Teachers Health Trust recently enacted a number of plan design changes for the 2016 plan year. Some of the changes made to the prescription drug plan created unintended increases in out-of-pocket costs for our members. Recognizing the need for change, Teachers Health Trust, together with our partners at WellHealth Quality Care and our prescription benefit consultants, immediately began working on finding solutions. We’re pleased to say that the Teachers Health Trust Board has recently approved several measures that will greatly improve benefits to members and will relieve much of this financial stress!

A new out-of-pocket maximum pharmacy plan is being implemented for all prescription drugs and is slated to go into effect mid-March.  Going forward, members will have a $100 maximum copayment for generics, a $200 maximum copayment for preferred brand name drugs, and a $500 maximum copayment for specialty medications. These maximum copayments will apply to each 30-day supply of a particular medication. Any prescriptions filled as of January 1st, 2016 that exceed the out-of-pocket maximum will be reimbursed. Information on how to submit for reimbursement will soon be available on the Teachers Health Trust website.

This new out of pocket maximum is very competitive, and on par with other prescription plans throughout the State of Nevada. We are implementing this new program as quickly as possible, but it will take some time to enter the new Pharmacy Benefits into the Pharmacy Benefit Management system, and we thank you for your patience as we put these changes into place. We hope to have this completed mid-March and will continue to keep you updated.

Just a reminder, The Teachers Health Trust also recently improved benefits for diabetic drugs and supplies. Members who are enrolled in our “Control Is The Goal” diabetic management program will pay a maximum of $100 per prescription, per 30 day supply for their preferred (on formulary) diabetic medications (generic or name brand). In addition, the enrolled members also receive the following diabetic supplies at a $0 copay; Test Strips, Lancets, a One Touch Verio Glucometer (limit 1 per member/per year), needles, and syringes. You can learn more about this prescription change by emailing KeepItLow@wellhealthqc.com.

As with any large undertaking, there are often unforeseen bumps in the road, but your health and wellbeing are our first priority. If you have questions or concerns, please feel free to reach out to our Healthcare Advocate team at (855) 404-9355 or email them at advocates@wellhealthqc.com.