Front Page
What you need to know about pharmaceutical benefits
The American Maritime Officers (AMO) Medical Plan is pleased to announce the engagement of Envision Pharmaceutical Services, Inc./Rx Options, Inc. as its new Pharmacy Benefit Manager (PBM) effective April 1, 2004.

There will be no change in the current prescription benefit that went into effect January 1, 2004. The reason for the change to Envision/Rx Options is that the AMO Medical Plan expects and anticipates ultimate savings to both the participant and the Plan. The change in PBM's to Envision/Rx Options should involve no change in the prescription service you currently receive.

Double-digit average increases in trends are expected to continue in 2004 for prescription drugs. As it has for the last several years, the cost of prescription drug coverage is expected to exceed other coverage increases. Studies forecast trend rates of nearly 18 percent for 2004.

These studies and the potential for cost savings to the Plan, and its participants, by reducing co-payment dollars, are the driving factors behind the change to Envision/Rx Options.

The AMO Medical Plan and Envision/Rx Options technical support staff are here to assist you with the transition to the new PBM. If you have any questions regarding prescription drug coverage, you may contact Envision/Rx Options' Customer service at 1-800-361-4542 or as always, you may contact the AMO Medical Plan Participant Services at 1-800-348-6515 extensions 12 and 13.

Information about the new pharmacy benefit manager

Envision Pharmaceutical Services (EPS) is a full service pharmacy benefit management company that has been selected by the AMO Medical Plan to provide benefits and overall savings to Plan participants and dependents.

Envision, along with its affiliated company, Rx Options, Inc., has local offices in Aurora, Ohio, and remote offices in Ft. Lauderdale, Florida and Folsom, California. Envision/Rx Options provides pharmacy network administration, formulary and benefit management to employers and health plans throughout the country.

The Envision/Rx Options pharmacy benefit program differs from other pharmacy programs that we have used in the past. Envision/Rx Options ensures that all discounts, rebates and concessions from pharmacies and pharmaceutical manufacturers are reflected in the price available to the AMO Medical Plan and its participants.

New material to obtain prescription drugs effective April 1, 2004

You will receive a Welcome Packet that outlines all of the services offered by Envision/Rx Options. Your packet will contain two Prescription Identification Cards for you and your dependents to be used at participating pharmacies. It will also contain a directory of network pharmacies and information about Envision/Rx Options' secure website for drug and disease state management to keep you up to date on the newest techniques, programs and information available to manage your health. A section of Envision/Rx Options' website, www.envisionrx.com, will explain in simple, easy to understand language important information about your medications and some of the do's and don'ts to follow when taking or mixing medications, as well as side effects you may experience.

Important information when acquiring prescription drugs
  • THERE WILL BE NO CHANGE TO CURRENT PRESCRIPTION BENEFIT PROVISIONS UNDER THE AMO MEDICAL PLAN
  • PLEASE BE SURE TO PRESENT YOUR NEW PRESCRIPTION IDENTIFICATION CARD AT THE PHARMACY THE FIRST TIME YOU USE IT.
  • THE PRESCRIPTION IDENTIFICATION CARD CONTAINS INFORMATION NEEDED BY THE PHARMACIST TO PROPERLY PROCESS YOUR PRESCRIPTION CLAIMS
  • YOUR OLD PRESCRIPTION IDENTIFICATION CARD THROUGH THE PREVIOUS PHARMACY BENEFIT MANAGER WILL NO LONGER BE VALID EFFECTIVE APRIL 1, 2004
  • IF YOU HAVE ANY QUESTIONS ABOUT DEDUCTIBLES, CO-PAYMENTS, OR ANY OTHER CHARGES WHICH YOU MAY BE RESPONSIBLE TO PAY AT THE PHARMACY, PLEASE FEEL FREE TO CONTACT ENVISION/RX OPTIONS AT ITS TOLL FREE CUSTOMER SERVICE HELP DESK AT 1-800-361-4542 OR VIA E-MAIL AT info@envisionrx.com, AND BE SURE TO PROVIDE YOUR NAME, PARTICIPANT ID NUMBER AND TELEPHONE NUMBER SO AN ENVISION/RX OPTIONS REPRESENTATIVE CAN RESPOND TO YOUR INQUIRIES PROMPTLY
  • IF YOU HAVE QUESTIONS REGARDING BENEFITS OR ELIGIBILITY UNDER THE AMO MEDICAL PLAN, PLEASE CONTACT THE PLAN'S PARTICIPANT SERVICES AT 1-800-348-6515, EXT 12. OR EXT. 13
In-network pharmacy information

Envision/Rx Options' network of participating pharmacies should include all of the pharmacies you are presently using so that there should be no disruption in your routine. In fact, the change should be virtually invisible. However, in order to confirm or locate a participating pharmacy in your area, you may access Envision/Rx Options' pharmacy locator at www.envisionrx.com.

If you discover that your pharmacy is not a part of Envision/Rx Options' network of participating pharmacies, you may contact Envision/Rx Options and provide your pharmacy's name, address and telephone number. Envision/Rx Options will contact your pharmacy and attempt to enroll them in its network. Simply present your new Prescription Identification Card (participating pharmacies will have been notified that the card is changing and that there is a new processor) and Envision/Rx Options will do the rest. The pharmacy will send the claim to Envision/Rx Options, which will process and send a response back to the pharmacy telling it how much you should pay (deductibles, co-payments and other non-covered charges). This all takes place within seconds at the point-of-purchase.

