Prescription Drug Program

Prescription drug coverage is provided under the UVa Health Plan as a covered benefit for employees and their eligible dependents. The Outpatient Prescription Drug program is administered by CatalystRx and covers certain medically necessary prescription drugs dispensed by licensed pharmacies with mandatory generic substitution. For enrollees with diabetes, the program also covers insulin, glucose meters, syringes, and lancets. For all prescriptions, if a generic drug is available, only the allowance for the generic is covered. If the physician prescribes a brand name drug, you must pay the brand copayment as well as the difference between the price of the generic and the cost of the brand name drug, which can potentially be a significant member expense, unless the brand is approved by medical necessity appeal with Catalyst Rx.

The prescription copayments for generic drugs (tier 1) are $6 for a 30-day retail supply and $14 for a 90-day mail order supply. Brand drugs purchased at a retail pharmacy have an annual deductible of $100. After the annual prescription deductible has been applied, the prescription coinsurance for a 30-day retail supply of a formulary brand drug (tier 2) is 20% of the cost of the drug with a minimum payment of $24 and a maximum payment of $100. A 90-day mail order supply of a formulary brand drug (tier 2) is 20% of the cost of the drug with a minimum payment of $56 and a maximum payment of $300. The prescription coinsurance for a 30-day retail supply of a non-formulary brand drug (tier 3) is 20% of the cost of the drug with a minimum payment of $48 and a maximum payment of $100 after the prescription deductible has been applied. A 90-day mail order supply of a non-formulary brand drug (tier 3) is 20% of the cost of the drug with a minimum payment of $112 and a maximum payment of $300.

If you fill a generic script at a pharmacy with a "$4 generic program", remember to present your UVa Health Plan Prescription Drug member ID card. The pharmacy will charge you the lower $4 copayment. It will also check your prescription history at Catalyst for potentially dangerous drug-to-drug interactions and allow your expenses to be applied to your deductible.

• Contact Catalyst Rx: Catalyst Rx Member Services Department is available 24 hours a day, 365 days a year at 877-629-3123. Catalyst’s website provides access to coverage, drug pricing, and pharmacy locations. Use UVAUVA123 as your ID and 07/01/1970 as your Date of Birth to gain access to the website during open enrollment.

• ID Cards: Participants will receive one set of ID cards and a welcome packet after joining the UVa Health Plan. The card will contain the name and ID number of the primary participant. All covered family members will use the same card and ID number. Additional cards can be requested by calling Catalyst Rx Member Services Department.

• Cost Calculator: Catalyst Rx’s website offers a variety of web-based features including locating a participating pharmacy and reviewing your plan’s benefits. It also allows you to search for lower-cost prescription alternatives and lists the cost-sharing for your particular prescription at each local pharmacy. View the Catalyst Price & Save Drug Pricing Center during open enrollment by accessing a sample account with UVAUVA123 as the ID and 07/01/1970 as the date of birth. This sample account assumes that your $100 brand retail deductible has been satisfied. It also allows claims for medications needing prior authorization or other clinical edits to price without rejection. The Price & Save tool includes $4 generic programs that exist at your local pharmacies when listing your cost-sharing amount.

• Catalyst Formulary: Catalyst RX Advantage Formulary identifies generic (tier 1), preferred brand (tier 2), and non-preferred brand (tier 3) drugs. See Catalyst Formulary for an abbreviated drug list which includes the most popular generic and preferred brand drugs.

• Catalyst Mail Service: Enroll in Catalyst's mail service pharmacy, IPS, by mail, online, or by telephone. Complete the IPS Registration and Prescription Order Form that was included in your Catalyst Welcome Packet, enroll online at www.catalystrx.com or phone Catalyst Rx at 1.877.629.3123 Monday through Friday from 8:00am to 10:00 pm EST or Saturday 9:00am to 5:00pm EST.

• Specialty Drugs: The Catalyst Rx Specialty Drug Management Program provides support and prior authorization for users of specialty drugs and dispenses these medications through Walgreens Specialty Pharmacy. Specialty drugs may also be filled at UVa's Barringer Outpatient Pharmacy. These drugs are used to treat complex and chronic conditions such as cancer, Hepatitis C, HIV/AIDS, multiple sclerosis, psoriasis, and rheumatoid arthritis. See Specialty Drug List to determine if you are currently taking one of the Catalyst specialty medications. This list is subject to change without notice to accommodate the introduction, removal and availability of new drugs and clinical information. Prescriptions written by UVa physicians that are filled at Barringer Outpatient Pharmacy cost the health plan a fraction of the cost charged by retail pharmacies.

• Clinical Programs: Catalyst Rx manages several clinical programs including Step Therapy, Quantity Limitations, Prior Authorization, and Diabetes Management Program.

  • Step Therapy requires members to try a preferred alternative before a non-preferred brand-name medication will be covered. Drug classes that require Step Therapy include those used for blood pressure, osteoporosis, sleep aids, nasal allergy, ulcer, antidepressants, growth hormones, androgens, atypical antipsychotics, and anti-migraine agents. See Pharmacy Utilization to view the list of drugs that require Step Therapy. If you have previously tried the generic or preferred brand-name medication and it did not work for you, your healthcare provider can request that a prior authorization be initiated.

  • Quantity Limits are based on FDA and manufacturer dosing recommendations and/or current literature. Quantities in excess of the established limits will require a Prior Authorization. The list is subject to change to accommodate new drugs and to reflect the most current clinical literature. The drug classes that have quantity limitations include ADHD/Stimulants, anti-nausea products, antidepressants, antipsychotics, blood pressure, cholesterol lowering medications, family planning/hormone replacement, flu agents, migraine products, nasal allergy, osteoporosis, pain management products, respiratory products, sexual dysfunction drugs, sleep aids, ulcer, and supplies. See Pharmacy Utilization to view the list of drugs that have quantity limits.

  • Prior Authorization ensures appropriate use of prescription medications. Medications subject to a PA require pre-approval from the Catalyst Rx Prior Authorization team before they can qualify for coverage. Drug classes needing pre-approval include acne medications for participants over age 18, ADHD/Stimulants for participants over age 18, raw bulk chemicals, compounds, many specialty drugs, and new drugs on the market less than 6 months. See Pharmacy Utilization to view the list of drugs that require prior authorization.

  • The Diabetes Management Program provides you with tools and resources to help you manage your diabetes. The Diabetic Sense program, administered by Liberty Medical Supply for Catalyst Rx, gives you access to Certified Diabetes Educators, registered pharmacists, and dieticians who can answer your questions about diabetic issues. You can also receive a 90-day supply of diabetes testing supplies delivered to your home at the mail order costsharing amount. Call 1.866.325.9036 or visit catalyst.libertymedical.com for help managing your diabetes.

---

Prescription Drug Summary Information

Catalyst Website - CatalystRx

Catalyst Customer Service - 1.877.629.3123

Links and Forms

• Mail Order Form

• Formulary List

• Speciality and Injectable Drug List

• Prescription Drug Claim Form

• Catalyst Mail Order Fax

• Prior Authorization Form

---