This notice was first published in the June 20, 1995 issue of Almanac. If you have any questions or if you have not received your PCS ID card, please contact the Benefits Office at (215) 898-7282 immediately.
Effective July 1, 1995 prescription drug benefits--including those associated with the drugs dispensed and billed separately during a doctor's visit--will no longer be provided through Blue Cross.
Prescription drug coverage for employees and their covered family members currently enrolled in a Blue Cross plan (or in the new PENN Care plan) will be provided by PCS Health System, Inc. through its Client- Based Network (CBN). This network includes all the pharmacy chains in the Philadelphia area.
PCS has four national pre-contracted networks of chain and independent pharmacies. The University has selected the Client-Based Network, currently the most cost-effective PCS network, as the preferred network. The Client-Based Network is comprised of more than 47,000 nationwide pharmacies including all the major pharmacy chains: CVS, Drug Emporium, Eckerd Drug, Kmart, Pathmark, Rite-Aid, Thrift Drug, and Wal- Mart. Call PCS at 1-800-838-5346 to find out if your pharmacy is a participant of the Client-Based Network. (For your convenience, this 800 number is printed on your ID card.)
Pharmacies that are affiliated with PCS generally display a light-blue PCS decal. For the independent pharmacies, the decal is not an automatic indication that the pharmacy is part of the University's Client-Based Network. Be sure to ask the pharmacy if it is in the Client-Based Network or call the 800 number.
Unless you just enrolled in a Blue Cross plan or PENN Care, you should have received your PCS ID card and a CBN directory by now. An additional card was generated if you have family coverage. Data on all eligible dependents will be maintained by PCS and accessed on-line by their participating pharmacies.
When you use your PCS ID Card and purchase covered prescription drugs from a PCS Client-Based Network pharmacy, your $200 single/$400 family Blue Cross/PENN Care deductible will be waived. You pay the pharmacist only your 20% coinsurance; for prescriptions related to mental health the coinsurance remains 50%.
+ If you do not use a Client-Based Network pharmacy, in addition to your applicable Blue Cross deductible you will now incur a separate prescription deductible of $25 for single/$50 aggregate for family and you will be reimbursed only 75% of the charge.
Expenses incurred out of the country:
You will NOT be subject to the separate prescription deductible and the lower reimbursement rate if you incur eligible prescription expenses out of the country. In those cases, you will need to file a claim with PCS. PCS will waive the $25/$50 deductible and reimburse you at 80%.
Unlike Blue Cross's Paid Prescription program, you will not need to pay the full amount and then wait for reimbursement. At PCS participating pharmacies, you will only be required to pay your share of the coinsurance.
At all PCS participating pharmacies, you will have to pay only your share of the cost. At PCS Client-Based Network pharmacies, your cost will be the 20% coinsurance unless the prescriptions are prescribed for mental health. At all other PCS participating pharmacies, you will have to pay any portion of the separate $25 prescription deductible that remains unsatisfied and 25% of the remaining expense.
Claim filing will be required only if you do not use a PCS pharmacy. These forms and filing instructions can be obtained from the Benefits Office at (215) 898-7282.
Be sure to file a Major Medical Blue Cross claim form for any prescription expenses incurred before July 1, 1995. Remember that you need to file only for those expenses that will not automatically be reimbursed because you did not present your Blue Cross ID card to your pharmacist.
The Hospital of the University of Pennsylvania (HUP) Pharmacy:
(The pharmacy is located on the Ground floor of the Ravdin Building)
Under a special arrangement, the HUP pharmacy has been added to the PCS's Client-Based Network. If you use the HUP pharmacy for prescriptions written either by HUP doctors or non-HUP doctors, your deductible is waived and you pay only 20% for covered non-mental health prescription drugs.
HUP pharmacy also provides special services to Penn employees including calling in refills and faxing in refills or new prescriptions. TEL: (215) 662-2920; FAX: (215) 349-8340.
Coordinating Benefits with Blue Cross Employees who during the plan year meet the applicable out-of- pocket Blue Cross/PENN Care maximums for medical expenses other than prescription costs will need to notify the Benefits Office for the waiver of any applicable PCS coinsurance cost. The Benefits Office will be working with Blue Cross on the coordination and reviewing possible plan design alternatives for next year.
Retiree Benefits: For now, retirees age 65 or over and their dependents age 65 or over who are enrolled in the Blue Cross 65-Special contract will continue to receive the prescription coverage through Blue Cross.
Retirees under age 65 and retirees' dependents under age 65 who are enrolled in a Blue Cross non-65 Special contract are affected by the change.
-- Benefits Office/Human Resources