Out-of-network pharmacy information, direct reimbursement

Should you decide to purchase your prescription drugs through a non-participating pharmacy, Envision/Rx Options will process the claim for direct reimbursement to you. Please note that you must comply with the following rules and guidelines in order to receive direct reimbursement for prescription drugs obtained through a non-participating pharmacy:
  • You will be required to pay the pharmacy full price for the prescription drug.
  • In order to receive reimbursement, the drug must be a covered drug under the AMO Medical Plan.
  • A Direct Member Reimbursement Form must be completed by the Plan participant and submitted to Envision/Rx Options along with the pharmacy receipt showing name of drug, date of service, dosage, supply quantity and NDC #. Direct Member Reimbursement Forms are available through Envision/Rx Options' toll free number, via their website or through the AMO Medical Plan office.
  • Reimbursements will be processed according to the negotiated discounts arranged by Envision/Rx Options and are subject to any co-payment or deductibles in accordance with the Rules and Regulations of the Plan.
  • PLEASE BE AWARE THAT PURCHASING PRESCRIPTION DRUGS AT NON-PARTICIPATING PHARMACY MAY RESULT IN A GREATER OUT-OF-POCKET EXPENSE.
Specialty drug treatment benefit

Specialty Drug Treatments, Specialty Drug Programs and Specialty Drug Therapies are associated with a chronic or critical illness/condition including, but not limited to, chemotherapy, IV infusion therapies and hepatitis-C and HIV.
  • Specialty Drug treatments must be pre-certified through AMO Medical Plan Case Management at 1-800-348-6515, ext. 13, prior to dispensing.
  • The AMO Medical Plan's Case Management, in conjunction with Envision/Rx Options, will help you obtain the required medications at the discounted rates.
  • The Specialty Drug Treatment Benefit will be covered under the provisions of the AMO Medical Plan subject to the annual medical deductible and co-insurance. You may be required to pay these and any non-covered charges at the time of service.
Your new prescription identification card

The Prescription Identification Cards in your packet contain identical information. They list the AMO Medical Plan's participant's name and important information for the pharmacy. Plan participants and all eligible dependents can use the same Prescription Identification Card. The card also reflects an identification number. This unique number is considered Protected Health Information (PHI) under the 1996 HIPAA Privacy Act. This information is private and confidential and is only used in the aggregate for billing purposes where it cannot be related to a particular person.

PLEASE BE SURE TO GIVE THE PHARMACIST THE NEW PRESCRIPTION IDENTIFICATION CARD WHEN YOU FILL YOUR PRESCRIPTION FOR THE FIRST TIME BEGINNING APRIL 1, 2004. This will help the pharmacist direct the prescription to the right place and avoid your being denied eligibility for benefits. The card is a durable hard plastic card (about the same thickness as a credit card) and will fit easily in your wallet or purse.

Frequently asked questions

How Does the Plan Work?
  1. You receive a new prescription from your doctor and take it to your local pharmacy to be filled.
  2. When you drop off the prescription make sure to also give the pharmacy associate your new prescription identification card. Your old prescription identification card will no longer be valid effective April 1, 2004.
  3. The pharmacist will fill the prescription, give you the medication, and charge you the co-payment, deductible and any other ineligible cost based on the discounted price of a generic prescription. If you elect to purchase a brand drug when a generic is available, you will be responsible for the difference between the generic price and the brand price, plus co-payment and deductible.
Should my prescription be filled with a generic drug?

Under the Rules and Regulations of the AMO Medical Plan all prescription drugs are required to be filled as generic (if available), unless the physician specifically requires a brand drug based on medical necessity and it is approved by the Plan office. When your physician writes you a prescription, ask him/her if the medication is available as a generic. If so, ask him/her to sign the prescription allowing for generic substitution. When your prescription is signed allowing generic substitution, your pharmacist can fill your prescription with a generic drug. If you have any questions concerning your medications, always ask your doctor or pharmacist.

What if I want to call in a refill?

If you call in for a refill, make sure to speak to a pharmacy associate and let them know that there has been a change in your prescription billing. When you go to pick up your prescription you will need to show your new card to the pharmacy associate so he/she can bill it correctly.

How soon can I call in a refill?

You may not refill a prescription until at least 80% of the days supply has passed. (i.e. If you have 30 days' supply of a medication you cannot refill that prescription until at least 24 days have passed.)

Is there a supply maximum of medication that I can obtain with a prescription?

Yes. The supply maximum is as follows:
  • 30-day supply maximum on all acute medications purchased at the retail pharmacy
  • 90-day supply maximum on maintenance medications purchased at the retail pharmacy (unless working at sea, then a maximum of 180 days' supply).
Where can I go to get my prescription filled?

A pharmacy network of over 42,000 pharmacies nationwide is available. This includes all major chains and many independent pharmacies. Below is a list of some of the chains that participate:

Partial Listing of Participating Chain Pharmacies
A & P Publix Pharmacies Albertson's
Bi-Lo Pharmacy Ralph's Pharmacies Brookshire Pharmacy
Ralph's Grocery CVS Target
Costco Stores USA Express Drug Emporium
Value Health Center Eckerds Weis Pharmacies
Kroger Pharmacy Winn Dixie K-Mart Pharmacy
Walgreen's Medicine Shoppe Wal-Mart

What if my pharmacy does not participate?

If you find out that your pharmacy does not participate please call our Pharmacy Help Desk at 1-800-361-4542 with the name, address and phone number of the pharmacy and we will send a request to that pharmacy to join our network.

Can I get my prescriptions through the Mail?

Effective January 1, 2004, the AMO Medical Plan has no Mail Order Pharmacy Benefit.
Front Page   

Copyright ©2002 American Maritime Officers