Fall 2024

The approach of the holiday season brings with it an inherent sense of merriment, joy, and togetherness. However, it can also bring its own set of challenges, especially when it comes to managing stress and maintaining our health. To help our members embrace this special time while keeping their well-being in check, here are a few tips to limit stressors and make the seasons bright.

Effective Budgeting 

Holidays are often associated with gift giving, which can be a financial strain for many. To minimize this stress and simplify the gifting process, determine a budget and spend only what you can reasonably afford. Remember that the sentiment behind the gift is more important than the cost.

Maintain Healthy Habits 

The holiday season is also full of indulgences including delicious food and drink. To achieve balance, you should enjoy your favorite festive treats but continue to prioritize healthy habits that benefit your body and mind.

• Incorporate high-nutrient snacks like fruits, nuts, and vegetables to fuel your body and keep your energy levels stable.
• Drink plenty of water and avoid excessive alcohol consumption.
• Set aside time for physical activity in your daily routine, whether it’s a brisk walk, an at-home workout, or even a brief yoga session.

Rest and Recharge

Ensure you are getting enough sleep, as it is a necessity for maintaining your physical and mental health. Schedule downtime to relax in between social events to avoid overextending yourself with family gatherings and celebrations.

Practice Gratitude

Gratitude is a powerful tool to help shift your perspective and reduce stress. Take a moment to reflect on what you’re grateful for this season and share your love and appreciation with those around you. Conversely, if the holidays bring up difficult emotions, communicate openly about how you’re feeling, set appropriate boundaries for yourself and others, and seek support from a loved one or medical professional as needed.

Pharmacy Benefit Dimensions wants you to survive and thrive this holiday season. These few practical steps will help you manage holiday-related stress while enjoying what this season offers, and allow you to step into the new year with a strong foundation of physical and mental well-being.

For a fifth time in the last seven years, Pharmacy Benefit Dimensions (PBD) has earned a perfect 5-Star rating from the Centers for Medicare & Medicaid Services’ (CMS) Star Ratings system for its Medicare Employer Group Waiver Plan (EGWP) Prescription Drug Plan (PDP)*.

This is the fourth year in a row that PBD has been awarded a 5-Star rating from CMS, a feat that demonstrates our steadfast commitment to maintaining the highest level of excellence and value.  PBD’s consistent achievements set us apart from any other PDP, as our team is the only one in the nation to be awarded a perfect Star Rating for four consecutive years.

What are Star Ratings?

CMS Star Ratings are released annually and reflect the experiences of our EGWP PDP beneficiaries.** Ratings are based on a 5-Star system that measures the following key components:

• Customer Service: How well the drug plan handles beneficiary calls and appeals.
• Beneficiary Experience: Beneficiaries overall satisfaction with the drug plan.
• Drug Pricing: How well the plan prices prescriptions.
• Patient Safety: How often beneficiaries get prescriptions considered safe and clinically recommended for their condition(s).
• Complaints and Medicare Audits: How often beneficiaries filed complaints about the drug plan.

Why are Star Ratings Important to You?

Medicare Star Ratings are a tool to help you evaluate the value and reliability of your prescription drug plan. Pharmacy Benefit Dimensions’ consistent Star Ratings performance is a testament to the excellence in service and customer experience that our beneficiaries have come to expect year after year. For you, this top-level distinction means peace of mind knowing that your health is in capable hands and we will always be there to help you every step of the way.

* Pharmacy Benefit Dimensions is a subsidiary of Independent Health. Independent Health is a PDP with a Medicare contract. Enrollment in Pharmacy Benefit Dimensions depends on contract renewal between Independent Health and CMS. 

** Every year, Medicare evaluates plans based on a 5-star rating system.

In line with our ongoing commitment to transparency, Pharmacy Benefit Dimensions (PBD) is notifying members of an important change regarding our pharmacy network.

Effective January 1, 2025, CVS Pharmacy will no longer be a participating pharmacy in our network, including CVS locations within Target stores. This change impacts both self-funded and employer group waiver plan (EGWP) prescription drug program (PDP) plans.

Your Pharmacy Options

Please rest assured, PBD will continue to offer a comprehensive pharmacy network with over 54,000 local, regional, national chain and independent pharmacies. We also have convenient mail-order pharmacy options through ProAct Pharmacy Services and Wegmans Home Delivery Pharmacy.

You can view a complete list of participating pharmacies by using our “Find a Pharmacy” tool.

Reason For This Change

PBD has been in negotiations with CVS for several months to reach a new agreement for 2025. Unfortunately, CVS proposed new pricing that would have raised our members’ prescription costs significantly. We will continue to keep the lines of communication open with CVS in an effort to reach an agreement that is in line with reasonable industry standards. If an agreement is reached, we will notify you. In the meantime, we apologize for any inconvenience this network change may cause you.

As always, if you have any questions about your coverage and benefits, our Member Services Department is available to assist you. Please call (716) 635-7880 or 1-888-878-9172, Monday through Friday from 8 a.m. to 11 p.m. ET. TTY users please call 711.

Here are the quarterly changes to the Pharmacy Benefit Dimensions drug formulary:

The following medications will be added to the formulary:

The following changes were/will be made to the formulary:

• Adihydroergotamine subcutaneous – adding to T3, QL
• Edex® - from T2, PA except Urology, QL to T3, PA except Urology, QL
• Intrarosa® - adding to T3
• Lyumjev® - from T2 to non-formulary
• Migergot® - adding QL
• Praluent® - from T2, PA to non-formulary
• Reyvow® - from T2, PA to non-formulary
• Toujeo® - from T2 to non-formulary
• Tresiba® - from T2 to non-formulary
• Victoza®/liraglutide – from T2, ST to non-formulary 

The following new generic medications are available:

The following medications were reviewed and will remain non-formulary:

• Ohtuvayre® suspension
• Sofdra® topical gel
• Zoryve® 0.15% topical cream
• Onyda XR® suspension
• Vigafyde® solution
• Leqselvi® tablets
• Nypozi® subcutaneous
• Pyzchiva® subcutaneous
• Chewtadzy® chewable tablets
• Zituvimet XR® tablets
• Femlyv® orally disintegrating tablets
• Zunveyl® delayed-release tablets
• Tezruly® oral solution

Please reach out with any questions you may have. To best assist you, choose from the following:

Questions about your pharmacy benefits as a PBD member? Contact Member Services, 1-888-878-9172.

Questions about a claim from a pharmacy or provider? Contact our Pharmacy Help Desk, (716) 635-3578.

Questions about the benefits of partnering with PBD? Contact our Sales Department, (716) 860-0743.

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