Prescription Drugs

State of Mississippi Health Insurance Plan


 Catamaran Rx Pharmacy Program
Direct Member Reimbursement
Post Office Box 1069
Rockville, MD 20849-1069
1-866-757-7839  


The State of Mississippi Health Insurance Plan provides coverage for prescription drugs. The prescription drug program is offered through Catamaran Rx. Catamaran Rx is responsible for managing the prescription drug mail order program, negotiating with pharmaceutical manufacturers, developing and maintaining a network of participating pharmacies, developing a list of preferred drugs, processing prescription claims for the participating pharmacies, and processing prescription claims for you when you file a paper claim. Please refer to the sections on Base Coverage and Select coverage for information on prescription deductibles. Prescription drug benefits paid by the Plan will apply toward your $1,000,000 lifetime maximum.

 

When a prescription drug is purchased at a participating retail pharmacy, the participant is only required to pay the appropriate co-payment amount (after the applicable deductible is met) or the cost of the drug, whichever is less. There is no claim form to file. When a prescription drug is purchased at a non-participating pharmacy, the participant must file a claim with Catamaran Rx. Payment of the claim will be made based upon the Plan’s allowable charge. The participant is responsible for any amount in excess of the allowable charge, plus the applicable deductible and co-payment.

 

The co-payments for prescription drugs through the retail and mail order pharmacies are as follows:

 


Co-Payment Amounts

Retail Pharmacies

Mail Order

Prescription Drug Type

1-30 Day
Supply

31-60 Day
Supply

61-90 Day
Supply

90 Day Supply
(or less)

Generic Drug

$12

$24

$36

$24

Preferred Brand Drug

$40

$80

$120

$80

Other/Non Preferred Drug
(no generic equivalent)

$65

$130

$195

$130

                                                

Generic Drugs

Typically, generic drugs cost less than equivalent brand-name drugs. Because the generic drug co-payment is less, participants save money when purchasing generic drugs. To be covered by the Plan, a generic drug must contain the same active ingredients as the brand-name drug (inactive ingredients may vary), be identical in strength, form of dosage, and the way it’s taken, demonstrate bio-equivalence with the brand-name drug, and have the same indications, dosage recommendations, and other label instructions.

Preferred Brand Drugs

A list of preferred brand drugs is maintained by Catamaran Rx. Preferred drugs are chosen based on their clinical appropriateness and cost effectiveness. Catamaran Rx has the right to add drugs to the list at any time. Deletions will only occur on an annual basis. You can request a copy of the PDL by contacting Catamaran Rx directly or through the Plan’s website at http://knowyourbenefits.dfa.state.ms.us.

Vaccine Program

Benefits will be provided at 100% of the allowable charge of annual influenza (flu) and pneumococcal infection (pneumonia) vaccines administered by an immunization-certified pharmacist at a participating pharmacy.  In addition, benefits will be provided at 100% of the allowable charge for participants age 60 and over who receive the herpes zoster (shingles) vaccine from an immunization-certified pharmacist.  Participants must use a Catamaran Rx participating pharmacy.

Mail Order Service

Plan participants can enjoy the convenience of home delivery by using Catamaran Rx’s mail order service.

In order to participate in the mail order program, participants must register as a first time user. Registering will establish your health, allergy, and plan information. This can be done by completing the registration form and mailing in with new prescription and/or refill information.

2 Steps to Enroll in the Mail Order Service

  • Call your physician and obtain a new 90-day prescription
  • Complete the Catamaran Rx mail order program Enrollment Form
    • Initial registration can be completed through
      • online at www.catamaran.com via the "Mail Service" link, 
      • by calling 1-866-757-7839 and selecting Option 1, 
      • by printing the form and mailing to the address on the form.
    • Prescription Order Form can be:
      • faxed to Catamaran Rx mail order program by the physician’s office or
      • mailed to Catamaran Rx mail order program by the participant
  • Order your refill 7-10 days before your supply runs out. This will allow ample time for shipping and delivery of your order.

A prescription submitted to the mail order service for less than a 90-day supply will be charged the same co-payment as for an entire 90-day supply. Catamaran Rx has the right to stop mail order services if an enrollee carries a delinquent balance on his account.

A mail order co-payment will be applied to each unit for any covered drug or medical item that requires a specific co-payment per unit or vial, such as insulin and diabetic supplies.

Prior Authorization

Certain prescription drugs require prior approval. The prescribing physician must contact Catamaran Rx at 866-757-7839 for prior authorization. The physician must provide appropriate documentation of medical necessity. Only the physician can request prior authorization approval.

Examples of prescription drugs requiring prior authorization include, but are not limited to:

  • medications for treating acne,
  • anabolic steroids,
  • medications for tobacco cessation,
  • brand name proton pump inhibitors
  • medications for male impotency, and
  • growth hormones for persons age 21 or older.

The fact that a physician has prescribed, ordered, recommended, or approved a prescription drug, does not, in itself, make the prescription drug medically necessary for purposes of coverage under the Plan.

 

Catamaran Rx Specialty Pharmacy Program

 

The Catamaran Rx Speciality Drug Management program, provides access to speciality medications with the convenience of express mail delivery. Speciality medications must be purchased through this program in order to be covered. Participants have access to a Speciality Care Team staffed by experienced pharmacists specially trained in complex health conditions and the latest medication therapies. The following chart shows the co-payment amount for speciality medications.

  In-Network (30-day supply) Out-of-Network
Speciality Drugs $65 *N/A

*There is no Out-of-Network co-payment since all speciality drugs must be purchased through the Catamaran Specialty Drug Management Program (In-Network).

This program provides medications for many chronic conditions, including following:

 

  • Multiple Sclerosis
  • Gaucher’s Disease
  • Hepatitis C
  • Respiratory Syncytial Virus
  • Crohn’s Disease
  • Pulmonary Hypertension
  • Rheumatoid Arthritis
  • Cystic Fibrosis
  • Anemia
  • Growth Hormone Deficiency
  • Neutropenia

 

Diabetic Sense

To help meet the needs of members with diabetes, Catamaran Rx offers the Diabetic Sense Program. To enroll or learn more, please contact the Diabetic Sense National Diabetic Pharmacy at 1-877-852-3512.

Some of the benefits of the Diabetic Sense program are:

  • Free blood glucose meters as provided through Diabetic Sense
  • Participants receive a 90-day supply of diabetic supplies for 2 generic copayments through mail
  • Educational materials
  • Access to certified diabetes educators and registered pharmacists

Tobacco Cessation

Coverage is provided for tobacco cessation prescroption and over-the-counter drugs. A prescription is required.  Benefits will be provided at 100%, not subject to the calendar year deducible, with an annual limit of 2 cycles (12 weeks per cycle).

 


Send questions and comments regarding this site to Lisa Giger.


 

 

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