The procedure for requesting prescription drug override requests was revised on March 8, 2010. The revision was completed as part of an effort to reduce the amount of personal health information (PHI) an employee/annuitant is required to share with PASSHE or the universities in order to request the prescription drug override.
Whenever possible, if the employee/annuitant has sufficient lead time, they should be encouraged to use the mail order feature through Medco to obtain up to three (3) months of prescriptions.
The new procedure will be as follows:
1) When a PASSHE member needs to request an Rx override, they will be calling the Highmark Member Services toll free number located on their Identification cards and indicate that they need an override (as opposed to either contacting their campus Benefit Coordinator or the System Human Resources Office with specifics).
2) The Highmark representative will obtain the required override details from the member, who should be prepared with the needed information. This information will include:
a. Employee/annuitant name
b. Highmark identification number (located on their Identification card)
c. Name of member taking the medication
d. Name of the medication, including strength and dosage
e. Name of pharmacy
f. Date leaving the country
g. Date returning
3) After gathering all of the override details, the Highmark representative will then send a secure email to Dee Billy with a cc to Mary Ann Spontak and provide just the non-PHI info, and request approval. The representative will need to have approval from PASSHE before proceeding with the override.
4) Dee will research that the employee/annuitant is eligible for the requested override time period. If the member requesting the override is a COBRA participant, it will be necessary for the COBRA premium to be paid for the amount of time being requested in the override process (i.e., if the COBRA participant is requesting an override for a 6-month period, COBRA premiums need to be paid for the entire 6-months of coverage). If employee is on a Leave Without Pay With Benefits status, employee contributions must be paid for the entire period for which the override is being requested.
5) The maximum amount of time an override will be approved for will be six (6) months or 180 days.
6) After Dee has researched eligibility (i.e., paid sabbatical leave, continued student certification, pending retirement), she will respond to the secure email with approval from PASSHE. Once confirmation is provided, the Highmark rep will forward the request to Medco for processing.
7) The Highmark representative will then contact the member to confirm that the authorization is on file and when the medications can be picked up or ordered through Medco Mail Order if the member uses the mail order feature to fill their prescriptions.