Benefits Plans - Prescription Drug Plan: Prescription Drug Plan Newsletter
In this issue, we are pleased to provide you information that includes vendor changes for 2006, results of the 2005 Customer Satisfaction Survey, and reminders and helpful tips on medication use and costs.
- New U-M Prescription Drug Plan Administrator
- New Mail Order Pharmacy Effective 1/1/06 -- Walgreens Mail Service
- Specialty Pharmacy Services
- Injectable Pilot Program
- Retiree Medicare Part D Coverage
- Prescription Drug Plan Customer Satisfaction Survey Results
- Formulary and Preferred Drug List (PDL) Updates
- New Quantity Limits
- Prior Authorization (PA)
- Diabetic Insulin, Needles and Syringes
- How to Lower Your Co-Pays
- PPO Plans Reduce Costs for Many Participants
- Travel Supplies
- Keep Your Address Current
1. New U-M Prescription Drug Plan Administrator
Effective January 1, 2006 the University of Michigan Prescription Drug Plan will be administered by SXC Health Solutions (SXC). Services from Caremark will end on December 31, 2005. All U-M drug plan participants will be issued two new drug plan ID cards in December 2005, mailed to their home address. Active prior authorizations and open refills at pharmacies with expirations beyond January 1, 2006 will be automatically transferred to the new vendor, SXC. SXC will provide ID cards, a toll-free dedicated customer service phone center for U-M participants, physicians and pharmacists, and will process prescriptions with network retail pharmacies. Members should not experience any disruption in obtaining prescription medications.
2. New Mail Order Pharmacy Effective January 1, 2006 — Walgreens Mail Service
Walgreens Mail Service will provide U-M mail order pharmacy services from their Tempe, AZ facility, effective January 1, 2006. Prescriptions with open valid refills as of January 1, 2006 will be automatically transferred from the Caremark Mail Order Service to the Walgreens mail order facility. Prescriptions for controlled substances, compound medications or expired prescriptions will not be transferred. Note that plan members can continue to access a full network of retail pharmacies. Walgreens Mail Service will be the exclusive pharmacy only for members choosing mail order fulfillment. Further details will be provided in December 2005, including how to register on the Walgreens Mail Service Web site for continuing refills.
3. Specialty Pharmacy Services
University of Michigan Prescription Drug Plan participants currently using either the CAREMARK specialty pharmacy ( Southfield, Michigan), University of Michigan pharmacies, or other retail pharmacies to order specialty injectable prescriptions can continue to receive these medications from the same retail pharmacies.
4. Injectable Pilot Program
Are you being treated for rheumatoid arthritis, multiple sclerosis or hepatitis C with an injectable drug? Are you seeing a University of Michigan Health System physician? If so, you may qualify to participate in the pilot Specialty Drug Program. Call the Benefits Office at (734) 936-3847 for information.
5. Retiree Medicare Part D Coverage
In August and September 2005, U-M Medicare-eligible retirees/survivors and enrolled Medicare-eligible dependents received from the Benefits Office their notice of “Creditable Coverage” relating to the Medicare Part D prescription drug plan. U-M encourages all retirees and their dependents to continue their enrollment in the University drug plan for calendar year 2006 and not to enroll in the Medicare Part D drug plans as the U-M plan offers lower cost and equal or better coverage for most members. There is one notable exception: People who qualify for the low-income assistance as defined by the government may benefit from both a) signing up for Part D and b) maintaining enrollment in a University of Michigan medical/prescription plan. Further details on the requirements for the low-income subsidy and general information on the Medicare Part D plans will be provided to U-M Medicare-eligible retirees in the fall of 2005.
6. Prescription Drug Plan Customer Satisfaction Survey Results
In May 2005, the Benefits Office conducted its first annual survey of Prescription Drug Plan member satisfaction. The results of the 2005 survey, administered by the College of Pharmacy’s Center for Medication Use, Policy and Economics, were released in early September.
A sample of 4,000 U-M Prescription Drug Plan members who had used either retail pharmacies or the mail order pharmacy received the survey, which yielded a 56% response rate.
“The purposes of the survey were to benchmark the satisfaction of U-M employees and retirees with the Prescription Drug Plan and identify factors associated with employee/retiree satisfaction,” said David Nau, R.Ph., Ph.D., principal investigator of the survey project. “Overall, the results of the survey are positive. Over two-thirds of the respondents reported satisfaction with the plan, with noticeably higher levels of satisfaction reported in the quality ratings for retail pharmacy services. However, one noticeable area for improvement identified in the survey is mail order pharmacy. The consistently lower quality ratings for mail order pharmacy services indicated that plan members desired an improved ability to have their questions answered and improvements in obtaining refills at the mail pharmacy.”
Key results of the survey showed that over two-thirds of respondents were “satisfied” or “very satisfied” and 47% rated the U-M drug plan as better than other drug plans. Faculty and staff rated the plan similarly in satisfaction, while retirees were slightly more satisfied. Plan participants were overall satisfied with services of retail and network pharmacies. U-M pharmacies received the best marks. Future improvements were identified in questions involving access to information about plan coverage, obtaining prior authorizations, and understanding how medications are selected for the Preferred Drug List. Respondents who clearly understood the drug plan coverage reported fewer difficulties with obtaining needed medications.
The annual survey is expected to be a valuable tool for continuous improvement of the U-M Prescription Drug Plan. “Conducting a confidential and independent annual survey provides the Benefit Office with a mechanism for internal assessment, offering valuable feedback on current plan performance, participants’ responses to plan changes, and a framework for future programming improvements,” explained Keith Bruhnsen, manager of the plan.
