Express Scripts will become the PBM for all Medica members starting January 1, 2020.
To enhance quality outcomes for members while achieving greater cost efficiencies.
The pharmacy can contact the Express Scripts Pharmacy Help Desk at 1-800-922-1557 (toll free) to request participation in the network.
Yes. Starting January 1, 2020, Medica’s List of Covered Drugs (formulary) will change as a result of the new PBM. Some members will see changes in their prescription coverage for certain drugs and supplies. These members will receive a letter in the mail explaining the drug list change and include covered alternative options.
Medica will continue to update drug lists on medica.com on a monthly basis. Until they are reviewed and approved for drug formularies, new drugs will be either pended (won’t adjudicate until reviewed) or placed on tier 3 (non-preferred for retail; specialty tier 2 non-preferred for specialty products).
There will be a new List of Covered Drugs (formulary) for all members on January 1, 2020. Medica will begin mailing impacted members coverage change notifications in October 2019, and will continue through the end of the year.
There is one BIN (003858) for all Medica members. However, the PCN and RX Group numbers vary by membership.