1.2 Importance of the 2024 PDF Document

The 2024 PDF document is essential for understanding the Empire Plan’s prescription drug coverage. It details the formulary, including covered drugs, tier changes, and exclusions. Members can find updated lists of generic, brand-name, and specialty drugs, along with any prior authorization or step therapy requirements. The document also outlines cost-sharing details, annual limits, and program administration. Regular updates ensure members have the latest information to make informed decisions about their prescription drug needs and benefits.

Empire Plan 2024 Formulary Updates

The 2024 Empire Plan formulary includes updates on covered drugs, with the most recent revisions on March 26, 2024. It lists generics, brand-names, and exclusions, ensuring members stay informed about changes in drug coverage.

2.1 List of Covered Drugs and Formulary Changes

The 2024 Empire Plan Advanced Flexible Formulary lists commonly prescribed generic and brand-name drugs. Updated on March 26, 2024, it includes exclusions with formulary alternatives. Members can access the full list online at empireplanrxprogram.com or by contacting CVS Caremark. Changes ensure cost-effective treatment options while maintaining access to essential medications. The formulary is designed to balance affordability and therapeutic effectiveness, reflecting the latest clinical guidelines and drug availability.

2.2 Specialty Drugs and Pharmacy Program Details

The Empire Plan’s Specialty Pharmacy Program covers high-cost, complex medications, such as biologics and injectables, for chronic or rare conditions. These drugs must be filled at preferred specialty pharmacies to ensure proper management and adherence. The program emphasizes clinical oversight to optimize therapeutic outcomes. Members are encouraged to use in-network providers for these medications to maximize benefits and minimize costs. Details on specific specialty drugs and requirements are outlined in the 2024 formulary and CVS Caremark resources.

Prescription Drug Cost-Sharing and Limits

The Empire Plan features an annual out-of-pocket maximum of $1,450 for individuals and $2,670 for families. Copays vary for generic and brand-name drugs.

3.1 Annual Out-of-Pocket Maximum for 2024

The Empire Plan’s annual out-of-pocket maximum for prescription drugs in 2024 is $1,450 for individual coverage and $2,670 for family coverage. This limit applies to in-network services and helps protect members from high healthcare expenses. The out-of-pocket maximum includes copays, coinsurance, and other eligible expenses under the Prescription Drug Program. Once this limit is reached, the plan covers 100% of eligible drug costs for the remainder of the plan year, providing significant financial relief for members with high prescription needs.

3.2 Copays and Coinsurance for Generic and Brand-Name Drugs

The Empire Plan requires copays for generic drugs and coinsurance for brand-name medications. Generic drugs typically have lower copays, while brand-name drugs may require higher coinsurance percentages. Members pay a fixed amount for generics and a percentage of the drug’s cost for brand-name medications. The plan differentiates between preferred and non-preferred brand drugs, with varying cost-sharing amounts. These amounts are outlined in the 2024 formulary and are designed to encourage the use of cost-effective medications while ensuring access to necessary treatments.

Specialty Pharmacy Program and Site of Care (SOC) Redirection

The Empire Plan’s Specialty Pharmacy Program manages high-cost drugs, requiring specific coverage criteria. SOC redirection ensures drug infusions are administered at cost-effective, approved sites, maintaining quality care.

4.1 Requirements for Specialty Drug Coverage

Specialty drugs under the Empire Plan require prior authorization and adherence to step therapy protocols. Patients must obtain these medications through designated specialty pharmacies. The program ensures that drugs are dispensed in clinically appropriate settings, optimizing therapeutic outcomes. Certain drugs may require site of care redirection to maintain cost-effectiveness while preserving quality of care. Members should consult the formulary or contact CVS Caremark for specific coverage criteria and requirements.

4.2 Impact of the SOC Program on Drug Infusions

The SOC program redirects drug infusions to lower-cost, clinically appropriate settings, such as outpatient facilities, starting January 1, 2024. This ensures cost-effectiveness while maintaining quality care. Members benefiting from in-network providers experience reduced out-of-pocket costs. The program optimizes therapeutic outcomes and aligns with Empire Plan’s cost-containment strategies, enhancing affordability without compromising patient care quality.

Empire Plan Prescription Drug Program Administration

CVS Caremark administers the Empire Plan Prescription Drug Program, managing claims, prior authorizations, and providing 24/7 customer support. Visit empireplanrxprogram.com or call 1-877-769-7447, option 4, for assistance.