Process for obtaining certain specialty drugs changes for URMBT non-Medicare members

Effective Jan. 1, 2017, non-Medicare members who are part of the UAW Retiree Medical Benefits Trust will be required to obtain certain specialty medications through Accredo, an Express Scripts specialty pharmacy, under their prescription drug benefit for the drugs to be covered. This change affects URMBT Ford, URMBT GM and URMBT Chrysler PPO and Traditional Care Network non-Medicare members.

Previously, regardless of where they were obtained, certain specialty medications may have been covered under these members’ medical plan. As of Jan. 1, 2017, these specialty medications, when obtained in the outpatient setting, will only be covered under the member’s prescription drug benefit through Accredo. If members don’t order from Accredo, they’ll be responsible for the cost.

For dates of service on or after Jan. 1, 2017, there will be a coverage review for an initial specialty medication claim submitted under the medical plan. However, subsequent submissions under the medical plan will be rejected, with instructions to the provider to submit the medication under the patient’s prescription benefit plan through Accredo. The places of service may include the home, doctor’s office or outpatient settings.

Provider reimbursement for drug administration and supplies associated with the drug administration will continue through the patient’s medical benefit.

To submit a prescription for specialty medications on behalf of URMBT members, contact Accredo at 1-800-987-4904 or fax new prescriptions to Accredo at 1-800-391-9707.