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Humana Pharmacy Solutions: Pinellas County Schools 2013 Plan Benefits. Understanding Your Pharmacy Benefits. Contents. Your pharmacy benefit Pages 3-4 For your safety Pages 5-8 Filling your prescriptions Pages 9-15 Maximizing your pharmacy benefits Pages 16-17

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humana pharmacy solutions pinellas county schools 2013 plan benefits

Humana Pharmacy Solutions: Pinellas County Schools 2013 Plan Benefits

Understanding Your Pharmacy Benefits

  • Your pharmacy benefit Pages 3-4
  • For your safety Pages 5-8
  • Filling your prescriptions Pages 9-15
  • Maximizing your pharmacy benefits Pages 16-17
  • Humana web and mobile tools Pages 18-25
  • Questions to ask your doctor Pages 26-27
understanding your rx3 plan
Understanding your Rx3 Plan
  • Your Rx3 Plan assigns prescription drugs into three levels of coverage.
    • Level 1: generic drugs
    • Level 2: preferred brand-name drugs
    • Level 3: non-preferred brand-name drugs and specialty drugs
how levels are assigned
How levels are assigned
  • A committee of Humana pharmacists and doctors evaluate each drug after the U.S. Food and Drug Administration has approved them. This is also done once a year for maintenance.
    • The committee looks at medical research and literature to decide how the drug compares to similar products on the market in such areas as:
      • Effectiveness
      • Safety
      • Side effects
      • Drug interactions
      • Cost
  • This helps to ensure you get medicines that are safe, effective, and at an affordable cost.
for your safety prior authorization
For your safety- Prior Authorization
  • Certain medications require your doctor to ask for and receive approval before they are covered.
    • This is called a Prior Authorization (PA).
  • This process helps make sure you receive the right medication in the right dose for the right reason.
  • Prior Authorization helps keep you safe.
  • Medications requiring authorizations are:
    • Typically expensive
    • Only appropriate for specific diseases
    • Require frequent monitoring

*See page 22 to find out how to verify if your medication requires a PA.

for your safety quantity limits
For your safety- Quantity Limits
  • A quantity limit is the maximum amount of medication you can receive for a certain price and for a set period of time, usually 30 days.
  • Quantity limits help you get the right dose for your condition and help make sure you're safe when you take your medicine.
  • Quantity limits are based on:
    • FDA guidelines
    • Abuse potential
    • Cost/Waste

*See page 22 to find out how to verify if your medication has a quantity limit.

for your safety step therapy
For your safety- Step Therapy
  • Step therapy (ST) is when you are required to try a generic, or lower-cost brand-name medicine, before your benefit will cover the higher-priced brand-name medicine.
  • Before moving to the higher-priced brand-name medicine, try a generic medicine first.

*See page 22 to find out how to verify if your medication require Step Therapy (ST) or has a generic available.

why generics
Why Generics?
  • Because they’re the same:
    • Dosage
    • Safety
    • Strength
    • Quality
    • Performance
  • They save you money
    • They contain the same active ingredient as the brand-name drug but are usually 30 to 80 percent less than their brand name counterparts.
filling your prescriptions
Filling your prescriptions
  • Always use a pharmacy that is in the Pinellas County Public Schools pharmacy network. Those pharmacies are Walmart, Sam’s Club, CVS, RightSource and RightSource Specialty.
  • Networks are groups of pharmacies that agree to give discounted prices to members of certain pharmacy plans.

*Don’t forget to show your Humana member ID card!

right source right source specialty

RightSource & RightSource Specialty


Mail Order and



right source right source specialty1
RightSource & RightSource Specialty
  • RightSource is Humana’s Mail-Order pharmacy.
    • RightSource fills prescriptions for maintenance medications.
      • Maintenance medications are taken regularly and long-term for conditions such as: asthma, high cholesterol, and high blood.
  • RightSource Specialty is Humana’s Specialty pharmacy.
    • RightSource Specialty fills prescriptions for specialty medications.
      • Specialty medications are used to treat chronic, complex illnesses and are typically high-priced injectable drugs. But can also include expensive tablets, capsules or inhaled medications.

