Transitioning to a New Year - Information for Members

Publish Date

As we get ready to begin a new year, your clients may have questions about where to find information regarding their plan. These are some of the topics members may have questions about: 


Wellness Allowance and Weight Management Reimbursement 

 

Over the Counter (OTC) benefit 

  • Details on how to use the OTC benefit, including quarterly amounts by plan, are available here. 
  • In 2023, members of Smart Saver Rx, Saver Rx, and Access PPO plans will have $60 per calendar quarter to spend on over-the-counter health items. An increase from the 2022 amount of $50 per calendar quarter
  • As a reminder, members will receive new OTC cards in December

 

PBM change

  • Beginning January 1, 2023, Tufts Health Plan is partnering with a new Pharmacy Benefit Manager (PBM), OptumRx, to administer our pharmacy benefit. 
  • Members will receive new ID cards in December because of the PBM change
  • The OptumRx retail pharmacy network has more than 67,000 pharmacies nationwide, including CVS Pharmacy and many others that Tufts Health Plan members currently use. 
  • Members can search for an in-network pharmacy at thpmp.org/hmo-pharmacies
  • Beginning January 1, 2023, Walmart, Rite Aid, and Stop & Shop pharmacies will be part of our preferred pharmacy network (Note: Preferred pharmacy benefit doesn’t apply to HMO Prime Rx and HMO Prime Rx Plus plans.)

 

New Members

  • New members will receive their new member kits which include the helpful Welcome Guide in early 2023
  • New members should receive their Tufts Health Plan ID cards before their coverage begins on January, 1, 2023.  

 

Questions