Programs and Services
• SaveOnSP expands program
• Formulary Changes
Christian Brothers Services Employee Benefit Trust members who are enrolled in HSA plans will soon begin to take advantage of copay assistance that the newly added SaveOnSP Adapt program offers beginning January 2024.
What is Adapt?
SaveOnSP Adapt is a variation of the standard SaveOnSP-administered copay assistance benefit that clients with an HSA-eligible High Deductible Health Plan can implement. Adapt works with Express Scripts® to help members save on the costs of certain specialty prescriptions. With assistance from SaveonSP Adapt, participants with eligible prescriptions will be contacted and enrolled in manufacturer copay assistance programs, reducing member responsibility after the deductible has been met.
Under the Adapt program, you must fulfill your deductible before the program applies to select specialty drugs classified under non-essential health benefits (NEHBs). During the pre-deductible phase, the total drug cost accumulates towards the deductible and maximum out of pocket. Once the deductible is met, select drugs will have a 30% coinsurance, which will not count towards the maximum out-of-pocket expense.
After meeting the deductible, you could pay as little as $0 for included specialty medications.
There are some important things you should know:
You can fill your specialty medication at the specialty pharmacy approved by the plan.
To ensure you pay as low as $0 for your included specialty medications, you should contact Express Scripts at 800.683.1074 right away. You should do this prior to January 1, 2024, which is when this new benefit starts, to ensure you understand this change and can take advantage of this new benefit without delay.
You must complete the manufacturer copay assistance enrollment process and allow Express Scripts to monitor your account on the plan's behalf.
How does it work?
The Adapt program encourages the usage of manufacturer copay assistance (CPA) to decrease the cost of the drugs to members. For example, if the drug cost is at $10,000, and the member’s deductible at $4,000 is yet to be met and they have a maximum out-of-pocket expense of $6,000, once that deductible is met, the member will only have to pay a 30% coinsurance, in this case $1,800. The CPA would cover the remaining $4,200.
The prescription drug plan, administered by Express Scripts Inc. (ESI) on behalf of Christian Brothers Services Employee Benefit Trust, includes a formulary. At its most basic level, formularies are lists of drugs, generic and brand name, which offer the greatest overall value to plan participants.
Medications indicated on the formulary list are typically grouped into three tiers: generic, preferred brand and non-preferred brand. Formulary management enables you and your physician to choose clinically appropriate and cost-effective drugs for specific conditions. The tier the medication is in determines the portion of the drug cost. Medications not on the formulary list are not covered by the Plan.
You will be notified well in advance and informed of other drugs available in the same therapeutic class.
You can find the most updated formulary information by logging on to mycbs.org/health. The list is not all-inclusive and does not guarantee coverage, as it is subject to change. In addition to using the list, you are encouraged to ask your doctor to prescribe generic drugs whenever appropriate.
Quarterly, ESI announces changes to its formulary drug list. Some prescription drugs currently covered will be excluded from coverage, while other prescription drugs move from a Preferred Brand status to a Non-Preferred Brand status.Please note that while the Trust subscribes to Express Script’s National Preferred Formulary, certain prescription drugs and/or preventative care inconsistent with the tenets of the Catholic Church may not apply or be covered. Please refer to your plan booklet for further details.You can view the most up to date formulary list and exclusion list by visiting our website.
Each year, the IRS sets the minimum deductible and maximum out-of-pocket expenses for High Deductible Health Plans (HDHP), which participants must be enrolled in to qualify for a Health Savings Account (HSA).
*Participants who may be affected will be notified in advance.
Out-of-Pocket Limits on Health Savings Account (HSA) Qualified High Deductible Health Plans
The Department of Health and Human Services has indexed the 2024 Out-of-Pocket Requirements and Minimum Deductible levels as follows.
2024
2023
Change
HDHP Minimum Deductibles
Individual: $1,600Family: $3,200
Individual: $1,500Family: $3,000
Individual: $100Family: $200
HDHP Maximum Out-of-Pocket Limits
Individual: $8,050Family: $16,100
Individual: $7,500Family: $15,000
Individual: $550Family: $1,100
Out-of-Pocket Limits on non-Grandfathered Plans under Affordable Care Act (ACA)
The Department of Health and Human Services has indexed the 2024 Out-of-Pocket Requirements to a maximum of $9,450 for self-only coverage and $18,900 for family coverage. In addition, the self-only Out-of-Pocket maximum is applied to each covered individual, whether the individual is enrolled in self-only coverage or family coverage.
ACA Maximum Out-of-Pocket Limits
Individual: $9,450Family: $18,900
Individual: $9,100Family: $18,200
Individual: $350Family: $700
Express Scripts, the pharmacy benefit manager for Christian Brothers Services medical trusts, now partners with GoodRX, expanding savings to members at the pharmacy counter while improving adherence, safety and overall health outcomes.
Effective November 1, 2023, the program unlocks additional potential savings on generic medications when a participant fills prescriptions at an in-network pharmacy. The savings is automatic—you do not have to do anything additional to receive this benefit.
This integration allows you to automatically access lower prices on your medications and apply them to your deductible, enhancing overall cost savings without any effort on your part.
Express Scripts incorporates "lesser of" logic when processing prescription claims, ensuring you pay the lowest available price at the pharmacy, be it their co-payment or the pharmacy's price for the medication. While Express Scripts recognizes that its negotiated price within the benefit usually offers the best prescription medication price, there are instances where cash discount pricing is lower, especially for members in High Deductible Health Plans. By integrating access to the GoodRx discount program into the benefit, Express Scripts ensures that members don't miss out on potential cost savings.
Affordable medication not only promotes adherence to treatment plans but also helps in avoiding downstream medical costs, ultimately leading to healthier outcomes. This integration also ensures visibility of claims within the pharmacy benefit, conducting health and safety checks to guarantee the right medication at the right time.
