Oct 31, 2019
Effective January 1, 2020, CVS Caremark will be Sharp Health Plan’s new pharmacy benefit manager (PBM). New customer enhancements include:
- Dedicated prescription helplines staffed by experts to answer questions from customers, providers, and pharmacists 24/7
- The ability for customers to access information on pharmacy benefits, networks, and costs through their website and Sharp Connect
- Enhanced digital tools, like the free CVS Caremark mobile app, which lets members see their personalized pharmacy benefit information, refill or request new mail service prescriptions, track order status, view prescription history, and much more.
The pharmacy network will remain 99% the same. Members can continue using all Sharp pharmacies, in-network community pharmacies, and retail pharmacy chains, such as Albertsons, Costco, Ralphs, Rite Aid, Vons, Walgreens, and Walmart in addition to CVS Pharmacy stores.
Formulary Updates
Sharp will be updating their formulary for 2020 with more positive than negative changes. They will cover non-formulary drugs when their use has been determined to be medically necessary after a review of a member’s needs. There will also be some updates to tiers, specialty drugs, and utilization management. That includes new step therapy, prior authorization, and quantity limit requirements. In November, you will be able to see the 2020 formulary on their website at sharphealthplan.com/search-drug-list.
Sharp will do the following to help ensure this is a seamless transition for you and your clients:
- They will honor existing pharmacy prior authorizations until the date noted on the client’s original approval letter from Sharp Health Plan.
- For clients who are enrolled in benefits on their Tier 3 formulary, they will provide a 31-day grace period on current medications if clients are impacted negatively by the 2020 formulary changes. These clients will have until February 1, 2020 before the negative changes go into effect. All other changes will still be effective on January 1, 2020.
Here’s what Sharp will be communicating and when:
- In November and December, they will notify members about any potential impact. These notices will only be mailed to members who are taking drugs affected by formulary changes. Members will be directed to work with their doctors if they have questions. Doctors will be notified of these changes.
- In December, Sharp will issue new member ID cards to all members. Beginning January 1, 2020, members must use their new cards when getting care and filling prescriptions.
- In the coming months, Sharp will send email updates to brokers before sending any employer or member-facing communications.
For more information, contact your LISI Regional Sales Manager.
