Pharmacy Resource Guide – Section 2

The changes below take effect January 1, 2025, to help manage the rising cost of medications and simplify how plan members use this benefit.

Fill all specialty medications with the health system pharmacy

Now all specialty medications will be filled at the health system pharmacy regardless of who prescribes it. For members of the HSA Advantage plan, coinsurance will be less because of the health system pharmacy’s lower costs.

• Existing prescriptions: No need for you to do anything. The health system specialty pharmacy will work with providers to transition these prescriptions.
• New prescriptions: Ask your provider to send it to the health system’s Southlake pharmacy location.

Access guidance savings program

Starting Jan. 1, 2025, members who take Glucagon-Like Peptide Receptor Agonist (GLP1-RA) can enroll in this program to take advantage of copay assistance offered by manufacturers. Here’s what you need to know:

• Your GLP1-RA medications will still be covered by the health system medical plans in 2025 (with approved prior authorization).
  • Signature Plan members will pay a reduced amount offered by the manufacturer (usually less than $30).
  • HSA Advantage Plan members will still need to satisfy the deductible before the manufacturer assistance will help with your coinsurance.
• What’s different: The amount of the manufacturer assistance will no longer apply toward the deductible or out-of-pocket maximum in either medical plan. Only the amount paid by the medical plan member will apply to their deductible or maximum out-of-pocket.