YOUR OPTUMRx PRESCRIPTION DRUG BENEFIT
(All Active and Non-Medicare, Pre-65 Eligible Participants)
Refill Too Soon. Effective immediately, in consideration of the COVID-19 situation, the DC 37 Health & Security Plan requested and OptumRx has agreed to immediately lift the “Refill Too Soon” restriction on covered drugs until further notice. Drugs with significant abuse potential (i.e. opioids) or those that are generally dosed for finite durations or intermittently (i.e. hepatitis or fertility treatments) as identified by OptumRx will follow the normal process for renewals.
Prior Authorizations Extended. OptumRx has also agreed to extend Prior Authorizations (PAs) for member medications that are set to expire on or before May 1, 2020. This policy went into effect March 18, 2020. For chronic condition medications, OptumRx will extend PAs for an additional 90 days past May 1, 2020. OptumRx, in consultation with the DC 37 Health & Security Plan, will continue to re-evaluate the need for further extensions.
Prior authorization requirements for newly prescribed medications will remain in place.
Specialty Drug Considerations. During the COVID-19 outbreak, when an existing patient calls to refill their specialty medication, OptumRx Specialty Pharmacy will offer patients a one-time, 90-day supply of key specialty medications instead of the traditional 30-day supply.
This policy will not apply to patients newly initiating specialty therapy, or drugs within the following categories which will remain limited to 30-day supply only: (1) acute medications; (2) Controlled substances; (3) Drugs subject to REMS programming requiring 30 day dispensing and monitoring; (4) Drugs with limited expiration dating; (5) Drugs where storage/handling issues would increase risk of waste; (6) Office-administered more than once monthly; and (7) Drugs whose monthly ingredient cost exceeds $10,000.
Will medications used to treat COVID-19 be covered by the DC 37 H&S OptumRx drug plan? Medications used in supportive care for the treatment of COVID-19 will likely be covered per the member’s current City health benefit plan. Members should check with their health plan for this information.
While there is no current treatment other than supportive care, OptumRx is monitoring the use of anti-viral products and the production of a vaccine and will continue to aggressively monitor CDC recommendations and outcomes of clinical studies.
YOUR AETNA/SILVERSCRIPT PRESCRIPTION DRUG BENEFIT
(All Medicare Eligible Retirees)
Effective immediately, and to ensure the needs of our retirees during this crisis are being met. the DC 37 Health & Security Plan requested and Aetna/SilverScript has agreed to lift the following restrictions on covered prescription drugs for the next 90 days: Refill-Too-Soon, Prior Authorizations, Quantity Limits and Specific Drugs with 30-day limits.
For those retirees who are using CVS, you may request free home delivery not only for your medications but for all merchandise that you may purchase at CVS. You may call your local CVS for delivery and further information.
MELS (Municipal Employees Legal Services)
During this time, MELS and its attorneys are continuing to provide legal assistance to our DC 37 participants. Please call the MELS Intake Telephone Line at 212-815-1111 with any questions about pending legal matters or for assistance with any new COVID-19 related legal matters.
Personal Services Unit (PSU) – Telephone Counseling Available
PSU will continue to provide short term telephone counseling for personal issues, work-related concerns, and provide referrals as needed. Social workers are also available to provide stress management techniques and assist members coping with the emotional stress related to COVID-19. Please call the PSU Screening hotline at 212-815-1250.
**IMPORTANT – PLEASE READ BELOW **
DC 37 Health & Security Plan Services Impacted by COVID-19
DC 37 Dental Centers Closed
Given our concern for your well-being and following the recommendations of the American Dental Association and NYS Department of Health, both the Manhattan and Brooklyn Dental Centers are closed until further notice. All appointments will be rescheduled when we resume operations. Starting Monday, March 23, 2020, both Dental Center locations at 115 Chambers Street and 186 Joralemon Street are physically closed.
Dental Center Staff will be available via telephone to consult on Dental Care Emergencies. Members with Dental Care Emergencies can call 212-766-4440, ext. 102 to leave a message to speak to a Dentist or ext. 123 to leave a message to speak to a Supervisor. Our Dental Center staff will be regularly checking these two telephone extensions throughout the day and returning voicemail messages.
Audiology Services Suspended
All Audiology Services have been suspended effective Monday, March 23, 2020 at our current location (55 Water Street). As soon as we resume operations, we will reschedule all March and April appointments as quickly as possible. We will not be scheduling any new Audiology appointments for the month of May until operations restart. Please check this website for future updates. To speak to an Audiology Services representative, please call 212-791-2126.
Optical Voucher Requests on Hold
DC 37 Health & Security Plan Optical Vouchers will not be processed or mailed to participants until further notice. Please hold all requests for Optical Vouchers or voiding of Optical Vouchers at this time. We will be working with our Optical Providers to extend the length of existing Optical Vouchers and/or reissuing new Optical Vouchers when we resume operations at 55 Water Street.