Pharmacy Benefit Managers (PBMs) administer prescription drug programs and serve as an intermediary between employers and wholesalers. PBMs help develop formularies, negotiate discounts and rebates, process prescription claims, provide support for clinical services and customers, contract and manage pharmacy networks, and deliver management reports.
PBMs have two main goals:
1. Reduce costs within prescription benefits plans
2. Increase access to appropriate medications to deliver better health outcomes
List of approved drugs used to treat patients in a drug benefit plan. Products listed on a formulary are covered for reimbursement at varying levels.
There are three common types of formularies.
- Open: Nonformulary products are covered at a defined level in the benefit.
- Closed: Nonformulary products are not covered for reimbursement in the benefit.
- Incented: Formulary products are classified for reimbursement by product type including brand, generic, specialty, lifestyle, preferred, and nonpreferred. Incented formularies are increasingly popular because, when aligned with rational cost sharing levels, they help drive utilization to the lowest net cost drugs.
Prior authorization means that you must receive approval before you can receive certain drugs.
PRESCRIPTION DELIVERY SERVICE
The WellDyneRx Prescription Delivery Service is a convenient and cost-effective way to order up to a 90-day supply of medicine for delivery to a home or business. This helps to avoid having to visit a local retail pharmacy each month and save money on prescriptions.
WellDyneRx’s Prescription Delivery Service is convenient for members who regularly take medicines for chronic, long-term conditions such as high blood pressure, high cholesterol, and diabetes.
WellDyneRx recommends obtaining a new prescription from a health care provider when transferring to the WellDyneRx Prescription Delivery Service. Members must register online, or complete the Prescription Delivery Service registration form and mail it to WellDyneRx, before a prescription can be filled.
A doctor writes your prescription for the number of days a plan allows for mail service (for example, 90 days).
Prescriptions are received approximately 7 to 10 business days after WellDyneRx receives an order. To check the status of an order, one would sign in to an online account or call our automated phone system.
It’s our priority to ensure members have the medicine they need, when they need it.
WellDyneRx will call or email with a refill reminder, allowing enough time to order before a current supply is finished. Then, a member needs to request a refill online through the WellDyneRx member portal, or call our automated phone system to place an order for the medication.
Refills are easy. Members can order online through the WellDyneRx member portal or through our automated phone system. A payment card on file will be charged for the medication order.
Yes, WellDyneRx will send a generic equivalent when available unless otherwise noted by a member or doctor, or restricted by federal or state law. Since the brand name product may require a higher copay (based on plan), we recommend that a member contact WellDyneRx for copay pricing before an order is placed for a brand.
Yes. Copays apply to Prescription Delivery purchases, but since Prescription Delivery orders usually include a three-month supply, the result is fewer refills throughout the year and increased savings. A member must check their plan information for copay details.
Prescription Delivery Service orders are sent via first class U.S. Postal Service. If a choice is made to have medicines rush ordered, additional costs will apply and vary by shipping method. All orders are shipped in unmarked, tamper-proof packaging to ensure security and complete confidentiality. If necessary, WellDyneRx will use insulated and temperature-controlled packaging to ensure the integrity of the medicines.
Yes. Pharmacists are available to answer questions regarding prescriptions medicines 24 hours a day, 7 days a week.
No. Legally, WellDyneRx is allowed to accept faxed prescriptions only from a doctor.
Yes. A doctor can send the prescription electronically to WellDyneRx Prescription Delivery Service.
Yes. We ask for some personal information when setting up accounts, and we keep this information completely private. We use this information to ensure the members receive the best care possible.
PRESCRIPTION BENEFIT COVERAGE
A benefit program may have multiple medicine categories, or tiers, that determine a copay. Members must check their plan information to see which tiers are included in the plan. Typical copay tiers for WellDyneRx benefits are:
- Tier 1 drugs are typically generic drugs and have the lowest copay.
- Tier 2 drugs include preferred brand drugs and cost more than Tier 1 drugs.
- Tier 3 drugs are typically non-preferred brand drugs, and they have the highest cost medicines.
- Your plan may have additional tiers for specialty drugs or drugs that treat non-life threatening conditions. The copay for these tiers may be more or less expensive, depending on the plan.
You can see which tier a medicine is in by checking WellDyneRx’s Formulary and Drug Alternatives List.
Some medicines are excluded from the formulary in order to help control overall health care costs. A member can call the member services number (shown on the member’s ID card) if a drug is not listed on the plan’s formulary.
Yes, WellDyneRx will fill OTC medicines if the medicine is covered by a prescription benefit plan and the doctor has written a prescription for the OTC medicine.
The biggest advantage of using a generic is price. On average, the cost of a generic drug is 80 to 85 percent lower than the brand name product.
The FDA thoroughly tests each potential generic drug to make sure it is effective and safe. To gain FDA approval, a generic drug must:
- Contain the same active ingredients as the original brand drug
- Be identical in strength, dosage form, and how it’s taken
- Be used to treat the same conditions and have the same dosing and labeling
- Provide the same effectiveness and safety to patients
A generic drug often has a different color or shape than the brand name drug. These differences don’t have any effect on how the drug works-they help distinguish one product from another.
No. When new drugs are introduced by a company, they have a patent. The patent protects the company by not allowing anyone else to make and sell the drug. Most drug patents are protected for 17 years. When the patent expires, other drug companies can start selling the generic version of the drug. But first, they must test the drug and the FDA must approve it.
The member can ask their doctor if a generic drug is available and appropriate for them. If it is, a doctor can write the prescription so the pharmacist knows to give the generic when available.
It depends on the doctor. A member can ask the doctor to write a prescription that allows a generic drug when appropriate. Also, a member can ask the doctor whether a generic drug will be as effective and less costly.
Yes, WellDyneRx will send a generic equivalent when available unless otherwise noted by the member or the doctor, or restricted by federal or state law. Since the brand name product may require a higher copay (based on the plan), we recommend that a member contact WellDyneRx for copay pricing before an order is placed for a brand.
U.S. trademark laws don’t allow generic drugs to look exactly the same as another drug already on the market. For that reason, the color and shape of a generic pill may be different from the brand name. Sometimes it will have a different coating or flavor. Differences in taste or appearance do not affect the drug’s safety or effectiveness.
Generic drugs are versions of brand drugs that become available when the brand drug’s patents expire. When a drug patent expires, the original manufacturer does not have exclusive rights to produce the medicine. Other manufacturers can apply to the FDA to produce and sell generic versions of the drug. Because of lower research costs and more competition, the generic drug usually costs less than the brand name drug. Many brand name manufacturers or their subsidiaries make generic medicines.
Before a generic drug is approved for use in the U.S., the drug company must prove to the FDA that the generic drug has the same active ingredient as the brand name version. In addition, the generic must meet FDA standards for the amount of active ingredient and how much of it is absorbed into the body.
The role of the FDA is to ensure all new brand and generic drugs are safe and effective. The FDA requires generic drug manufacturers to:
- Meet the same requirements for strength, purity, and quality as the original manufacturer
- Follow the same strict manufacturing practices
If there are questions, a member can visit the WellDyneRx member portal or call the Member Services number shown on their member ID card.
To ensure the safety of your medicine, WellDyneRx only purchases from manufacturers and wholesalers that are licensed and approved by the FDA to conduct business and distribute medicines in the United States.
WellDyneRx complies with patient privacy regulations and requirements set by the Health Insurance Portability and Accountability Act (HIPAA).
If a member would like WellDyneRx to discuss and/or release their protected health information to another person or entity, they must authorize us to do this by completing a Protected Health Information Authorization Form.