Value-Based Benefits

Because your plan includes Value-Based Benefits, if you are at risk for cardiovascular disease (taking high blood pressure medications in combination with high cholesterol medications) or have asthma, diabetes, or coronary artery disease (CAD), or depression associated with any of these conditions, your coverage can help you more affordably manage your care. Also, if you are a current smoker and are ready to quit, your Value-Based Benefits coverage gives you access to no-cost smoking cessation programs and medications (when prescribed by your doctor).

Fill your prescriptions through our convenient, low-cost mail service pharmacy, and you'll pay the same copayment for a three-month supply of certain Tier 1 and Tier 2 medications as you would for a one-month supply from a retail pharmacy. This is a savings of up to eight copayments per year for each medication.

Your spouse and covered dependents are also eligible for these savings.

Step 1—List Your Current Medications
Make a list of your current medications (including dosages) and fill in the remaining information as you go through the other steps.

Step 2—See How Your Medications Are Covered
You can see which of your medications are on the Value-Based Benefits medication list. If your medications aren't on the list, you can see what your costs will be by checking the Medication Look-up tool.

Discuss Your Prescription Options with Your Doctor
If your medications aren't covered or are unavailable at a lower-cost tier, ask your doctor if there's an alternative medication to save you money. The medications on the Value-Based Benefits medication list and the lower-cost tier may be as effective as brand name medications on higher tiers.

Step 3—Begin Using Your Benefits
If your medications are on the Value-Based Benefits medication list, simply begin ordering them via our convenient, low-cost mail service pharmacy. First, you'll need to call your doctor to get a 90-day prescription. Then, download, fill out, and send in the Mail Service Patient Profile form or call the mail service pharmacy at 1-800-698-3757.

Which chronic disease medications qualify for a waived copayment?
To see, download a copy of the Value-Based Benefit Medication list.

I currently take a medication for one of the conditions. How do I get my prescriptions for less?
If your medication is not on the Value-Based Benefits medication list, speak with your physician about switching to an alternative. You must use the mail service pharmacy to fill your prescription, so ask your doctor to write a new 90-day prescription for you to send to the mail service pharmacy. (Doctors who e-prescribe can do this electronically.)

Are my spouse and covered dependents qualified for the lower-cost prescriptions too?
Yes. Your spouse and covered dependents automatically qualify for the Value-Based Benefits prescription drug savings. Just remember to follow the same mail service pharmacy process when ordering their medications listed on the Value-Based Benefit medication list.

Why was I was charged a higher copayment by the pharmacy when I filled my high blood pressure (or high cholesterol) medication than the copayment on the Value-Based Benefits medication list?
For Value-Based Benefits medications used to treat CAD or manage the risk of cardiovascular disease, you pay a lower copayment only if you are taking medications to treat both high blood pressure and high cholesterol. To validate that you are being treated for both conditions, we look at your prescription history (up to 184 days back).

How does my coverage work for medications used to treat depression?
If you qualify for enhanced medication benefits for medications used to treat asthma, diabetes, CAD, or risk of cardiovascular disease (treating both high blood pressure and high cholesterol), you will also pay less for certain generic anti-depressants when you get them from the Mail Service Pharmacy. That's because adhering to a prescribed depression medication treatment plan can help you better manage your other chronic conditions.

What support is available to help me quit smoking?
In addition to the no-cost smoking cessation medications your doctor prescribes, you can also take advantage of online and phone-based smoking cessation resources from the following programs.

• 1-800-TRY-TO-STOP (1-800-879-8678)-A multi-session telephone counseling service with experienced counselors who will help you set a date, prepare for quitting, and give you helpful advice and support along the way. If you live outside of Massachusetts, call 1-800-QUIT-NOW (1-800-784-8669) to access the program.
• Help Online- www.trytostop.org offers advice, success stories, and tools in 11 different languages. Look for the Quit Wizard to help you put together your personal quitting plan.

How do I take advantage of my free diabetic monitoring visits?
Just tell your doctor that your plan includes no copayments for the first two office visits in each calendar year for certain diabetic monitoring care. (The two office visits can be used for diabetes evaluation and management, diabetic foot care, and diabetic eye exams.) We will take care of reimbursing the doctor for your copay.

Printable Resources

• Getting Started Guide to Value-Based Benefits
• Value-Based Benefit Medication list
• Mail Service Patient Profile form

Online/Telephonic Resources

• Medication Look-Up Tool
  
  
• 1-800-TRY-TO-STOP (1-800-879-8678)-A multi-session telephone counseling service with experienced counselors who will help you set a date, prepare for quitting, and give you helpful advice and support along the way. If you live outside of Massachusetts, call 1-800-QUIT-NOW (1-800-784-8669) to access the program.
  
  
• Help Online-www.trytostop.org offers advice, success stories, and tools in 11 different languages. Look for the Quit Wizard to help you put together your personal quitting plan.