New PBM effective January 1, 2020

Here’s what you need to know.


As a reminder, we are transitioning to a new pharmacy benefit manager (PBM) effective Jan. 1, 2020. Below is a quick recap of what you need to know.

Enhancements for next year

Here are just a few of the improvements coming in January.

We will be offering some exciting new customer enhancements, including:

  • Dedicated prescription helplines staffed by experts who are available to answer all customer, provider and pharmacist questions 24/7.
  • An improved digital pharmacy experience that allows members to access pharmacy benefit, network and cost information through our website and Sharp Connect.
  • Enhanced digital tools, like the free CVS Caremark® mobile app that lets members see their personalized pharmacy benefit information, refill or request new mail service prescriptions, track order status, view prescription history and much more.

2020 formulary changes

Our drug list is changing.

We are updating our formulary (or drug list) in 2020. We have notified members who are currently taking drugs that have formulary changes for next year. Our communications directed members to work with their providers if they had questions about their medications. To help make this a smooth transition, we are honoring all existing pharmacy prior authorizations until the date noted on the member’s original approval letter from Sharp Health Plan.

Please note, your clients who are enrolled in benefits on our Tier 3 formulary will have a 31-day grace period on their current medications if they are impacted negatively by the 2020 formulary changes. These clients will have until Feb. 1, 2020 before the negative changes go into effect. All other changes will still be effective Jan. 1, 2020. We notified your clients of their specific effective dates in our communications. If you want to check what Tier formulary your client is on, you can contact your account management executive.

New member ID cards

New 24/7 prescription helpline, plus new BIN and PCN info.

All members will receive new member ID cards by the end of December. These cards will include a new, dedicated prescription helpline for 24/7 support with pharmacy-related questions and new BIN and PCN information. New cards will be effective Jan. 1, 2020.

Plan Type 24/7 Prescription helpline BIN PCN
Commercial, Exchange 1-855-298-4252 004336 ADV

Questions

If you have questions, here’s where you can find more information.

If your employer clients have questions, please refer them to sharphealthplan.com/pbmemployers to learn more. If they still have questions after reading our FAQ, please have them contact their account management executive.

Please direct member clients with pharmacy questions to sharphealthplan.com/2020pharmacyinfo. Beginning Jan. 1, 2020, they can also call the pharmacy helpline. The number will be printed on the back of their new member ID card.

If you have questions, please visit sharphealthplan.com/pbmbrokers to learn more, or contact your account management executive.