Important Changes for 2025
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
Members who take certain medications will be entered into this program to take advantage of copay assistance offered by manufacturers. If enrolled:
- You will pay a reduced amount for your specialty or GLP1-RA medication as set by the manufacturer.
- Some of the programs require the member to enroll themselves in the programs vs. allowing the pharmacy to enroll them.
- Only what you actually pay out of your pocket will apply toward your deductible and/or out-of-pocket maximum.
- For example, if the regular price of your medication is $100 and the manufacturer program price is $5, only the $5 you pay will be applied to your deductible and count toward your out-of-pocket maximum.
Simplified tiers based on medication cost
The higher the tier number, the higher the cost of the medications in it. Because of rising costs, some medications and products will move to the new tier 4. These may include treatments for migraines, continuous glucose monitors and disposable insulin pumps, among others.
Section 5: How the formulary works