StayWell Insurance is pleased to announce its partnership with Medimpact Healthcare Systems, Inc., a pharmacy benefit manager (PBM) based in San Diego, California. Medimpact has been successfully managing pharmacy benefits for almost 30 years and will administer StayWell's pharmacy benefit beginning January 1, 2019. Together, we aim to provide the same high quality of care, while helping to manage the increasing costs of prescription drugs. Medimpact's pharmacy network provides flexibility in receiving your prescriptions within the following networks.
Retail Pharmacy Benefits
Medimpact's participating pharmacy network includes more than 64,000 participating pharmacies, including regional and national chains as well as independent community pharmacies. One enhanced feature is the Choice 90 pharmacy benefit that allows members to obtain a 90-day supply of formulary medications through local and nationwide retail stores at a reduced out of pocket expense.
Mail Order Pharmacy Benefits
Members can obtain a 90-day supply for ongoing maintenance medication(s) through the mail- order program with Medimpact Direct. With mail-order, you can have your prescriptions delivered right to your home and copayment is waived. As part of this transition, any prescriptions currently filled through CastiaRx (formerly known as LDI) with remaining refills will be transferred to Medimpact Direct Mail Order on January 1.
Specialty Drug Benefits
Your Specialty Pharmacy is Medimpact Direct Specialty. Our specialty pharmacies were carefully chosen to provide members with convenient delivery and personalized service. The Specialty program supports patients with complex health conditions who need injectable medications, medications with strict compliance requirements, or who have special storage needs. As part of this transition, your new pharmacy will work with your provider to transfer your prescription, set up an account and start service for you.
Below are some frequently asked questions about MedImpact.
A pharmacy benefit manager (PBM) is a company that administers, or handles, the drug benefit program for your employer or health plan. PBMs process and pay prescription drug claims and are responsible for creating and updating your health plan’s drug formulary.
An official list of drugs covered by your pharmacy benefit as defined by your health plan. A formulary can contain both name-brand and generic drugs.
You may visit the MedImpact Consumer Portal at www.medimpact.com and view formulary status of drugs.
If the drug is non-formulary, the non-formulary copay will apply. If the drug is excluded, it will reject at the point of sale and you will be expected to work with your doctor to obtain a drug on the MedPerform formulary. Will my payment increase? *If you are moving from a formulary to non-formulary drug, yes, you may experience a payment increase due to the increased cost share for non-formulary drugs.
Yes, the formulary changes bi-annually every April and October. Please refer to StayWell’s website under Pharmacy Benefits for the most updated formulary.
Please make an appointment with your prescriber to discuss other drug options available for you that are safe and work just as well. These are “formulary” or “preferred drugs” which may cost less.
Our pharmacy network provides flexibility to receive prescription drugs through retail, mail or specialty pharmacy.
Retail 30 & Retail 90
The Retail 30 benefit allows you to obtain a 30-day supply of covered non-formulary medication. The Retail 90 pharmacy benefit allows you to obtain a 90-day supply of formulary maintenance medications at a discounted rate.
The Specialty Pharmacies provide convenient delivery & personalized service for those who have complex health conditions.
The MedImpact Direct mail-order program allows you to have your formulary maintenance medications delivered to your door with your copayment waived. You can set up your maintenance mail order prescriptions by: 1) having your doctor submit your prescription, 2) mailing your prescriptions, or 3) requesting for prescriptions by signing into their website or mobile app. For more information, call toll-free at 888-274-8736 or visit www.medimpact.com.
MedImpact Direct promotes the refill reminder program. A patient will receive an email notification reminding the patient that a prescription is due for refill. The patient has the ability to log on MedImpact’s consumer portal or mobile app for requesting the refill when reminded. Due to the logistical differences for Guam (vs continental US) and potential long shipping times (USPS indicates 7–21 day delivery time), our refill reminder notifications for StayWell will be sent out at 75% utilization (day 67) to ensure that with increased transit times there will not be a disruption in therapy.
Automatic refills for Mail Order can be requested at the individual prescription level with a MedImpact Direct CSR. Some medications are not eligible for auto-refill program such as controlled substances or directions of use PRN (“as needed”) or on a sliding scale.
The internal mail order process takes 2–5 business days for order shipment. Medications will ship from Michigan or Ohio. Shipping can take between 7–21 days to arrive, although the USPS does not guarantee delivery dates or times. All orders which have been filled and shipped by MedImpact Direct will have a tracking number with a clickable link to the courier.
Most deliveries are planned between you and the pharmacy vendor at the time the prescription is filled. If it doesn’t arrive at the agreed upon time, you should call MedImpact’s pharmacy helpdesk toll-free at 888-274-8736. The MedImpact Customer Service Representative will be able to assist you with next steps.
If you are out of medication, you can obtain a fill through a retail pharmacy. The retail pharmacy will need to call MedImpact to do the override.
MedImpact has a contract with most retail pharmacies located on Guam and Saipan. A listing of pharmacies may be found in StayWell’s Provider Directory. This directory is also available online at www.staywellguam.com/health/provider-listing. You may also visit www.medimpact.com to search for a specific pharmacy.
Yes. Medication requiring coldpaks can be completed by MedImpact Direct with an additional cost for special packaging.