A repeat of the survey in the Fall of 2006 is planned to learn about satisfaction with the new drug plan administration and mail order pharmacy vendors selected for 2006.
1. Formulary and Preferred Drug List (PDL) Updates
A formulary is a broad listing of drugs by category, including generic and brand name medications. The U-M formulary provides specific co-pay tier levels. The U-M Preferred Drug List (PDL) is a useful guide of select therapeutic categories that provide the “best value” drugs for members and physicians to choose. The PDL list is updated quarterly and can be found online at benefits.umich.edu/plans/drugs/pdl.html
A searchable U-M formulary that allows you to find medications and their tier co-pay level can be found on the U-M Benefits Office Web site at benefits.umich.edu/plans/drugs/formulary.html
2. New Quantity Limits
The quantity limit list has been updated and some drug quantity allowances have been changed. If your medication need exceeds the quantity limits on the list, your physician may contact Caremark (SXC after January 1, 2006). Caremark will discuss your condition with your doctor and see if the U-M prescription drug plan prior authorization (PA) criteria will allow additional quantities. The complete list of quantity limits can be found at benefits.umich.edu/plans/drugs/limits.html
3. Prior Authorization (PA)
There are several drug classifications that require Prior Authorization (PA). These drugs are on the PA list due to safety and cost concerns. The plan requires that use of the drug meets clinical criteria and follows acceptable, evidence-based treatment guidelines. If your drug requires a PA, your physician must call Caremark at 1-800-294-5979 before the medication can be approved. See Prior Authorization for the list of drugs requiring prior authorization.
4. Diabetic Insulin, Needles and Syringes
Diabetic insulin, needles and syringes are available at zero ($0) co-pay using your Caremark prescription drug ID card at your pharmacy. For coverage of other diabetic supplies, such as glucose monitoring supplies, alcohol swabs, and lancets, contact your medical insurance plan.
benefits.umich.edu/plans/drugs/updates/diabetic.htm. These supplies will continue to be available to members at no co-pay after the transition to the new plan administrator (SXC) on January 1, 2006.
“Ask your doctor if _____ might be right for you.” Advertising on television, radio and in the newspapers entices people to demand prescriptions for expensive drugs which are very profitable to the manufacturer, but costly to purchasers and may not offer any additional benefit over the current medication you are being prescribed. This in turn drives up your prescription co-pays and premiums. Use generic drugs for lowest available co-pay whenever possible.
If your doctor advises you that you need a brand-name prescription medication,
- Ask your health care provider to select medication from the preferred drug list (PDL), available on the Benefits Office Web site at benefits.umich.edu/plans/drugs/pdl.html.
- Enroll in a Health Care Flexible Spending Account (FSA) during Open Enrollment.
- Consider the mail order pharmacy for longer-term supplies of ongoing drug treatment. If you are participating in a Tier Co-pay plan, you can receive up to a 90-day (3 months) supply for only two (2) times the Tier Co-pay. Participants with 20% coinsurance on drug costs (after meeting the annual deductible) do not have tier co-pay, and will pay 20% / annual deductible both for prescriptions filled at retail and mail order.
6. PPO Plans Reduce Costs for Many Participants
The new M-CARE PPO PLUS and Blue Cross Blue Shield Community Blue PPO plans offered as U-M medical insurance plans in 2005 have been a success. The three (3) tier co-pay structure and one-stop claims have been well-received by members previously enrolled in the traditional BCBS/United and POS plans. Information on the PPO plans is available on the Benefits Office Web site at benefits.umich.edu/plans/medical/ppos.html, and will be printed in your 2005 Open Enrollment books.
7. Travel Supplies
If you are leaving the United States for more than 90 days and need additional supplies of prescription medication to take with you, call the HR/Payroll Service Center at 734-615-2000 or 1-866-647-7657 (toll free).
8. Keep Your Address Current
It is very important that the University always have your current home and work addresses on record so you can receive benefits mailings and other important information. If your home or work address changes, make sure you update your address with the University. You can:
- Email your change of address to firstname.lastname@example.org
- Call the HR/Payroll Service Center at 734-615-2000 or 1-866-647-7657 (toll free).
- View and update your Current Address (home address) on Wolverine Access. Go to the Wolverine Access home page at https://wolverineaccess.umich.edu. Click on “My Personal Information” and log in using your uniqname and Kerberos (UMICH) password. Then click on “Addresses” to update your address and/or phone number. (Please note that after Oct. 31, the “My Personal Information” link will be changed to “Employee Business.”)
If you have questions regarding the Prescription Drug Plan, you can email them to email@example.com. Benefits Office staff will respond to your message. Or call the HR/Payroll Service Center or Caremark at the numbers listed below.
For More Information
Benefits Office Web Site:
HR/Payroll Service Center: 734-615-2000 or 866-647-7657 (toll free)
Caremark: 866-485-0268 (toll free)
The University of Michigan in its sole discretion may modify, amend, or terminate the benefits provided with respect to any individual receiving benefits, including active employees, retirees, and their dependents. Although the university has elected to provide these benefits this year, no individual has a vested right to any of the benefits provided. Nothing in these materials gives any individual the right to continued benefits beyond the time the university modifies, amends, or terminates the benefit. Anyone seeking or accepting any of the benefits provided will be deemed to have accepted the terms of the benefits programs and the university's right to modify, amend or terminate them.