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Pharmacy Benefits-URx
URx is a prescription drug management program developed by the State of Montana and the Montana University System. Effective January 2010, your pharmacy benefit plan changed to URx. The new URx prescription drug plan groups drugs into classes based on how well they treat disease. URx is designed to:
- Improve your overall health;
- Put you and your doctor in control of your health care decisions;
- Help you reduce your out-of-pocket costs for prescription drugs.
There is no deductible for prescription drugs in 2012. Out-of-pocket maximums for 2012 are $1650/year for an individual and $3300/year for a family.
Quick Information Links
How does URx work?
One component of the URx program is the Pharmacy & Therapeutics Committee (PTAC). The committee consists of Montana doctors, pharmacists, and consumers. Development of PTAC was assisted by the University of Montana Skaggs School of Pharmacy and a group of nationally recognized medical and pharmacy researchers whose focus is achieving clinical excellence. The PTAC committee develops the formulary (the list of preferred drugs covered by the plan) that will make the most effective prescription drugs the least expensive to the member, regardless of the drug's actual cost. The PTAC looked at the scientific research and medical studies on prescription drugs and graded them on the formulary from A to F. Prescription drugs with a higher grade have better health outcomes--in other words, they are more effective--and will cost you less out-of-pocket. With URx there will be no deductible, and Class A, B, and C prescriptions accumulate toward an out-of-pocket maximum.
PTAC Members
- Dr. Doug Carr--Medical Director for Billings Clinic
- Dr. Mary Kleschen--Director Currey Health Center U of M
- Dr. Keith Foster--Psychiatrist Shodair Hospital
- Starla Blank--PharmD
- Greg Loushin--BS Pharm, RPh (Kmart Pharmacist of the Year)
- Dr. Vince Colucci--PharmD, Associate Professor U of M School of Pharmacy
- Dr. Ken Hapner--Retired Professor MSU
- Quinton Nyman--MEA/MFT and consumer
- Julie Reardon--Case Management Nurse Coordinator
- Mark Eichler--BS Pharm, RPh-Chair
Who is Eligible?
The Prescription Drug Plan is a benefit for all state employees, legislators, retirees, COBRA members, and eligible dependents. Any member enrolled in a medical insurance plan will automatically receive this plan. There is no separate payment for benefit/contribution for this plan.
URx Drug Classification
| URx Drug Classification (Based on medical evidence of impact to health and overall net cost) |
Drug Class |
Deductible |
Retail Rx (30-day supply) |
Mail Rx (90-day supply) |
| Excellent level of value based on best medical evidence, best opportunity for improved health outcomes, and best overall net cost. | Class A | $0 | $0 Copayment+ | $0 Copayment+ |
| High level of value based on medical evidence of outcomes and lower overall net cost. Includes generic and brand name drugs compared to higher cost brand name counterparts | Class B | $0 | $15 Copayment+ | $30 Copayment+ |
| Good level of value based on fair medical evidence grading, but displaying higher overall net cost relative to generic or brand name drug counterparts | Class C | $0 | $40 Copayment+ | $80 Copayment+ |
| Lower level of value based on evidence of outcomes relative to other clinical alternatives. Generally have much higher overall net costs. | Class D | $0 | 50% Coinsurance+* (You will pay half of the discounted price.) |
50% Coinsurance+* (You will pay half of the discounted price.) |
| These drugs have the lowest level of value (based on clinical evidence) or the highest overall net cost in relation to generic or other brand alternatives. Class F includes drugs that were not previously covered, allowing members to purchase them at a substantial discount. | Class F | $0 | 100% Coinsurance+* (Your will pay 100% of the discounted price.) | 100% Coinsurance+* (Your will pay 100% of the discounted price.) |
| Specialty Drugs | Drug Class | Deductible | Retail Rx (30-day supply) |
Mail Rx (90-day supply) |
| If you take a Specialty Drug, you are encouraged to use the URx Specialty Pharmacy program with Diplomat specialty Pharmacy to qualify for a $150 copayment. If you fill your prescription at a retail pharmacy, you will have to pay 50% coinsurance. Specialty drugs are not covered through the mail-order program. Certain preferred Specialty Drugs will be available for a $0 Copayment. | Class S | $0 | 50% Coinsurance+* if purchased through standard retail pharmacy |
Not covered |
+ A copayment is a flat dollar amount you pay for Rx services. Coinsurance is a percentage of the total discounted price you pay for Rx services. Coinsurance is calculated on the discounted cost of drugs. Discounts have been negotiated for most drugs purchased through URx.
* The amounts you pay in these categories do not count toward your annual out-of-pocket prescription maximum.
How do I determine my drug(s) class?
