Medical Mutual Pharmacy Updates Effective July 1, 2021
Applies to all segments with the exception of Medicare Advantage and Medicare Supplement.
- National Preferred Formulary Updates: MMO is updating their National Preferred/National Preferred Plus formulary. About 30 medications will be added to the exclusion list (attached).
- Will effect less than .25 percent of members.
- Any members who are currently taking these medications will receive a letter notifying them of these changes at least 60 days before they take effect.
- These changes will immediately apply to new groups that enroll on or after July 1, 2021, and any members who begin taking these medications after July 1, 2021.
- No changes to the Basic/Basic Plus or High Performance Plus formularies at this time.
- Step Therapy Updates (apply to Basic Plus, National Preferred Plus, High Performance Plus formularies)
- Effective July 1, 2021, the MMO step therapy programs will be updated. Any members impacted by new step therapy rules will receive a letter notifying them of the change at least 60 days before the rules take effect. As with any step therapy program, if there is a medical reason a plan-preferred first-line drug cannot be used, the provider can request a coverage review.
Medical Mutual Life Renewals
- MedMutualLife completed a comprehensive review of the Council of Smaller Enterprises (COSE), Toledo Regional Chamber of Commerce (TRCC) and Richland Area Chamber of Commerce (RACC) benefit plans for the upcoming renewal effective July 1, 2021. As a result, current rates will be guaranteed for three additional years. This included an analysis of the incurred loss ratio, demographic information, and the overall benefit package.
- New sales or renewals with effective dates between July 1, 2021, and June 30, 2022
- Effective July 1, 2021, participating employers with renewal dates prior to July 1, 2022, will receive a renewal letter within 60 days of their renewal date advising them their rates have been guaranteed for an additional three years.
- Proposal exhibits prepared for participating employers with effective dates from July 1, 2021, through June 30, 2022, will include a three-year rate guarantee.
- New sales or renewals with effective dates between July 1, 2022, and June 30, 2024
- Participating employers with renewal dates between July 1, 2022, and June 30, 2024,will receive a renewal letter within 60 days of their renewal date advising them their rates have been guaranteed for an additional two years.
- Proposal exhibits prepared for participating employers with effective dates between July 1, 2022, and June 30, 2024,will include a two-year rate guarantee.
Contact your Cornerstone representative with any questions.