Drug Programs to Help Patients Save Money

The following programs and resources can help your patients save money on their medications:

Generic Advantage Program

You can help your members save money on their medication by prescribing generic alternatives when it’s medically appropriate. The Generic Advantage Program promotes the cost-savings benefit of choosing approved generic alternatives over more costly brand name medication. This program is part of our drug benefit and is designed to encourage value when selecting prescription drugs.

This program applies to a list of brand name drugs that have Food and Drug Administration (FDA) approved generic alternatives.

How the program works:
If members purchase a brand name medication when there is a generic equivalent available, they will pay both the generic co-payment/coinsurance amount, and the difference between the cost of the more-costly brand name medication and our price for the less expensive generic.

EPIC: The Plan for Seniors who Need Help Paying for their Prescriptions

Elderly Pharmaceutical Insurance Coverage (EPIC) is a New York State program* for seniors that helps with out-of-pocket Medicare Part D drug plan costs. It works together with Medicare Advantage plans, and over 250,000 New Yorkers have already joined EPIC to save on their prescription drug coverage. EPIC helps pay Medicare Part D drug plan premiums or provides assistance by lowering deductibles. There are two plans based on income:

  • The Fee Plan is for members with incomes up to $20,000 if single or $26,000 if married.
  • The Deductible Plan is for members with incomes ranging from $20,001 to $75,000 if single or $26,001 to $100,000 if married.

How to Join the Program
Joining the program is easy and you can apply at any time of the year. Just complete the application and mail or fax it to EPIC. EPIC verifies information with the Social Security Administration and the New York State Department of Taxation and Finance.

* You must be a New York State resident 65 years of age or older and be enrolled or eligible to be enrolled in a Medicare Part D drug plan to receive EPIC benefits and maintain coverage. EPIC provides secondary coverage for Medicare Part D- and EPIC-covered drugs after any Part D deductible is met. EPIC also covers approved Part D-excluded drugs such as prescription vitamins as well as prescription cough and cold preparations once a member is enrolled in a Part D drug plan. Learn more at the New York State Department of Health website.

Specialty Drug Split-Fill Program

In an effort to provide greater patient support and avoid medication waste, Univera Healthcare introduces our specialty drug split-fill program. The split-fill program allow doctors and patients to try expensive medications that have serious side effects for a shorter time so that they can confirm effectiveness and tolerance prior to paying for a full 30-day supply to minimize unnecessary expenses, as well as medication waste.

The split-fill program applies to new starts only, Univera Healthcare members with commercial benefits, for the first two months of therapy. The program does not apply to members under our Medicare D, Medicaid Managed Care and Child Health Plus plans.

The following medications are included in the split-fill program:

  • BalversaTM
  • BraftoviTM
  • Cabometyx®
  • Erlotinib
  • Inlyta®
  • Inrebic®
  • Lenvima®
  • Lorbrena®
  • Mektovi®
  • Nexavar®
  • NerlynxTM
  • NubeqaTM
  • Odomzo®
  • Piqray® 250mg and 300mg
  • RozlytrekTM
  • Sprycel®
  • Tarceva®
  • Targretin®
  • TegsediTM
  • Tibsovo®
  • TuralioTM
  • VerzenioTM
  • Vizimpro®
  • Vitrakvi®
  • Votrient®
  • XpovioTM
  • Xtandi®
  • XuridenTM (limited distribution)
  • Yonsa®
  • ZejulaTM
  • Zytiga®

With this program, the monthly supply for included drugs will be split into two fills, each with a 15-day supply. The medication supply will be split for the first two months. The money the member pays for their medicine is less to match the smaller supply.

During the first two months of treatment, claims for included drugs will reject at point of sale if billed for greater than a 15-day supply. The pharmacy will need to rebill for a 15-day supply or less in order to get the claim to go through. After the member has received two months of treatment of a drug, it can be billed for full 30–day supply for subsequent fills.

If you have questions regarding this program, please contact the Pharmacy Help Desk at 1-800-724-5033.