FAQs Transition to Catalyst Rx as PBM

1. Why is ICHIP making this change?

The change to a new Pharmacy Benefits Manager (PBM) was made in conjunction with a competitive bidding process. The Board strives to provide CHIP participants with the most comprehensive pharmaceutical service currently available in a cost effective manner providing value to everyone involved with the program. The services available through Catalyst RX include a full complement of the most advanced techniques and strategies, clinical programs for complex diseases and a 24-hour toll-free support line. The phone number for Catalyst Rx Member Services Department is 1-877-629-3121.

2. Who is Catalyst Rx?

Catalyst Rx was founded in 1994 and is a full service Pharmacy Benefit Manager. Catalyst is responsible for developing and administering managed pharmacy benefit programs. Catalyst Rx provides customized products and services in the management of prescription drug programs.Catalyst offers a nationwide retail pharmacy network, claims processing and comprehensive clinical programs.

3. How do I contact Catalyst Rx?

The phone number for Catalyst Rx Member Services Department is 1-877-629-3121. This line can be contacted for the following items:

• General questions about prescription benefits
• Coverages/Exclusions of prescription benefits
• Copays
• Pharmacy locations
• Mail order registration/Questions
• Website information
• To begin a Clinical Prior Authorization process
• To check the status of a Clinical Prior Authorization
• To file an appeal for an adverse decision involving prescription benefits

Catalyst Rx Specialty Drug Management Program is supported by Walgreens Specialty Pharmacy. The Catalyst Rx Member Services Department at 1-877-629-3121 can assist with the following Specialty Pharmacy items:

• Questions about coverage of specialty prescriptions from members, pharmacies, physicians and staff
• Enrolling in the Specialty Pharmacy Program
• General specialty prescription questions
• Questions about ordering and the delivery of specialty medications

4. Are my drug benefits changing?

Prescriptions are still covered at 80% with the participant still being responsible for 20% of the cost. For HDHP plans, the participant pays the full contracted price of the medication until the deductible is met. The minimums and maximums are the same and the “member-pays-the-difference for brand when generic is available” also applies. Medications for preexisting conditions for Plan 3 and W participants are not covered for the first 6 months of coverage until the preexisting condition waiting period is met. Some medications require a Clinical Prior Authorization or have limits on the quantities that can be filled at the pharmacy. Catalyst Rx can assist participants with questions about these programs at 1-877-629-3121.

5. What will I need to do differently on January 1, 2011?

Don’t forget to show the pharmacist the new ID card that was mailed out on December 10, 2010. The new ID card contains important routing information that the pharmacist needs to submit the drug claims to the new PBM, Catalyst Rx. If you did not get a new ID card, contact the Plan Administrator, Blue Cross Blue Shield, 800-367-6410 (Hearing Impaired 800-545-2455 (TTY)) at and request that a replacement card be sent to you.

6. How does the mail-order program work?  Who is the mail-order vendor?

As an added benefit, the mail service benefit will remain the same through Walgreens Mail Service. If you currently received mail service prescriptions through Walgreens Mail Service there is no need to re-enroll. If the participant is not currently enrolled through Walgreens Mail Service, they need to perform the following steps:

1. Members should have already received a mail-registration form that can be completed and sent in along with a new prescription.
2. Members can enroll in the mail-order program by calling the Customer Care Representative for Walgreens Mail Service at 1-866-845-3590. Assistance can be provided by the Catalyst Rx Member Services Department at 1-877-629-3121.
3. Members can also register for mail service online at www.catalystrx.com. Members must still send in their new prescriptions.
4. Members should allow up to 2 weeks for delivery.
5. 5. The Walgreens Mail Service Customer Care Center phone number is 1-866-845-3590. Hours of operation are 7:00am-9:00pm [CST] Monday through Friday and 7:00am-4:00pm [CST] Saturday and Sunday.

7. What pharmacies can I use?

The Catalyst network consists of more than 60,000 participating chain and independent pharmacies nationwide. Following is a list of some f our network pharmacies. This list is subject to change. For the most up-to-date, complete list of participating pharmacies, please visit www.catalystrx.com. Members must set up an account online to access the Pharmacy Locator. Members will need their ID card to set up an account on the Catalyst website. Members may also contact Catalyst via telephone at 1-877-629-3121 for assistance as well. Below is a general list of participating pharmacies in the Catalyst Rx network. Not included in this list are the 20,000 plus community independents and regional chains.

8. What does 90-day at retail mean? Prescriptions can be filled for a 90-day supply without using mail order if you use the 90-day at Retail Network. This program allows you to obtain a 90-day supply of maintenance medication at select retail locations. Members may contact Catalyst Rx at 1-877-629-3121 to determine what pharmacies participate in this program.

9. Are Specialty medications handled differently than other medications?

Specialty medications are medications that require special handling, administration or monitoring. Specialty medications will need to be filled exclusively through the Walgreens Specialty Pharmacy in order for the medication to be eligible for coverage. To determine if a member’s medication is a specialty medication they may contact Catalyst Rx at 1-877-629-3121. For assistance with refilling a specialty medication or other specialty medication questions the member may contact Walgreens Specialty Pharmacy at 1-866-823-2712.