Empire Plan Rx Drug Vendor Award

The state has announced the contract for the Empire Plan Prescription Drug Program is being awarded to United Health Care/Medco. The 4-year contract will become effective January 1, 2008. The Program is currently insured by Empire Blue Cross Blue Shield with Caremark serving as Pharmacy Benefit Manager. United Health Care (UHC) is the insurer for the medical portion of the Empire Plan.

As with other contract awards, very little information has been released this early in the process. Civil Service is organizing a briefing for the unions to explain how United Health Care/Medco was selected, but the date has not been announced yet.  It is important to remember that while the state has made their selection, they now must sign a contract with UHC/Medco before they can become the new vendor.  We mention this because of the past difficulties in bringing the selected vendor to contract.  (Past experience has also been that the selection was challenged by one or more of the vendors not selected.)  We have no other information.  Once the Department of Civil Service has signed the contract, it then must be reviewed and approved by the Attorney General and the State Comptroller.  We expect that this process will take several months.

Members should remember that PEF and the state negotiate benefits. Vendors do not have the authority to change benefits. Therefore, a change in vendors does not mean that copays will change. However, a change in vendor can mean a change in the Preferred Drug List (including tier placement), the list of drugs requiring Prior Authorization, and the network of participating pharmacies. We do know that Medco has mail service pharmacies located in Willingboro, New Jersey and Las Vegas, Nevada.

Obviously, many questions need to be answered and we will provide updates as more information becomes available. If you have questions please contact Health Benefits staff at 800-342-4306 or 518-785-1900 x283.