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State Health Plan Pharmacy Benefit Changes Effective 1/1/2013


Release Date: December 13, 2012

Effective January 1, 2013, the State Health Plan will be enrolling its Medicare-eligible population into a group sponsored Medicare Part D plan. This coverage will continue to be administered by Express Scripts, who as you may be aware merged with Medco, the Plan’s previous pharmacy benefit manager.

 Key Facts:

  • The name of the new plan will be Express Scripts Medicare™ (PDP) for the State Health Plan
  • State Health Plan Medicare-eligible members will be issued new prescription member ID cards prior to the plan’s effective date of January 1, 2013
  • The new ID cards will feature both the Express Scripts Medicare and State Health Plan logos
  • Please visit the State Health Plan website at for a copy of the Express Scripts Medicare formulary.  Please note that the drug tiers listed on the formulary may not represent the final member copay.  In an effort to continue similar drug coverage as the Traditional Pharmacy plan, many copays have been reduced by the State Health Plan.
  • Due to CMS regulations, medications requiring prior authorization will differ from the SHP Traditional pharmacy benefit plan, and all authorizations will need renewal within the first 60 days of the new plan.  Members and providers may call 800-935-6103 to initiate a coverage review. We want you to be aware of these changes as you may be contacted by Express Scripts for further information in order to complete a coverage review on behalf of your patients. As standard with Medicare Part D plans, members may obtain a 31 day transition supply of medications while the review is completed to ensure continued access to medications as prescribed.

 Questions? Beginning January 1, 2013, contact Express Scripts at 800-935-6103.