Lincoln Financial - General Information

Lincoln Financial Group is a financial services company

Zendesk Org Tag: Lincoln Financial

Landing Page: https://www.vida.com/lincoln

Programs & Devices Offered

• For full details on programs offered, please review this VP Card
• For full details on devices offered, please review Device Eligibility Google Doc

Prescribing Information

Effective 1/1/2026 PBM change from CVS to Rightway- members will get a 90 grace period.  Rightway is not outreaching to members on a WL GLP-1 pre 1/1/26 but Vida is sending a letter to them just reiterating the GLP-1 companion requirements and letting them know to outreach to their provider if their PA is expiring.  We will also do an in-app message to those we prescribe for.  Those on Mounjaro will get a letter from Rightway that it will not be covered without a diabetes diagnosis upon PA renewal. We do not have a looker to check engagement at this time. Please check admin and the HGP to verify.

• It takes >48 business hours for compliance to reflect with the PBM
  • Day 1: Member becomes compliant with engagement requirement
  • Day 2 (2 AM): Vida sends updated file 
  • Day 3: Rightway processes the update

How to Verify Member Engagement & Troubleshoot Medication Blocks

1. Verify Status Do not rely on Looker for this metric. You must verify the member's engagement progress by checking:

• The Admin Panel

• The Health Guide Platform (HGP)

• If member is missing required engagements inform of missing metrics, and let the member know to wait 48 business hours and try to pick up their medication again. 

2. Determine the Next Step Once you have checked the tools above, follow the appropriate path:

• Path A: Requirements are Met, but Member is Blocked If the system shows the member has met the goals, but they are still unable to access their medication, escalate this case to Tier 2. (Tier 2 will handle the escalation to the Account Manager).

• Path B: Requirements are NOT Met, but Member Claims Completion If the member states they have finished the requirements, but Admin/HGP does not reflect this, escalate via JIRA for technical review.

On 1/1, VMPs with Lincoln patients on Mounjaro will receive the following IDO:
Medication Update: Starting 1/1/26 member's insurance plan will no longer cover Mounjaro for weight loss. Please transition to Zepbound.
 

VP Card

Prescribing Overview

Use Case 1 & 2 + Activity Requirements

Is Vida Prescribing?

• For Members taking GLP1 without diabetes Use case 1 - member is required to enroll in Vida and maintain monthly activity in order to continue getting prescription. See Vidapedia for more info on activity guidelines (Note: activity requirements do not include labs/VMP visits so they don't have to do those things if they don't want to.) Vida can also prescribe GLP1s but is not a sole prescriber, therefore members can have prescription prescribed outside of Vida once they have enrolled and are active in the program. 
  • If member is asking who completes the Prior Authorization for the prescription advise it depends on the prescriber. If Vida prescribes, the prior authorization is not needed

  • If prescribed outside of Vida then Member will need to work with their doctor to obtain Prior authorization after enrollment and program activity started

     

• For Members on GLP1 to treat Diabetes, enrollment is not required to continue use of GLP1, however if member would like to enroll Vida can be a prescriber but is not a sole prescriber, members can sign up and continue have prescription prescribed outside of Vida
• Vida can prescribe:
  • AOM (Anti obesity medications)
  • HTN (Hypertension medications to treat high blood pressure)
  • HLD (Hyperlipidemia medications to treat high cholesterol)
  • CHF (congestive Heart Failure) and COPD (Chronic Obstructive Pulmonary Disease)
  • Diabetic medication
• Prescribing programs are Whole Health, and Medical Weight loss but are based on individual eligibility, to review all programs available see client Vidapedia link above
• Grandfather (those currently on a AOM): Member will be required to submit Medical Record Verification if they choose Vida as prescriber (application will prompt for doc uploads before being able to meet with Vida Medical Prescriber).Lincoln changed cost share for AOMs in 2025 from $80 copay to 30% cost share.
• Lincoln changed cost share for AOMs in 2025 from $80 copay to 30% cost share.

