IngenioRx Client Guide
Important Information About This Transition
Anthem, Inc. recently announced the acceleration of the launch of IngenioRx, its new pharmacy benefit manager. Anthem has spent more than 15 months planning this transition and, based on the results from their rigorous testing, Anthem is confident in their ability to transition our members with as little disruption as possible. Moreover, by accelerating, Anthem can deliver new value to our schools sooner than expected.
The goal is to make this move as easy as possible for our members. Almost all of the changes will be happening behind the scenes, and there will be no changes to our benefit design as a result of this move. There will be some enhancements to the service model, and members who use home delivery and/or specialty pharmacy medications will be transitioned to IngenioRx pharmacies. Anthem will walk members through any changes they may encounter in advance of the move.
In anticipation of our move, Anthem has developed the frequently asked questions below, which should help answer any questions members may have. If you have a specific question that isn't addressed below, please contact your district Treasurer.
Sample Letters of Mail Employees May Receive
Sample Switch to IngenioRx Letter
Frequently Asked Questions
What is the relationship between Anthem, Inc. and IngenioRx?
IngenioRx is a wholly owned subsidiary of Anthem, Inc.
Will anything about a member's benefits change?
There will be no changes to the benefit plan and products that members have as a result of the transition to IngenioRx.
What enhancements will members experience?
There are several enhancements that will be effective once members move to IngenioRx. These include:
- A dedicated pharmacy member services team that will be staffed with pharmacy subject matters experts who are available 24/7.
- A dedicated specialty pharmacy with a care team that is also available 24/7.
- A redesigned website and mobile app that provides members with the ability to access and manage their pharmacy and health plan benefits through integrated capabilities.
- Helpful online tools that allow members to find a doctor or pharmacy, price medication, find and compare costs across pharmacies, manage and refill home delivery and specialty pharmacy prescriptions, and much more.
Depending on their benefits design, some members may also see lower out-of-pocket costs at the pharmacy counter.
Will members have to do anything?
Every subscriber will also receive a "welcome" letter introducing them to IngenioRx, explaining the service enhancements they can expect and any steps they may need to take in their health plan website. Members who fill home delivery and/or specialty prescriptions will need to fill these prescriptions through IngenioRx effective May 1, 2019.
Will members need new ID cards?
The majority of members have already been sent new ID cards, which contain all of the information needed to process claims and access member service. These cards will work both before and after the move.
What will members who use home delivery need to do?
Effective May 1, 2019, members will begin to fill home delivery prescriptions through the IngenioRx Home Delivery Pharmacy. If they have active refills, those prescriptions will be automatically transferred to IngenioRx.
A targeted letter will be sent to members who use home delivery that walks them through the move. The letter will explain the following:
- For security reasons, payment information WILL NOT transfer to IngenioRx. The letter will explain how to re-enter that information on their health plan website.
- Prescriptions for controlled substances and compound medications CANNOT be transferred. Individuals filling these prescriptions at home delivery will have to contact their provider for a new prescription.
- Individuals who are currently enrolled in the "auto-refill" program with Express Scripts home delivery will have to restart their auto-refills after the effective move date. A letter will instruct these members to visit their health plan website or call the pharmacy member service number on the back of their ID card to re-establish their auto-refill program.
What will members who use specialty drugs need to do?
Effective May 1, 2019, members who fill specialty medications through Accredo will begin to fill those medications through IngenioRx Specialty Pharmacy. If they have active refills, those prescriptions will be automatically transferred to IngenioRx. A targeted letter will be sent to members who use home delivery that walks them through the move. Additionally, every member who fills a specialty drug will be contacted by our specialty care team, via telephone, to introduce them to IngenioRx, check in on their care, and help with the move.
Are drug lists changing?
No.
Will prior authorizations transfer?
Yes, prior authorizations for traditional and specialty medications will transfer
Are retail pharmacy networks changing ?
We are still finalizing a few pharmacy network contracts and, while unlikely, it is possible a pharmacy may move out of network. Any member who is impacted by such a move will receive a letter, along with advice on how to move their prescriptions to an in-network pharmacy. Based on a current analysis, fewer than 2% of members should have to change pharmacies.
What should a member do if they have a problem filling their prescription?
Once members have transitioned, they have 24/7 access to pharmacy-specific member services associates by calling the number on the back of their ID card. These member service associates will have tools and resources that allow them to troubleshoot member issues in real-time.
What enhancements are being make to your Anthem website and mobile app portal?
For many years, Anthem members have had to use different websites and mobile apps when accessing the pharmacy benefit and medical benefit information. Once a member moves to IngenioRx, this will no longer be the case. Effective May 1, 2019, member will have a new, fully integrated digital experience that allows them to access their pharmacy benefits information, alongside their medical benefits information, through their health plan website and mobile app.
Some examples of specific functionality members can access include:
- A "medicine" cabinet functionality that stores their list of medications
- A "Price a Medication" feature where members have the ability to price a drug at multiple pharmacies to see various savings
- The ability to access their historical pharmacy claims
- The ability to check order status on home delivery and specialty prescriptions, check their home delivery/specialty account balance, sign up for auto refill and an express checkout functionality
Given there will be a separate phone number for pharmacy, how will IngenioRx deliver an integrated experience?
IngenioRx member service teams will be able to seamlessly transfer members between Anthem general and pharmacy service teams, as needed, to help ensure any pharmacy and medical questions are answered by the right specialist. If a member needs to be transferred between general and pharmacy member service teams, they will be placed at the top of the queue, will not have to re-authenticate themselves, and will be introduced to the next care specialist.