Empire Plan Prescription Drug Program Update

On January 1, 2006, Empire Blue Cross Blue Shield (BCBS) and Caremark replaced Cigna and Express Scripts as vendors for the Empire Plan Prescription Drug Program. The following information is current as of 3/6/06. 

State Comptroller Alan G. Hevesi announced the Department of Civil Service should conduct a new competitive bid for the three-year $4.9 billion contract for prescription drug coverage for Empire Plan enrollees. The selected proposal from Empire Blue Cross Blue Shield/Caremark did not meet bid requirements because after the initial submission, Empire Blue Cross was allowed to change its bid three times in order to meet mandatory requirements. This is a violation of contracting rules designed to ensure fair competition.

Under an agreement reached previously to prevent disruption of essential medical coverage for public employees, Empire Blue Cross/Caremark will continue to provide drug coverage under an emergency contract until 12/31/07. Empire Blue Cross/Caremark may submit a new bid as part of a new competitive process ordered by the Comptroller.

Retail Pharmacies

Empire BCBS/Caremark expected to contract with most of the retail chain pharmacies and independent pharmacies that were in the Empire Plan Pharmacy Network in 2005. If you have refills remaining at a local, retail pharmacy, check with the pharmacy to make sure it is in the network for 2006. If it is not in the network you would still be able to use the pharmacy, but your benefits would be significantly reduced and you would have to pay more out of pocket.

The first time you fill a prescription at a retail pharmacy after January 1st, it may be helpful to bring the following information:

Rx Group: NYSTATE

Processor Control Number: NYSTATE

Bank Identification Number: 004336

If the pharmacist has trouble submitting a claim to Caremark, there is a dedicated toll-free line for pharmacists:  1-800-364-6331. If the pharmacist incorrectly submits a claim to Express Scripts, s/he will receive a message indicating the claim should be submitted to Caremark.

Mail Service Pharmacy

If you previously used the Express Scripts Mail Service Pharmacy and had refills remaining, your prescription (except for compound drugs and controlled substances that will require a new prescription) were automatically transferred to the Caremark Mail Service Pharmacy as of January 1, 2006. The address for the Caremark Mail Service Pharmacy is:

Caremark

P.O. Box 3223

Wilkes-Barre, PA 18773-3223

Caremark Website  www.caremark.com

As of 1/18/06, Caremark’s website is recognizing members’ alternate identification numbers. Information posted on the website can still be obtained by calling the Empire Plan toll-free at 1-877-7-NYSHIP (1-877-769-7447). Choose the Empire Plan Prescription Drug Program on the main menu, then choose option 2. Caremark is updating certain features on their website so you may see some changes in the next few weeks.

Caremark Phone Numbers

Customer service                                                1-877-7-NYSHIP (1-877-769-7447) 

Choose the Empire Plan Prescription Drug Program on the main menu, then choose option 2.  

Dedicated toll-free line for doctors                    1-877-727-7455

Toll-free fax line for prescriptions                      1-888-891-6334

 

More detailed information about the transition to Empire Blue Cross Blue Shield/Caremark is available in a special Empire Plan Report which was mailed to all Empire Plan enrollees in November. It is also posted on the Civil Service website www.cs.state.ny.us. Click on the Employee Benefits link, then Publications and Forms. Under Current Publications, choose the group PEF, then scroll down to select the Empire Plan Special Report, November 2005.

If you need additional assistance, please contact Health Benefits in Contract Administration at 1-800-342-4306 or 518-785-1900 ext. 283.