Drug list: HTN, HLD, AOMs, Diabetes Rx, CHF/COPD

• Formulary: Standard Drug List; Advanced Control List
• Contrave: Use generic option

Grandfathering: Vida Standard - Req'd Medical Record Verification

Gold-carded: Yes

Population Details

• 9300 employees
  • 8700 spouses + dependents

HQ Philadelphia; throughout US 

Additional Info

• What segment is this org in?
  • Employer
• Are there any Fees at risk (FAR) org?
  • Yes (No support related PGs)
• When did we launch with this org?
  • 1/1/2025
• How is the service being paid for?
  • Lincoln financial health plan enrolled EE, Sp, Dep over 18
• How do members enroll?
  • Vida App, VSC outreach campaign
• Where should non-eligible members be directed?
  • Rightway Member Services: 833-502-7081
    Rightway Specialty: 888-665-1678
    Download the Rightway app from the App Store or Google Play Visit joinrightway.com/rx

     

• Who is eligible?
  • All Lincoln Financial employees and their eligible dependents aged 18+ enrolled in an Aetna medical plan are eligible for Vida health at no charge.

• Are there engagement requirements?

  • Yes.
    Account Engagement Criteria:

    Program	Engagement Requirement	Incentive
    Medical Weight Loss OR Weight Loss+	Schedule a Consult	Members will receive coverage for anti-obesity medications prescribed by a Vida medical provider or external provider, as long as they meet the monthly engagement requirement. Members must complete at least one of the listed engagement requirements monthly.
    	Complete a Consult
    	Log Meal in Food Logger
    	Open Lesson / Content
    	Add / Complete a Habit
    	Send Message to Provider
    	Send Message to Group
    	Log a Metric (Manually or Device Sync)
    	Complete a Survey Tool

   

• It takes >48 business hours for compliance to reflect with the PBM

  • Day 1: Member becomes compliant with engagement requirement
  • Day 2 (2 AM): Vida sends updated file 
  • Day 3: Rightway processes the update

  Continued Issues After Completing Engagement

  • If the member has signed up for Vida and 48 hours have passed, then an engagement file has been sent to meet the Vida engagement requirement for the member to get their GLP1
  • If the member is still having issues getting their prescription filled you can use the below verbiage to communicate with the member:
  • Macro: "Lincoln/Mondelez Engagement Requirement - Activities Already Complete and Sent"
    • This medication now requires 2 things before it can be filled and covered by your health insurance plan:
      1. Vida engagement activity and
      2. Prior authorization from your prescribing doctor.
      I can confirm you are engaged in Vida. Your engagement status was sent to, the pharmacy benefit manager, 24 hours after enrollment.
      To avoid any delays in getting your medication filled, please reach out to your doctor as soon as possible. Ask them to start the prior authorization process with your health insurance provider. Your doctor can submit the required documentation directly to your insurance.
       
    • If member has done the above steps, escalate the ticket via JIRA support escalations using the process outlined here Member Services JIRA Ticket Creation
       
    • Members enrolled in MWL, WL+ will continue to be sent over to Rightway  on the engagement file provided activities are maintained monthly
       
    • Uploading labs is not a blocker or a requirement for PA engagement requirement but would be a blocker for having Vida prescribe the meds (member can have their outside provider continue to prescribe)
       
    • Meeting with a provider is not a blocker so ensure member understands activities are what matters for PA coverage maintenance, if Vida is the prescriber than a provider session would be required once labs/med records uploaded
    • IF the Pharmacy tells the member Vida is the issue and we are not the prescriber of record, send to Tier 2
      • Tier 2: Escalate to AM Jennifer Rice with "Account Management (AM) Escalation" completely filled
• Is the org on the eligibility file?
  • YES

How often will terminations take place?

• Monthly 

Do we offer Phone and/or Email support?

• Phone + Email

Is VSC outreach involved?

• YES