Pharmacy benefit manager change

On a regular basis, UCare engages in a competitive selection process to identify a pharmacy benefit manager (PBM) partner. After rigorous review, we selected Navitus Health Solutions because they share UCare’s member-first approach, have nationwide pharmacy networks, partner with Costco Pharmacy for mail order services and have reduced drug costs while still continuing to offer programs to keep our members healthy.

A pharmacy benefit manager (PBM) is a third-party administrator of prescription drug programs that help negotiate costs and payments between drug manufacturers, pharmacies and health insurance providers. UCare will still manage the Formulary (List of Covered Drugs) and provide oversight of the PBM to ensure compliance with MHCP and CMS rules and regulations.

The change to a new pharmacy benefit manager will mean few or no changes for most members, as the prescription medications we cover and the terms of coverage will remain the same for most medications. Also, most of our current network pharmacies will remain in network. If you’re going to be affected by the change, we’ll let you know by mail and we’ll guide you through any action you need to take.

Mail order pharmacy services

Beginning in 2024, UCare is teaming up with Costco Mail Order Pharmacy as our mail order pharmacy. You don't need to be a Costco member to use this service.

Formulary (List of Covered Drugs)

UCare will continue to manage the Formulary — also known as the List of Covered Drugs or drug list. Most changes to the drug list occur on January 1. We regularly review and may make changes each month. This will continue with our new pharmacy benefit manager. Throughout the year, we might add or remove drugs from the drug list, move them to different cost-sharing tiers or add new restrictions. We’ll reach out to you if there are changes that require your attention.

On January 1, 2024, active UCare members will be able to see all pharmacy claims paid by the new pharmacy benefit manager. To see these claims, log in to your UCare online member account. Select the “My Pharmacy Benefits” tile on your dashboard and click on the link to visit the Navitus member portal. Once there, members can view their pharmacy claims in their Medication History section.

On January 1, active UCare members will be able to look up drug coverage costs in real time, meaning the cost you see is a moment-in-time estimate of the out-of-pocket costs you are expected to pay. To use this tool, log in to your UCare online member account. Select the “My Pharmacy Benefits” tile on your dashboard and click on the link to visit the Navitus member portal. Once there, enter a drug name in the "Get Started" pop up window, then enter your drug information and select a pharmacy. You can also call UCare Customer Service for this information.

Before Costco Mail Order Pharmacy can begin filling your prescriptions on January 1, 2024, you will need to have or create a Costco account and create a Costco Mail Order Pharmacy patient profile. You don’t need to be a Costco member to use this service.

Create an account and patient profile through the Costco Mail Order Pharmacy website or call 1-800-607-6861 (TTY users call 711). You will need your pharmacy billing information — RxBIN, RxPCN and Rx Group —to complete the patient profile before you can order prescriptions. Your pharmacy billing information can be found on your 2024 member ID card or call UCare Customer Service after October 1, 2023, and a customer service representative can provide the information you need. Once you have an account and patient profile, you can fill prescriptions with Costco Mail Order Pharmacy online or by phone on or after January 1, 2024.

Costco offers an auto refill reminder program. After you begin filling prescriptions with Costco Mail Order Pharmacy, you can select "auto refill" for each medication you want to enroll in the program. After you select the auto refill option, you will be notified by email that it is time to refill. You will be able to click a link in that email to order your prescription refill. You must repeat this step for every refill on every medication you enrolled in auto refill.

Yes. The Costco Mail Order Pharmacy is a separate pharmacy service from the retail pharmacy in Costco stores. Before Costco Mail Order Pharmacy can begin filling your prescriptions on January 1, 2024, you will need to have or create a Costco account and Costco Mail Order Pharmacy patient profile. You don’t need to be a Costco member to use this service.

Create an account and patient profile through the Costco Mail Order Pharmacy website or call 1-800-607-6861 (TTY users call 711).You will need your pharmacy billing information — RxBIN, RxPCN and Rx Group — to complete the patient profile before you can order prescriptions. Your pharmacy billing information can be found on your 2024 member ID card or call UCare Customer Service after October 1, 2023, and a customer service representative can provide the information you need. Once you have an account and patient profile, you can fill prescriptions with Costco Mail Order Pharmacy online or by phone on or after January 1, 2024.

You’ll have access to an extensive pharmacy network of over 63,000 pharmacies nationwide. Check that your pharmacy is in network or find a new pharmacy using our online search tool.

We’ll contact you by mail if your specialty pharmacy is no longer in network. Fairview Specialty Pharmacy will remain in network for 2024.