Prescription drug coverage for PPO Plans A & B are administered through Elixir for employees, non-Medicare retirees, and their dependents. For Medicare-eligible retirees and/or dependents, prescription drug coverage is administered through Elixir Rx Plus.
For more details on these plans (including tiers, copays, and contact information), please review the “Overview” section below. For details regarding the JHMB’s special program for maintenance medications, please select the “Rx90 Program” tab below. For details regarding the JHMB’s Select Formulary, please select the “Select Formulary ” tab below.
For questions, contact Elixir at the JHMB’s special customer service line: (833) 640-2849.
NOTE: The prescription drug coverage information provided in this section does not apply Plan C Kaiser participants. For information specific to Plan C participants, please visit the “Your Benefits” page.
Elixir – Formulary, Tiers & Copays
The Elixir plan has 4 tiers based on its current drug formulary (a list of prescriptions drugs covered by the plan). Elixir determines which drugs are placed on the formulary via its Pharmacy and Therapeutics Committee, which selects drugs from virtually all therapeutic types and bases its decisions upon factors such as – drug effectiveness, cost, quality, safety and potential side effects. The formulary is updated periodically as new drugs or new prescribing information becomes available.
The following is the list of the current Rx tiers and their respective 30-day/90-day copays:
- – Tier 1 – Generic Drugs ($0/$0): Low-cost medications that are used for treating hyperlipidemia, hypertension, diabetes, and depression.
- – Tier 2 – Generic Drugs ($10/$20): All other categories of covered, generic medications.
- – Tier 3 – Preferred Brand-name Drugs ($35/$70): Covered drugs included on the formulary.
- – Tier 4 – Non-preferred Brand-name Drugs ($50/$100): Covered drugs not included on the formulary.
Tier Exceptions: A copay exception may be available if you are taking a Tier 4 medication and your physician submits a Letter of Medical Necessity (LMN). The LMN is a letter from your physician to Elixir that sufficiently documents the reason(s) why you are unable to tolerate the Tier 3 medication. If Elixir authorizes the LMN exception, you will pay the Tier 3 copay instead of the Tier 4 copay.
“Dispense as Written” (DAW): Also, it is important to note that if you purchase a brand name prescription when there is a generic equivalent available, you will pay the brand copay plus the difference in cost between the brand name and the generic. However, should your physician indicate “Dispense as Written” on the brand name prescription and provide documentation showing that the brand name prescription is medically necessary, the cost difference penalty will be waived if authorized by Elixir.
NOTE REGARDING MAINTENANCE MEDICATIONS: For members taking maintenance prescriptions (such as a drug that is required to treat a chronic condition such as diabetes, high blood pressure, or high cholesterol) this program requires that you adhere to the Rx90 maintenance medication program. Please select the “Rx90 Program” tab above for more details.
What to Do If the Pharmacy Says Your Prescription is Denied
Did you know that there are four key steps you can take if a pharmacy denies your prescription? These four steps, along with information about maintenance medications, specialty medications, and common reasons for pharmacy denials, are included in a flyer we developed to help you understand and address prescription denials at the pharmacy.
We invite you to review this helpful resource and save it for the next time you experience an issue at the pharmacy. It’s just one of the ways we’re working to keep you informed and prepared to advocate for yourself and your health.
How to Address Issues/Questions Regarding Your Prescriptions
For assistance with your prescription drug benefit, please first contact the appropriate Elixir Customer Service phone number shown below based on your plan participation. If you feel that your issue is not being addressed appropriately, you may ask to speak with an Elixir Customer Service Supervisor. Should you feel that you require additional support beyond the Elixir supervisor, you may ask the supervisor to send an email to “FUSD Member Issues.” This process has been established to more effectively handle JHMB plan participant issues and concerns.
Elixir Participants: For assistance with your Elixir prescription drug benefit, please contact the Elixir Customer Service Help Desk at (833) 640-2849. The Help Desk is available to assist you with prescription questions 24 hours a day, 7 days a week.
Elixir RxPlus Participants: The Elixir RxPlus plan has a different customer service phone number than the Elixir Rx plan. If you have been issued an Elixir RxPlus Medicare Prescription ID card similar to the one shown on the right, then you are a participant in the Elixir RxPlus plan. For questions specific to the Elixir RxPlus plan, please call (833) 661-1996.