Effective Oct. 1: New Maintenance Drug Program

From Thomas C. Woodruff, Director, Healthcare Policy & Benefit Services Division, Office of the State Comptroller:

The Governor and SEBAC (State Employee Bargaining Agent Coalition) have reached an agreement that establishes a Maintenance Drug Network Program, effective October 1, that provides two options for state employees and retirees under age 65 to obtain their maintenance drugs for certain chronic conditions:

  1. 1. Obtain maintenance drugs through mail order; or
  2. 2. Pick up maintenance drugs in person at any local pharmacy that is participating in the Maintenance Drug Network.

To date, pharmacies participating in the Maintenance Drug Network include: all Big Y, CVS, ShopRite and Stop & Shop pharmacies. In addition, Bordornaro’s Pharmacy in Portland, Hope Street Pharmacy in Stamford, and Manchester Pharmacy in Manchester have agreed to participate. This means that, instead of receiving these drugs through the mail, participants may pick up their prescriptions for maintenance drugs at any of these pharmacies.

The Office of the State Comptroller will post details as additional pharmacies may join the network in the coming weeks.  The pharmacy list is located at :

http://www.osc.ct.gov/empret/healthin/2011hcplan/MaintenanceDrugList.pdf

Maintenance medications are those used to treat chronic conditions and are typically taken on a regular basis. If a participant is currently getting a 90-day supply of a medication for a chronic condition at their pharmacy, it is likely a maintenance drug. Caremark, the state’s pharmacy benefits manager, maintains a list of those drugs frequently used by state plan members that are considered maintenance medications. The list can be accessed at this link:

http://www.osc.ct.gov/empret/healthin/MaintenanceDrugListJuly2011.pdf

After October 1, if a participant refills a maintenance drug at participating Maintenance Drug Network pharmacy, the refill should be made for a 90-day supply for one co-pay.   It is the responsibility of the local pharmacist to contact the physician if a 30-day script for maintenance drugs needs to be converted to a 90-day script.

After October 1, if a participant refills a maintenance drug at a pharmacy that is NOT participating in the Maintenance Drug Network he/she will only receive a 30-day supply. Following that prescription fill, Caremark will notify the participant directly by mail that their next refill for that medication must be refilled through the maintenance program.

Caremark will also inform participants of these prescription filling options outlined above. Participants can register for the mail order process by phone at 1-800-875-0867 or can log on to www.caremark.com/faststart and sign in to register. Participants should have their prescription card number, the names of medicines, their doctor’s information and payment information (credit card, debit card, check) ready.

Some employees have expressed concern that for security or privacy reasons, they would rather not receive maintenance drug(s) by mail. If they would prefer to pick up maintenance medications in person, they should use one of the local pharmacies in the Maintenance Drug Network.

Currently, pharmacies in over 250 locations throughout the state have agreed to participate in the Maintenance Drug Network. If participants fill their maintenance drug prescriptions at these locations they will be able to get a 90-day fill for one co-pay.

3 thoughts on “Effective Oct. 1: New Maintenance Drug Program

  1. The information in the 3 paragraphs following the link to the maintenance meds list is incorrect. 1) Current meds are being immediately denied refill if they are NOT 90 days (ie. NO one refill, then mailorder), 2) It is the patient’s responsibility to have one’s doctor change the prescrip to 90 days (from 30 days), NOT the pharmacist, 3) One does NOT have to sign up for CVS/Caremark mailorder, merely have their doctor send the prescrip to a participating pharmacy (eg. Stop & Shop) – this part is good news; plus, they confirmed that the actual prescrip will be filled on site of the local pharmacy by your local pharmacist (ie. NOT mailed to them as a mere drop-off point). Spent one hour today talking w/ CVS/Caremark Customer Service office (in Pittsburgh) to get all the answers – after a simple short-term use muscle relaxant was denied coverage since it was only for 30 days; and, they told me it would have been covered had it been for 90 days (ie. the maintance med list is grossly incomplete – NON-maintenance meds are being considered maintanence meds by CVS/Caremark and are hence being denied coverage UNLESS they’re written for 90 days). I was told this was a new update (via a CVS/Caremark interoffice e-mail) today. Hope this helps the many others who are having their meds denied coverage. Best advice is immediately ck one’s CVS/Caremark account’s prescription history after submitting a med refill and it will show if it’s accepted (denied do not show up at all) – this system is literally simultaneous (ie. if you electronically submit a refill to your local pharmacy, even if it’s closed for the day, your CVS/Caremark acct will show if it’s been accepted).

  2. The choice to pick up prescription drugs from the pharmacy of our choice should not have been taken from us! I don’t want mail order, nor do I want 3 months worth of controlled drugs in my home. I don’t want to wait in line for 20 min at CVS while they rifle through hundreds of bags of prescriptions looking for mine. I want to be able to support the small business owner of the independant pharmacy that we have been using for years. With unemployment as high as it is, why is the State of CT and Caremark trying to add to the unemployed by trying to shut down small indepenant pharmacies?

  3. I went to my doctor and had my Maintenance medications changed to 90 days; I went to a designated pharmacy to have them filled. I only needed 5 of my 10 Maintenance prescriptions filled. They were not a controlled substance. The pharmacist stated that the insurance company would only fill one prescription for 90 days the other 4 were only for 30 days. When I spoke with them about this they stated they have the right to decide the amount of the drug that will be dispensed no matter what the doctor has written. Then there are 2 prescriptions that are controlled substances and not available in a generic form that are taken in my family for Maintenance medications. First the Prescription Plan representative stated the reason for this was I had to have the prescription written for 90 days and mail it in. Then I was switched to a supervisor and he said that they are not on the list of Maintenance medications (my son has been taking his med now for about 10 years and Mine I have been taking my for 2.5 years) so we must pay a 20 dollar co-pay vs the 10 dollar co-pay if it was on the list. How does a prescription plan decide how much they will fill in a prescription even though the doctor what’s a specific amount, or how can they decide when they are not your doctor what medications you are taking are Maintenance medications or not. Isn’t that up to the doctor? I am having multiple problems with this new plan.

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