Commercial Plan: The Commercial Plan will provide pharmacy coverage for all non-Medicare Members in the State Health Plan, MUSC Health Plan, as well as all Medicare primary Members who have opted out of the Indirect Employer Group Waiver Plan with Wrap Plan (EGWP). As of November 2024, there are 439,376 participants in the Commercial Plan. Administrative services shall be based on the current prescription drug plan and shall be based on a self-funded, transparent “pass-through” financial pricing arrangement. Under this arrangement, PEBA will receive all manufacturer payment amounts as proposed by the Contractor in response to this RFP, in addition to all monies received by the Contractor from pharmaceutical manufacturers revenue including but not limited to formulary, price protection and other rebates, manufacturer administrative fees, and other manufacturer revenue paid to the PBM attributable to the utilization of PEBA’s pharmacy benefit program. Commercial Plan Participants must fill specialty medications through the Plan’s Custom Credentialed Specialty Pharmacy network. The Commercial Plan consists of: • State Health Plan – Standard Plan and Medicare Supplement Plan. Both the Standard Plan and Medicare Supplement Plan are grandfathered Affordable Care Act (ACA)-compliant plans. The Plans’ prescription drug benefit operates as a “drug card,” with the drug program carved out from the major medical provisions of the Plans...
