Reminder on Botox® for Empire members
- This is not a change in member benefits. This is a change in the Botox vendor only.
- If the member is not using IngenioRx Specialty Pharmacy or CVS Specialty Pharmacy to obtain Botox, no action is needed.
- This change does not affect any other specialty pharmacy coverage.
Medical specialty pharmacy benefits
Our members who obtained Botox through CVS Specialty Pharmacy using their medical specialty pharmacy benefits must move this prescription, as of January 1, 2022. Here are the options:
- Providers can purchase Botox for their patients, then supply it to Empire members. Providers would then bill Empire for the drug and administration of the drug. This will require a new prior authorization to notify Empire of this change.
- If the Empire member’s pharmacy benefit manager is IngenioRx, providers can transition the Botox prescription to receive the drug from any in-network pharmacy using their pharmacy benefits. Transferring the coverage will require a new prescription and new prior authorization.
For questions regarding a member’s medical specialty pharmacy benefits, call Provider Services using the information on the back of the member’s ID card.
Pharmacy benefits manager benefits
Effective January 1, 2022, members who obtained Botox through IngenioRx Specialty Pharmacy using their pharmacy benefits must move this prescription from IngenioRx Specialty Pharmacy to another in-network specialty pharmacy that dispenses Botox. If there are refills still available on the current prescription, members can transfer it to the new pharmacy. If not, members will need a new prescription.
For questions regarding a member’s pharmacy benefits, call Pharmacy Member Services using the information on the back of the member’s ID card.
April 2022 Newsletter