What does the new pharmacy network change mean for you?

Tufts Health Plan partners with a Pharmacy Benefit Manager (PBM) to administer your pharmacy benefit. PBMs provide many pharmacy services to members, including claims processing, contracting with the pharmacies in our network, and much more. Tufts Health Plan currently works with CVS Caremark to help manage your pharmacy benefits. Beginning January 1, 2023, we will be working with a new PBM, OptumRx, to improve how you get the medications you need.

Plus, you'll be able to easily find information about your pharmacy benefits, view your pharmacy claims, look up drug pricing, manage home delivery, and more through a secure OptumRx account.

The OptumRx retail pharmacy network has more than 67,000 pharmacies nationwide, including CVS Pharmacy and many others that Tufts Health Plan members currently use.

Visit thpmp.org/hmo-pharmacies to search for an in-network pharmacy near you.

If you receive your benefits from a current or former employer, visit thpmp.org/eg-pharmacies to search for an in-network pharmacy near you.

Additional information:

• In December 2022, you will receive a new member ID card with OptumRx information on it. (If you receive your benefits from a current or former employer, you will receive your new ID card in November.)
• You should begin using your new member ID card starting January 1, 2023.
• If you have prescriptions currently refilled by CVS Caremark mail order, OptumRx will notify you to sign up to receive the refills via home delivery. If you have a copay for your prescriptions, OptumRx will be contacting you directly for updated payment information. You can sign up for home delivery through OptumRx beginning January 1, 2023.
• If you use any specialty medications, starting January 1, 2023, you have the option to fill your prescription with our new preferred specialty pharmacy, OptumRx Specialty. To learn more, visit specialty.optum.com. CVS Specialty will continue to be in our network, so you can keep your prescription there, if desired.

What if you use preferred pharmacies?

Walmart, Rite Aid, and Stop & Shop pharmacies are part of our preferred pharmacy network. Starting January 1, 2024, Costco and Wegmans will also be preferred pharmacies.

If you need to transfer a current prescription to a new preferred pharmacy beginning January 1, 2023, simply call the preferred pharmacy of your choice and ask them to transfer your prescription. To search for preferred pharmacies near you, go to thpmp.org/hmo-pharmacies.

Please note: Preferred pharmacies are not available with Prime Rx and Prime Rx Plus plans or if you receive your benefits from a current or former employer