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Endowed Health

Endowed Three-Tier Prescription Drug Plan through Medco

Medco.com
2009 Medco Co-Pay Chart 2010 Medco Co-Pay Chart
Medco Questions and Answers
Medco Coverage Review and Prior Authorization Process
Medco Home Delivery Order Form
Medco Reimbursement Claim Form

Medco is one of the most experienced full-service pharmacy benefit management firms (PBM) in the nation. Medco contracts with pharmaceutical manufacturing companies and pharmacies to make sure that we are receiving the most competitive prices and discounts for prescription drugs, helping both the university and our faculty, staff and retirees save on prescription drug costs.

Medco has a broad network that includes more than 58,000 pharmacies nationwide, a convenient home-delivery service for easy ordering of refills, a full complement of Internet services on Medco's website, sophisticated drug use checks and balance, a 'round-the-clock clinical hotline for patients and well-trained member service representatives.

If you are a participant in any of the endowed health care plans administered by HealthNow or Aetna, you will be covered by the Medco prescription drug program. You need to use your Medco ID card for all of your prescription drug purchases. HealthNow and Aetna will not be authorized to service your claims at the pharmacy counter or by mail order. Remember, you will still need to use your Aetna or HealthNow ID card to receive all other medical services.

Walgreens pharmacy does not participate with Medco. If you purchase a prescription from non-participating pharmacies, you will pay more. You can call Medco's Member Services at (800) 230-0508 or log on to Medco's website to find out whether a particular pharmacy is participating.

To find out if the medication you are taking is on Medco's Formulary, you can call Medco's Member Services at (800) 230-0508. Member Services will be able to help you determine if your medication is on Medco's formulary list and if the medication is on the 1st, 2nd or 3rd tier.

Up to 30 days of medication at your local participating pharmacy will cost you $5 for generics (1st Tier), $25 for drugs on Medco's formulary (2nd Tier), and $45 for drugs not on Medco's formulary (3rd Tier). Cornell pays the rest.

You can access Medco's Formulary if you are not yet enrolled in an Endowed Health Plan by following the instructions below:
1) www.medco.com
2) On the left side of the screen, click on "Clients"
3) Next screen, scroll to the bottom and click on "Interactive Preferred Prescriptions Formulary Tool"
4) Enter medication name (minimum of four letters required), then click on "Select"
5) You will be provided with the drug name, available dosage, formulary status and whether the drug is generic or brand name.
Contact Medco at (800) 230-0508 with questions.

Key to Reading the Formulary
Generic drugs are shown with a “circle” and mean the drugs fall under the 1st tier
Approved drugs are shown with a “check” and mean the drugs fall under the second tier
Non Formulary drugs are shown as “NF” in an octogon shape and mean the drugs fall under the 3rd tier

Prior Authorization
Some medications are covered by your plan only for certain uses and require prior authorization. The pharmacy will let you know if your health plan requires additional information. You or the pharmacy can then ask your doctor to call a special toll-free number. This call will initiate a review that typically takes 1 to 2 business days. Once the review is complete, Medco will notify you and your doctor of the decision. You always have the right to appeal any decision. Refer to the Medco Coverage Review and Prior Authorization Process, Speciality Medication and Personalized Medicine or call Medco at (800) 230-0508.

If you purchase a prescription from a participating provider but do not have your Medco ID card to present to the pharmacist, you can still pay the applicable copay if you know your Employee ID number, the Rx Group Number (which is "Cornell") and tell this information to the pharmacist. Be sure to let the Pharmacist know that Medco is the insurer. If you do not provide this information, you will have to submit the claim to Medco for reimbursement. You will be reimbursed at 100% less the applicable copay.

If you purchase a prescription at a non-participating pharmacy, you will pay more than if you purchased your prescription at a participating pharmacy. You will be reimbursed at 100% of the Medco negotiated rate, less the applicable copay. You will also need to submit a claim form to be reimbursed from Medco.

Medco's Home Delivery Pharmacy
If you are taking medication for a chronic ongoing medical condition, you may want to consider using Medco's Home Delivery Pharmacy to purchase your prescription medications. You will pay $10 for generics, $50 for drugs on Medco's formulary and $75 for drugs not on Medco's formulary for up to a 90-day supply.

You will save money relative to using retail pharmacies by using the home delivery plan. In addition, you'll save time with the convenience of home delivery. Your initial prescription will be delivered within 10 to 14 days of your call. Refill orders can be ordered online and delivered within seven days.

Let your doctor know that you have a home delivery prescription drug program and that you would like to have the maximum supply of medication (usually 90 days) plus refills for up to one year. You may mail your prescription(s) in Medco's special home delivery order envelopes or ask your doctor to call (888) EASYRX1 (888-327-9791) for instructions on how to fax the prescription. If your order is faxed, your doctor must have the member number (Employee ID number, not your Social Security number) from your Medco ID card.

To check on the status of an order, you may call Medco member services or find out over the Internet. You can find out the date your prescription was received, the status of your order, the date your prescription was mailed to you, and other billing and timing data.

If you would like to order online, you can do this through Medco's Home Delivery Program. You can order online anytime, or call (800) 4REFILL (800-473-3455) and use the automated telephone system. You can also mail in your refill orders by using the special home delivery envelope. If you order by phone or via Medco's website, you will need to provide your member number and the 12-digit prescription number found on the medication container and the refill slip.

If you need to order home delivery envelopes or retail claim forms, you can do this online also. Or if you prefer, you can call your Member Services toll-free number at (800) 230-0508 to use the automated telephone system. The requested materials will be mailed to you right away.