*This email is intended for producers in Delaware, Pennsylvania, and West Virginia
HIGHMARK TO OFFER NEW PHARMACY PROGRAM - SEMPRE HEALTH, EFFECTIVE JULY 1, 2021
Effective July 1, 2021, to help reduce member drug costs and improve adherence, Highmark and Sempre Health have worked together to offer an exciting new product for our members. This product will offer financial savings opportunities to members taking certain medications-- if they fill those medications in a timely manner. The product accomplishes this by leveraging manufacturer coupon dollars to lower the member cost share for certain medications. This program is available for members enrolled in one of the following plans:
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Large group and Cost Plus in PA and WV
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HDHP are excluded
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Groups are auto-enrolled
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Administrative Services Only (ASO) in DE, PA, and WV
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HDHP are permitted
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Opt-in only for ASO
*Please note that plans that use Exclusive Home Delivery or Incentive Home Delivery are not eligible for Sempre.*
How the Product Works
Sempre Health uses text-based messaging to contact members who are taking one of the medications on the Sempre Health drug list in order to alert them of savings opportunities. These savings opportunities change dynamically with respect to the member’s timely filling (adherence) of the medication(s). In other words, the more adherent a member behaves, the greater the savings that are offered. An example of such a message might look like this: “Save $5 dollars if you fill your “medication” before April 30th.
When a member is prescribed a medication on the Sempre Health drug list and takes the prescription to a participating retail pharmacy, the primary claim will process at the member’s plan cost share. Upon the member showing the pharmacist the texted offer, the pharmacist then submits a secondary claim to Sempre Health which reduces the member cost share by the savings amount offered via text message. The amount of savings offered can increase with each refill based on the member’s timely filling; conversely, the amount can decrease accordingly as well.
This is a completely optional program for the member. They do not have to respond to Sempre Health or participate in any way if they do not wish to do so.
The drugs in scope for the Sempre Health program are subject to change over time.
What does this mean for fully insured clients?
The Sempre Health program will be offered to all groups in scope starting 7/1/2021. Sempre Health will contact members who qualify for this program via mail and/or email. There is no fee for this product.
What does this mean for ASO clients?
The Sempre Health program will be available to ASO clients as an opt-in option. Sempre Health will contact members who qualify for this program via mail and/or email. There is no fee for this product.
THE VALUE
Plan Sponsor
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Increased medication adherence levels which can lead to cost savings related to expensive medical conditions.
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Maintain integrity of Plan's intended plan design(s). Savings are realized outside the plan design.
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Offered as a free program - no fee involved
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Improved plan satisfaction for members
Patient
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Reduced out-of-pocket cost for applicable medications
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Increased adherence which can lead to improved health
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Offered as a free program - no fee involved
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Interactive, modern approach to increase member engagement in his/her health
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Fast and convenient method of offering savings at the point of service
Questions?
If you have questions, please contact your Highmark Client Manager or Sales Executive.
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