Notice: Changes are coming to your pharmacy administration

[Date]

Dear [Recipient],

Beginning January 1, 2017, [Company Name Redacted] Insurance Company is enhancing its pharmacy administration for your preferred provider organization (PPO) or out-of-area (OOA) plan. As a result, you may notice some changes when you fill a prescription at a MedImpact pharmacy.

MedImpact will oversee your drug formulary (the list of drugs covered by your plan), which will remain open. This means your formulary will continue to include all FDA-approved drugs currently on the market.

What’s changing

Your prescriptions may now require certain utilization reviews, including:

Prior authorization
Step therapy
Quantity limits
Age edits

While these programs are intended to promote safe and effective drug use for all members, they may cause certain limitations in getting your prescriptions. MedImpact pharmacies will work directly with your doctor to get the information needed to process your prescriptions.

Your out-of-pocket costs

There will be some changes in the categorization of certain medications (generic, brand, and specialty). If your prescription categorization changes, you may need to pay less or more than what you’ve paid in the past.

You probably won’t see any changes to your current prescriptions. However, if they’ll be affected by the utilization review process or additional out-of-pocket costs, MedImpact will reach out to you directly at the end of December.

Expanded services

If you have diabetes, you’ll now be covered for diabetic testing supplies at participating MedImpact pharmacies, as well as through your health care provider.

Flu shots at MedImpact pharmacies will also be covered, though you can still use your health care provider, if you prefer.

To find out more

MedImpact’s new role with us is part of our commitment to making pharmacy services safe and convenient for you and your family. For more information, read the enclosed Drug Formulary Frequently Asked Questions. You can also call the Customer Service line at 1-800-XXX-XXXX, Monday through Friday, from 7 a.m. to 7 p.m.

Sincerely,

[Name Redacted] Insurance Company