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Revised Process for Prescription Drug Overrides

Effective March 8, 2010, the procedure for requesting prescription drug override requests will be revised. This is being done to in an effort to reduce the amount of personal health information (PHI) an employee/annuitant needs to share with State System 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 Express Scripts to obtain up to three (3) months of prescriptions.

The new procedure will be as follows:

  1. When a State System 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 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 Karrah Garland with a cc to Rex Rensel and provide just the non-PHI info, and request approval. The representative will need to have approval from State System before proceeding with the override.
  4. Karrah 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 Karrah has researched eligibility (i.e., paid sabbatical leave, continued student certification, pending retirement), she will respond to the secure email with approval from State System. Once confirmation is provided, the Highmark rep will forward the request to Express Scripts 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 Express Scripts Mail Order if the member uses the mail order feature to fill their prescriptions.

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