Benefits Plans - Prescription Drug Plan: Prescription Drug Plan Newsletter

Page last updated: Tuesday, 05-Oct-2010 12:11:06 EDT

Fall 2006

Each section below provides a Web link for additional details.

Topics covered in this issue include:

Printable Newsletter (PDF)

SHPS Flexible Spending Account Debit Card (Active Employees)

Effective January 1, 2007, U-M employees with a Health Care Flexible Spending Account may pay for prescription drug co-pays using the new SHPS Spending Account Card. The Spending Account Card works like a credit or debit card, and the funds for your eligible health care expenses are deducted from your Health Care FSA with no need to file a claim for reimbursement. SHPS will mail Spending Account Cards to everyone enrolled in a Health Care FSA by January 9, 2007. Be sure to show your SHPS Spending Account Card and U-M Prescription Drug Plan ID cards at the pharmacy counter. If you get medications by mail, also update your payment information at Walgreens Mail Service. See "Changing Your ‘Profile’ Information at Walgreens Mail Service" below.  In addition, many over-the-counter medications can be paid using your SHPS health reimbursement account. Details on eligible expense for your health care account can be found at benefits.umich.edu/forms/fsa_expense_guide.pdf

top

Changing Your “Profile” Information at Walgreens Mail Service

If you have a 2007 SHPS Spending Account Card and wish to use it for Walgreens Mail Service prescription co-pays, you will need to contact Walgreens at 1-800-745-7083 or go to your online account at WalgreensHealth.com/umich. If you do not enter your SHPS Spending Account Card information then your current credit card will be charged and you will need to file receipts for SHPS Flexible Spending Health Account reimbursement.

top

2007 Changes for Blue Cross Members

Community Blue PPO Members – No Annual Deductible
If you are a new Community Blue PPO member who had the BCBSM/United medical plan in 2006, you’ll notice starting in 2007 that you no longer have an annual deductible for prescription drugs.  In addition, your co-pays for up to a one-month supply will be $7.00 for Tier 1 generics, $14.00 for Tier 2 Preferred Brand Drugs and $24.00 for Tier 3 Non-Preferred Brand Drugs. 

CMM Diabetic Supplies - A Medical Plan Benefit
Effective January 1, 2007 diabetic patients who have the University of Michigan Comprehensive Major Medical (CMM) medical plan will start to receive all diabetic supplies (test strips, lancets, alcohol swabs, glucose monitors, etc.) under a diabetic rider in the CMM medical benefit.  Diabetic supplies will no longer be processed using SXC, the U-M Prescription Drug Plan ID card. For more information about CMM diabetic supply providers in your area, call CMM at 1-800-423-7488.

top

Expanding the U-M Specialty Drug Program

On July 1, 2005 the U-M Prescription Drug Plan, in cooperation with the University of Michigan Hospital and Health Center (UMHHC) Department of Pharmacy, implemented a voluntary pilot Specialty Drug Program. The program is for patients receiving a select group of maintenance specialty drugs.  On January 1, 2007 we are adding three more drug classes to this program: hematopoietics; oral cancer medications and growth hormones.  Patients meeting the following criteria are eligible to receive their medication at a reduced cost or at no cost.

U-M Specialty Drug Program Criteria:

  • Prescriber must be a physician employed by UMHHC 
  • Prescription must be filled at one of these three U-M pharmacies:
      • University of Michigan Ambulatory Care Pharmacy
      • U of M Cancer/Geriatric Center Pharmacy
      • U of M East Ann Arbor Pharmacy
  • Medication prescribed MUST be one of the following:
Multiple Sclerosis Hepatitis C Rheumatoid Arthritis

Avonex

Ribaviran capsules

Enbrel

Betaseron

Peg-Intron

Humira

Copaxone

Pegasys

Kineret

Rebif

Intron A

 

 

 

 

Hematopoietics Oral Cancer Drugs Growth Hormone

Aranesp

Gleevec

Genotropin

Epogen

Revlimid

Humatrope

Neulasta

Sutent

Norditropin

Neupogen

Tarceva

Nutropin

Procrit

Temodar

Tevtropin

 

Xeloda

 

Patients who have their prescriptions filled at these U-M pharmacies will have the following services available to them:

  • Pharmacy pick-up or ground delivery of the completed prescription
  • Packaging, including all materials for administration and disposal of supplies
  • Assistance with prior authorizations
  • Coordination of benefits
  • Consultation with a U-M pharmacist
  • No co-pay  (example: $0 co-pay on Copaxone, which is normally $14)

If you meet all of the qualifying criteria and want to participate, call the U-M Specialty Drug Program at 734-647-5705.  Please mention the "Specialty Drug Program." The program can assist with transferring an existing specialty prescription to a U-M pharmacy.  New prescriptions also qualify. No special pre-enrollment is required for patients who have qualifying prescriptions filled at a U-M pharmacy in the program.

