish your health, allergy and plan information with Walgreens. Upon receipt, please complete this form and send it to Walgreens Mail Service in the self-addressed envelope provided. When completing this form, please make sure that you put the member identification (ID) number that is printed on your prescription ID card on the form.
Online: You may also register online. To log on, go to the “Members Login” box and simply enter your member ID number (located on your prescription ID card), date of birth, and enter SANDIA in the Rx group number box and click “Login.” Next, click on “Mail Service Refills” and then the Walgreens Mail Service link located on the right side of the screen.
By Telephone: You may also register by calling Catalyst Rx at 1-866-854-8851 and selecting Option 2 to speak with a Customer Care Representative Monday through Friday from 6:00 a.m. to 8:00 p.m. (MST) or Saturday and Sunday from 6:00 a.m. to 3:00 p.m. (MST).
What do I do if I need to start taking a medication right away and want to do mail order?
Have your provider write you an initial prescription of 30 days and another one for a 90 day supply with three refills. Take the 30 day prescription to a retail network pharmacy and submit the 90 day supply prescription to Walgreens Mail Service.
I registered with Walgreens Mail Service but they did not send my refill prescriptions to me?
Because Catalyst Rx cannot assume you want your refill prescriptions immediately, after you have registered as a Walgreen’s customer, you will need to call the Catalyst Rx Customer Service Department in order to initiate a refill of the transferred prescription. Important: Your refill will not be mailed automatically.
Since prescriptions obtained at mail order is moving to coinsurance, how do I know what my copay will be to send in with my prescription?
The best way to obtain medications through the mail order is to call Catalyst Rx and put a credit card on file. To get an estimate of what your medication will cost, you can visit www.catalystrx.com. After logging in with your username and password (after 1/1/09), you can then click on the link to the “Drug Pricing Center,” and enter your zip code.” Hit submit. Select "price at mail service." After you enter your specific medication information and click “Price,” the system will return your cost based on that days information. You can also, contact Catalyst Rx by telephone at 1-866-854-8851 and any of the representatives can assist you. Some of your drugs may go down in cost and others may go up. Note that there are many medications that will be at the minimum copay and many at the maximum copays. According to Catalyst Rx, the cost of your medications should not fluctuate very much from month to month.
ID Cards FAQ's
What do I do if it is January and I haven’t received an ID card?
You need to contact Catalyst Rx at 1-866-854-8851 to request one.
How many cards will I get?
You will receive one if you have single coverage, and two if you have family coverage. If you need more cards, you can either call Catalyst Rx or request more through their website (after 1/1/108).
Specialty drugs are drugs used to treat complex, chronic conditions and usually require special handling and/or monitoring. They include drugs used to treat arthritis, growth hormones, hemophilia, hepatitis, multiple sclerosis, cancer, etc. Refer to the Specialty Drug List on this website.
Am I required to get my specialty drug through the Specialty Drug Management Program? I’m used to getting a 90 day supply through mail order with Walgreens Mail Service and would like to continue?
Yes. This is a new requirement. You will only be able to get a 30 day supply at a time for the brand name copayment that is in place at the retail pharmacy and you must go through the Walgreens/MedMark specialty drug pharmacy. Since these drugs are expensive, most likely you will pay the maximum copay of $40 every 30 days as these drugs tend to be preferred brand name.
Can a member get a specialty drug at the on-site pharmacy?
No. Specialty drugs can only be received through the Specialty Drug Management Program.
I work every day – how am I supposed to get a specialty medication at home?
If you are unable to be at home and need a specialty drug mailed to you, you can call the specialty pharmacy (Walgreens/MedMark) at 1-866-823-2712 to inquire about having your drug shipped to a local Walgreens pharmacy for pick up.
Is insulin a specialty drug?
No.
Why did Sandia implement this?
Sandia’s specialty drug spend is 12% of the drug costs. Many employers are implementing these programs as a way to control costs as more specialty drugs come to the market. This Program will help eliminate waste and allow Sandia to receive better discounts on the drugs purchased. In addition, members will have access to experienced pharmacists to assist with counseling.
What happens if I send in a new specialty drug prescription to the Walgreens Mail Service by accident?
The prescription will be forwarded to the Walgreens/MedMark specialty pharmacy for processing.
I get a specialty drug that is given to me in my doctor’s office – what is the procedure for these?
The process won’t change for these. The provider will send in the bill to your medical carrier (UHC or CIGNA) and it will be covered under the medical benefits portion of your medical plan.
Is the Walgreens/MedMark Specialty Pharmacy the same as the Walgreens Mail Order?
No. The Walgreens/MedMark Specialty Pharmacy is located in Carnegie PA. The number is 866-823-2712.
How will the specialty pharmacy program work?
When you send your prescription into the specialty pharmacy, you will be contacted by the pharmacy. They will go over how to use the medication with you and address any questions you may have. They will then ask you what date you would like to receive your medications. They overnight the medication, at no cost to you, via UPS or Fed Ex. If the drug requires, they will pack it in dry ice. Some medications require a signature. The pharmacy will work with you on this. If you are not able to be home, you can ask them to have it shipped to a local Walgreens pharmacy for pick up. If the medication does not require a signature, UPS or Fed Ex will leave it at your doorstep. If you are uncomfortable with that, you can request that they send it with signature required. A couple of weeks before your next refill due date, the pharmacy will contact you to discuss your next shipment. The prescription will not be shipped until they can speak to the member to verify receipt.
Website FAQ's
Will my prescription history from CIGNA be reflected on the Catalyst Rx website?
Unfortunately, this is not possible. The only information that is transferred to Catalyst Rx is for mail order refills, however, this is only for refill purposes and will not populate the website.
When can I logon to the Catalyst Rx website with my member ID?
Not until January 1st. You will need the group # (SANDIA) and your unique member ID number. Until then, you can logon to the Sandia specific website by using SNL as the user id and password.
I went to the Catalyst Rx website and put in a drug that is an injectable. It didn't come up for me to know what my copay is. Does that mean it isn't covered?
Due to variation in coverage, the Catalyst Rx website may not reflect all covered drugs, especially if it is an injectable. If your drug does not come up, call the Catalyst Rx Customer Service Department at 866-854-8851 to verify coverage.
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