These are separate pharmacies that fill different types of prescriptions and operate out of different locations.

    • If you use both pharmacies, you’ll receive individual invoices and shipments will arrive separately.
your right source experience
Your RightSource experience
  • RightSource receives the prescription order.
    • Doctors can send new prescriptions by fax, phone, or electronically.
    • You can send new prescriptions by mail with an order form or visit your claims page on MyHumana to transfer an existing prescription.
  • RightSource technicians
    • Check the Humana pharmacy benefits coverage
    • Add the profile to a secure database
    • Scan the order
    • Create a unique shipment number
  • Doctor’s instructions and prescription orders are loaded into RightSource computers.
  • A RightSource pharmacist reviews the prescription order for accuracy and possible drug interactions. If there are concerns or questions, a RightSource pharmacist contacts the doctor for clarification.
your rightsource experience
Your RightSource experience
  • Approved orders go through the payment process.
    • If for some reason your benefit doesn’t cover the medication, a technician will review the rejected claim.
    • RightSource will resolve the issue or return the written prescription with an explanation about why they couldn’t process it.
  • An automated system dispenses the medication and a RightSource pharmacist makes sure the product matches the label before it’s sealed.
  • RightSource mails the order to your home, along with an invoice, and all of the necessary medication information.
right source specialty
RightSource Specialty
  • RightSource Specialty pharmacists are available 24 hours a day, seven days a week to answer questions and listen to concerns.
  • Members receive a 30-day supply delivered to their home or doctor’s office, along with any required administrative supplies such as needles or syringes.
  • Every new patient is contacted by a nurse.
    • Nurses specialize in the patient’s condition and medications.
    • The patient’s condition is assessed and a follow-up outreach is determined.
    • Patients are provided with nurse contact information and may call as often as needed.
  • Learn more online at
want cheaper or free medications
Want cheaper or free medications?
  • Publix

Not a network pharmacy, so no need to show your Humana card, but you can still get these medications for FREE

    • Lisinopril (blood pressure medication)
    • Metformin (diabetes medication)
    • Certain Antibiotics such as:
      • Amoxicillin
      • Ampicillin
      • Cephalexin (capsules and suspension only)
      • Sulfamethoxazole/trimethoprim (SMZ-TMP)
      • Ciprofloxacin (excluding Ciprofloxacin XR)
      • Penicillin VK
      • Doxycycline Hyclate (capsules only)

For more information including limitations please visit

  • Walmart
    • $4 prescriptions: (on a 30 day supply)
    • Always show your Humana card at Walmart, and when you choose medications from this list your generic copay is only $4 instead of your regular $15 generic copay!

For a full list of these medications please visit:

24 hour online pharmacy resources
24- Hour online pharmacy resources

What is MyHumana? It’s Humana’s secure website that gives you access to your information anytime you want it.

If you haven’t registered for MyHumana:

  • Visit
  • Have your Humana ID card handy
  • Go to
  • Click “Register for MyHumana”
  • Follow the easy steps to register
pharmacy locator
Pharmacy locator
  • Select the Wal-Mart or CVS pharmacy locations based on address and/or zip code.
  • View pharmacy information (24 hour location, drive-thru, 90 days at retail, etc.).
drug pricing tool on my humana
Drug pricing tool on MyHumana
  • Locate drug level and copay amount.
  • Find generic or lower cost alternatives.
  • Please find the coverage information on your drug in the highlighted areas below.
my humana mobile
MyHumana Mobile
  • You can:
    • Determine if plan covers prescriptions
    • Find prices at RightSource and retail


    • Identify alternatives
    • Sign up for text message refill reminders
  • Available in:
    • Android Store
    • iTunes
    • Mobile device browser at
  • Future enhancements:
    • Medication adherence alerts
    • Biometric monitoring
    • Order RightSource refills at the click of a button
  • How will this medication help me?
  • How long should I stay on this medicine?
  • Is there anything I shouldn’t take while I’m on this medication?
  • What side effects can I expect?
  • Is there a generic available?