You can determine your drug's class by visiting MedImpact's website and using the Drug Price Check tool. In order to access the Drug Price Check tool, you will need to register as a user with the website. Please refer to the Creating an Account document. Determine your drug's class by:
- Logging into the MedImpact Member Portal;
- Click on Drug Price Check;
- Enter the name of your drug in search box and click Search
- The search results for the entered drug will be listed, select your drug
- Your drug's class will be listed under the Class column
You can also review our pharmacy quick list. This list identifies the most commonly used medications by major therapeutic class and divides them into the URx value based drug classifications.
Plan Exceptions
Some members may be eligible for a Plan Exception. If your drug is a Level D or F, and there is a documented medical reason that you must remain on this drug and are unable to take an alternative, have your provider complete a Plan Exception Form. Plan exceptions must be supported by medical evidence provided by your health care provider. To complete a plan exception, fill out the Plan Exception Request and return it with the medical documentation to the Health Care and Benefit Division, PO Box 200130, Helena, MT 59620-0130 or faxing the completed form to (406) 444-0080.
Where can I fill my Prescriptions?
Prescription drugs may be obtained through the plan at either a local pharmacy (30 day supply) or a mail order pharmacy (90 day supply). A current list of participating pharmacies is available on MedImpact's website. Please note: You must be a registered user in order to access the Pharmacy Locator tool. See the Creating an Account section above for instructions on registration. Members who use maintenance medications may experience significant savings by using a mail order pharmacy. The State of Montana has two mail order pharmacies: MedVantx and Ridgeway Mail Order of Montana. You can receive your medications from a mail order pharmacy by:
- Obtaining a written prescription for 90 days from your physician.
- Completing a Drug Mail Order Form for either Ridgeway Mail Order of Montana or MedVantx.
- Mail the Drug Mail Order Form and the 90 day prescription to the pharmacy you have selected
MedVantx Pharmacy Services
PO BOX 5736 2824
Sioux Falls, SD 57117-5736
(877) 870-MONT (6668)
Ridgeway Mail Order of Montana
2824 US Hwy 93 North
Victor, MT 59875
(800) 630-3214
Your physician may also fax the Drug Mail Order Form and the 90 day prescription to the pharmacy. Note: If you choose to submit your order by fax, the prescription MUST be faxed by your physician. Faxed mail order requests will not be accepted from members or the Health Care and Benefits Division.
Ridgeway Mail Order of Montana
Fax: (406) 642-6050
MedVantx Pharmacy Services
Fax: (605) 978-3999
URx Specialty Drug Program
Diplomat Specialty Pharmacy is the State of Montana's preferred vendor for specialty pharmacy medications within the URx prescription drug program. State of Montana members are required to obtain specialty prescription(s) from Diplomat.
Diplomat Specialty Pharmacy has been serving patients for over 35 years and is the largest independent specialty pharmacy in the nation. They provide you with education about your prescription and coordinate with your doctor to make sure you get the best possible care.
If you have questions on a specialty drug, contact Diplomat at (877) 319-6337.
MedImpact Services
The URx program is powered by MedImpact. As the pharmacy benefits administrator, MedImpact serves as the claims processor. URx uses the prescription process as a mechanism to manage overall care of a member by focusing on producing better clinical outcomes by making sure members get the best drug to treat their condition. MedImpact has a dedicated customer service telephone line for the State of Montana to answer any questions you may have regarding your benefits or claims processing. MedImpact's website also offers a wealth of resources for members:
- Drug Search- Find information on over 17,000 medications
- Health & Wellness- Valuable health tips plus information on diseases and health conditions
- Benefit Highlights- View your current copayment amounts and other pharmacy benefit considerations
- Drug Price Check- Make informed prescription choices and compare drug prices
- Pharmacy Locator- Find a participating pharmacy near your location
- PersonHealth Rx- Print your prescription history for a physician visit or tax reporting
Access these resources by visiting MedImpact's website and creating a member account.
Creating an Account
You can create a member account by clicking the Register Now button located on MedImpact's home page. To register you need your member ID. Your member ID is your employee ID assigned by the SABHRS application. This is the six digit number that can be found on your paychecks, pay advices, on your State of Montana identification badge, or on your URx membership card. If you need help identifying your employee ID, contact your payroll office.
Creating a Member Account Instructions
MedImpact Member Website Tutorial
Need help navigating MedImpact's member website? View our informational tutorial that will walk you through the MedImpact member website and the resources available to help you better understand your prescription drug benefits.
You may be prompted to download an Adobe Connect Add-On in order to view the tutorial. This software has been approved for use, and you may download the add-on to view of the web presentation.
Where can I get more Information on URx?
You can also learn about the pharmacy benefit by:
- Viewing the presentation slides
Contact Us
Questions about the new URx program? Please contact us at one of the following options:
- General Information and customer service: (888) 648-6764
- Ask-a-Pharmacist (clinical questions): (888) 5-ASK-URX [527-5879] or askapharmacist@urxmt.com
- Program Information: (800) 287-8266 [toll free] or (406) 444-7462 [Helena area], askurx@mt.gov
