A Pharmacy Benefit Manager (PBM) is a third-party administrator of prescription drug programs for insurance carriers. Senior Care Plus has contracted with Optum RX to manage our Medicare prescription drug program.

PBMs are responsible for making sure medications are available at an affordable price and that members have access to the right medications. They support Senior Care Plus by doing the following:

• Process and pay Rx claims
• Purchase and dispense medications (Mail and Specialty pharmacies)
• Manage the drug formularies
• Manage the pharmacy networks

For 2024 and beyond, we selected Optum Rx as our new Pharmacy Benefit Manager to support administration of pharmacy claims and manage our retail pharmacy networks. Optum Rx is one of the top PBMs in the nation and their goal is to help us enhance the value of our pharmacy and prescription drug programs for our members.

Member benefits will not change as a result of this transition.  That means,  as a result of switching to Optum, we were able to keep the member cost share of each tier the same in 2024 as they were in 2023.

The change will take effect January 1, 2024. Preparations are well underway to manage the change. We’re working diligently to ensure a smooth transition with no disruption to our members.

We’re making this change to improve flexibility and advance innovations resulting from stronger pharmacy administration technology. We’re excited about this new relationship that is already strengthening our ability to support the unique needs of our groups and members, improve the customer experience and enhance our creative solutions to improve health care in our communities.

• Overall Drug Expenses for the health plan will be reduced, which helps keep our plans affordable for you.
• Continued nationwide access to a robust pharmacy network  – Optum Rx has more than 65,000 participating pharmacies nationwide including CVS and Walgreens
• Advanced digital tools that will enhance member experience
• Our unwavering commitment to delivering value through true integrated pharmacy and medical benefit management
• Senior Care Plus will work to create a seamless experience for our customers, members, and healthcare providers during this transition.

Yes, Senior Care Plus worked with Optum Rx to create a co-branded web portal specifically for Senior Care Plus members. You can access it here: Optum Rx / Senior Care Plus Pharmacy Benefit Portal

We’ll use a combination of letters, email, and other communication outreach channels to tell members important details about the switch to Optum Rx. Included in these communications will be options for home delivery pharmacies, and changes and improvements to the pharmacy pages in their online MyChart accounts. Your new ID card with updated prescription drug information will be mailed in December so all members have their updated card prior to 2024.

Much of the communication set to go out to members is information about changes that may affect them specifically. The intent is to minimize disruption of member’s access to the medications they use by sharing any required changes in advance. We want to give members ample time to work with their doctors or pharmacies to make the necessary changes.