General Questions

General Questions

Why is UC changing prescription drug administrators?

For some PPO members, the transition to OptumRx (effective January 1, 2017) has been more challenging than expected. Despite our efforts to resolve key issues, OptumRx could not meet UC’s expectation to successfully transition members to Medicare, nor could they provide the customer support that UC faculty, staff and retirees are accustomed to.

After considering various options, and consulting with faculty, staff and retiree groups, UC Health and UCOP Human Resources senior management agreed that changing the prescription drug benefit administrator to Anthem Blue Cross, beginning January 1, 2018, is in the best interest of our members. The change applies to both Medicare and non-Medicare PPO members.

Why change to Anthem?

Anthem currently administers the medical and behavioral health benefits for UC’s PPO plans. They understand our members and the details of how our plans work. We recognize that another change is not ideal, but we expect that this will improve your overall experience. Anthem will offer an integrated customer service model, so you’ll be able to get answers to your medical, behavioral health and prescription drug questions with a single call to Anthem Health Guide.

What does the prescription drug administrator do?

The prescription drug administrator processes prescription drug claims, maintains a network of retail pharmacies and manages the maintenance medication home delivery service. The administrator also develops formularies (determines what drugs are covered by the plan), sets the preferred drug list, and establishes clinical policies and guidelines (including prior authorization criteria). 

Who’s affected by this change?

Members covered by these UC medical plans:

  • Core
  • UC Health Savings Plan
  • UC Care
  • UC High Option Supplement to Medicare
  • UC Medicare PPO with Prescription Drugs

When is the change effective?

The transition from OptumRx to Anthem will be effective January 1, 2018.

What do I have to do?

At this time, no action is required.  As we approach Open Enrollment and the end of the year, articles will be published and letters from Anthem will be mailed to your home.  We encourage you to read them so that you will be aware of how this change might impact you.  Through the end of 2017, continue to access your prescription drug benefits through OptumRx using your current plan ID card. 

When will I get more information?

More details will be provided during this fall’s Open Enrollment period. Anthem will begin outreach to members who need to take a specific action during the Open Enrollment period through the end of 2017. Read your mail for Open Enrollment materials from UC and notifications from Anthem.

When can I call Anthem Health Guide and the Anthem Medicare Prescription Drug Member Services for questions?

The best time to call regarding this change will be during Open Enrollment, which begins October 26, 2017.  To reach Anthem Health Guide at (844) 437-0486 or the Anthem Medicare Prescription Member Services at (833) 619-5708, call between the hours of 5 a.m. and 8 p.m. (PT), Monday through Friday.