The special reduced pricing opportunity is voluntary and only available if you meet all of the qualifying criteria. You may choose to continue to fill your prescriptions at any pharmacy.  The choice is yours, however the co-pay waiver and enhanced specialty services are only available at the three U-M pharmacies in the program. 

top

Generic Statins Come to Market

The cholesterol-lowering Statins are some of the most commonly prescribed medications.  In 2005, total U-M Prescription Drug Plan cost for the Statin class alone was over $6 million.  In 2006 there was generic market entry of two more Statins: pravastatin and simvastatin. With generic lovastatin already on the market, there are now three Statin generics available to patients at the lowest copay. 

Effective January 1, 2007 the preferred Statins will be: generic Tier 1 simvastatin, pravastatin and lovastatin, and Tier 2 preferred brand Lipitor 80mg.  The U-M Prescription Plan bases its coverage decisions on evidence-based medicine.  Current medical evidence indicates that any of the Statins are effective for patients to meet most goals of cholesterol (LDL) reduction.  Lipitor 80mg will continue to be a Tier 2 preferred agent for those patients who require very high reductions in cholesterol (LDL) to meet goal. 

If you are currently taking Lipitor 10mg, 20mg, 40mg or any strength of Vytorin, you will receive a letter notifying you of this change with suggested alternatives.

More information about the new generic Statins can be found at
http://benefits.umich.edu/plans/drugs/updates/index.htm

top

How the University of Michigan Prescription Drug Plan Works

Overview of Plan Features http://benefits.umich.edu/plans/drugs/index.html

The Prescription Drug Plan provides coverage for most United States Food and Drug Administration (FDA) approved drugs prescribed up to a maximum of 90 days supply per fill at either retail or mail order. The drug plan provides a consistent benefit and scope of coverage for all members.

  • SXC administers the U-M Prescription Drug Plan. Call SXC Customer Service at 1-866-715-0874 (toll free) for prescription claim information. To view drug prices, drug alternatives, and network pharmacies go to the U-M and SXC Web site at https://umi.rxportal.sxc.com
  • When your doctor writes a prescription for you, take it to a participating pharmacy and show the pharmacist your ID card from SXC. The pharmacist will confirm your enrollment in the U-M Prescription Drug Plan and fill your prescription at the appropriate plan co-pay.
  • A convenient, secure mail order service offers delivery of a 90-day supply of medications to your home, office, or elsewhere in the United States
  • Overrides for supplies larger than 90 days needed for extended travel outside the U.S. may be arranged by contacting the Benefits Office.
  • Plan Limitations and Lifetime Maximums:
    Some medications are limited to per-month and annual limitations. There are also lifetime maximum provisions on covered weight-loss medications and infertility medications. Please see “Exclusions, Limitations, Prior Authorizations (PA), Dose Optimization, Step Therapy, and Self-Administered Injectable Medications” at http://www.umich.edu/~benefits/plans/drugs/exclusions.htm for details.

top

Pharmacy Price Competition – Is it good for your health?

Recent stories in the media promote retail pharmacies (Wal-Mart, Target, and Meijer) offering new generic drug pricing.  The following information is intended for U-M Prescription Drug Plan members to understand the retail marketing motive behind these programs. These stores vie to get members into their stores to purchase other products. Stores may attempt to move existing prescriptions over from other retail pharmacies.

Even drugs advertised as "free" still require that a patient get a physician's authorization and prescription to obtain the medication. 

For your safety, if you do not use one pharmacy for all your prescriptions it is extremely important that you provide each pharmacist with your complete medication history.  Members receiving prescriptions from multiple prescribers and filling them at multiple pharmacies risk that your prescribers and pharmacists will have incomplete medication histories.  Prescriptions filled within one of these generic drug programs in some cases will not be processed through the U-M Prescription Drug Plan/SXC claim processing system. 

When prescription claims are processed by the U-M Prescription Drug Plan/SXC, each new drug claim is electronically compared against all other previously processed prescriptions for drug-drug interactions, therapeutic duplications and other clinical issues.  If a medication alert is detected, an alert message is transmitted to the dispensing pharmacist.  Claims not processed through the SXC claims processing system cannot provide these electronic medication alerts to the pharmacist. 

We are hopeful that the increased awareness of the value of generic drugs raised by the retail price programs will be positive for our members. Generic drugs approved by the FDA contain the same active ingredients and come in the same dosage forms as their brand-name counterparts. FDA-approved generics must meet the same safety, production and performance standards as the equivalent brand drug. The use of generic drugs often offers an affordable, effective and safe alternative to higher-priced brand medication.

top

Limitations
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.