Changes Effective Oct. 1, 2018
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TAC HEBP Standard Formulary
TAC HEBP's size enables extremely competitive prescription pricing. This helps stabilize and ultimately lower premiums for our members. The Pool uses a separately contracted prescription drug program with Navitus Health Solutions to provide excellent services and keep drug costs in check.
Navitus has several features designed to help contain costs for members and improve patient prescription drug access.
Maintenance Medication Retail-90 and Mail Order — TAC HEBP and Navitus offer members a savings of one-third of the co-pay for a 90-day prescription, either at any retail pharmacy within the Navitus network or through the Costco mail order pharmacy. You do not have to be a Costco member or go to a Costco location to use the mail order service. This is offset in cost because of the increased drug discount and decreased administration fee. Retail-90 and Mail Order can reduce out-of-pocket costs and save time for our members.
Medicine Match — Members who participate in the BlueCross BlueShield of Texas (BCBSTX) Condition Management program receive a 50 percent discount at point-of-sale (retail or mail order) on maintenance medications for the following conditions: diabetes, high blood pressure, high cholesterol and asthma.
Tablet Splitting — For certain drugs that come in tablet form and are identified as appropriate by Navitus' clinical team, members can save money by filling a prescription for a higher dosage, then splitting the tablet to essentially double the quantity of medication received.
Specialty Drug Management — Prior Authorization guidelines for specialty drugs help to ensure that members meet the appropriate criteria before these medications are first dispensed, experience the expected therapeutic outcomes while on therapy, and discontinue unsafe or ineffective therapy. The program also encourages providers to prescribe clinically-effective therapies at the lowest net cost via step therapy. Step therapy recommends the provider prescribe a more expensive medication for the member. Many specialty medications will also be subject to quantity limits, so that therapeutic value can be established and to minimize waste. Navitus considers current evidence-based guidelines, drug efficacy, FDA-approved indications, safety profile and prescribing patterns.
Pharmacy Benefit Manager Services — At Navitus, teams of skilled physicians, researchers and analysts work together to find new and better ways to optimize the delivery of patient care. The services include enhancing drug therapy protocols, creating physician education models, forecasting therapeutic impacts of drug and finding better ways to address the health needs of specific populations.