Benefits Plans - Prescription Drug Plan: Prescription Drug Plan Newsletter
- Spring 2003 - Prescription Drug Plan Newsletter
- New Drug Releases
- New Formulary and Preferred Drug List (PDL)
- Plan Updates
- Mail Order Pharmacy
- New Quantity Limits
- Self-Administered Injectables List
- Prior Authorization (PA) and Appeals
- Dose Optimization
- How to Lower Your Co-Pays
- General Reminders
- Keep Your Address Current
Welcome to the first U-M Prescription Drug Plan Newsletter. This newsletter is being sent to all participants in the University prescription drug plan. It updates the 2003 Prescription Drug Plan booklet you received in December 2002. We will provide updates to you several times each year to keep you informed of changes to your prescription drug plan, including benefit updates, new drug releases, tips to help you obtain medications, and how to lower your co-pays. To see the most current updates, visit either the U-M Benefits Office or Caremark Web sites.Each section below is linked to the U-M Benefits Office Web site to provide you additional details for each topic. In this issue, we are pleased to provide you information that includes approval of 20 new drugs to our plan, how to find your co-pay for any drug, increases to the quantity limits on some drugs, and helpful tips for vacation or other travel medication needs.
Since January 1, 2003, U-M has approved 20
new drugs for the plan. A complete list of new drug releases
and their co-pay tier levels can be found at
Claritin and Claritin-D were approved by the Food and Drug Administration (FDA) for Over-the-Counter (OTC) purchase and are no longer covered by the drug plan.
To learn more about allergies and the types
of medications used to treat them, see
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 has been updated and can be found at benefits.umich.edu/plans/drugs/pdl.html
A new searchable U-M formulary that allows
you to find medications and their tier level has been posted
on both the U-M Benefits Office and AdvancePCS Web sites.
The formulary can be found at
AdvancePCS has implemented a new feature on the AdvancePCS-U-M Web site that allows you to search for any drug and find out your specific co-payment or co-insurance amount. You will need to log in at the Web site registration area, go to Look Up Drug Coverage and Pricing, then click on Search Your Formulary to get to the drug pricing feature. Please visit the AdvancePCS Web site at https://umich.advancerx.com.
Participants in the BCBSM/United of Omaha
medical insurance plan have the advantage of Coordination
of Benefits (COB) for co-pays paid under other prescription
drug plans. The complete announcement can be found at
benefits.umich.edu/plans/drugs/updates/cob.htmlDiabetic insulin, needles and syringes are available at a zero ($0) co-pay under the AdvancePCS drug card for all members. To obtain other diabetic supplies that are available from your medical insurance plan, see the complete announcement at
AdvanceRx.com and the Benefits Office apologize for the inconvenience to the members who experienced mail order delays and other problems in January or February. All mail orders are now processed and returned to you within 10-14 days. For a complete understanding of when and how to use the AdvancePCS mail order pharmacy, see benefits.umich.edu/plans/drugs/mailorder.htmtop
The quantity limit list has been updated
and some drug quantity allowances have been increased (e.g.,
migraine drugs). If your medication need exceeds the quantity
limits on the list, your physician may contact AdvancePCS
to discuss additional supplies. For all Proton Pump Inhibitors
(gastric acid blocking drugs) such as Prilosec or Protonix,
the quantity limit is 120 per year based on manufacturer
labeling and clinical criteria that ensure treatment guidelines
are followed. Additional supplies are available if your
physician calls 1-800-294-5979 at AdvancePCS to request
the additional supply, and your condition meets the treatment
guidelines. The complete list of quantity limits can be
New drugs were added to the list of prescribed medications that individuals can safely self-administer.
There are several drug classifications that
require Prior Authorization (PA). These drugs are on the
PA list due to added safety and cost concerns, and the plan
requires that the use of the drug meets clinical criteria
and follows acceptable treatment guidelines. If your drug
requires a PA, your physician must call AdvancePCS at 1-800-294-5979
before the medication can be approved. The PA list can be
If you did not receive a medication or a
supply you requested, you have the right to appeal the decision.
See “Understanding the AdvancePCS Prior Authorization
and Appeal Process” at
Ten (10) drugs now have supply limits in instances where the medication is taken twice or several times per day, but can be safely taken with a single daily dose. The Dose Optimization program results in significant cost savings to the U-M drug plan, helps to limit future increases in premium costs for the University and members, and helps to avoid future co-pay increases for all members.
(1) Ask your physician or pharmacist if
a generic alternative is available. Using a generic lowers
your co-pay and saves you money.
(2) Ask your physician if a “preferred” drug is available.
(3) Order your larger supplies from mail order…you can receive up to a 90-day (3 month) supply for only two (2) times the co-pay.
If you plan on traveling and need an additional one-month supply of medication, call AdvancePCS at 1-866-485-0268 and ask for a “vacation override.” If you are leaving the U.S. for more than 90 days and need additional supplies, call the HR/Payroll Service Center at 734-615-2000 or 1-866-647-7657 (toll free).
Dates of Birth
Some members have experienced claim rejections for dependent prescriptions because the dependent date of birth at U-M was not recorded or accurate. Please keep the U-M Benefits Office current with your address and any dependent information. Call the HR/Payroll Service Center at 734-615-2000 or 1-866-647-7657 (toll free) with any questions regarding your prescription drug enrollment.
It is especially important that the University
always have your current home and office addresses so you
can receive benefits mailings and other important information.
If your home or office address changes, make sure you update
your address with the University. You can:
(1) Email your change of address to firstname.lastname@example.org
(2) Call the HR/Payroll Service Center at 734-615-2000 or 1-866-647-7657 (toll free).
(3) View and update your Current Address (home address) on Wolverine Access. Go to the Wolverine Access home page at http://wolverineaccess.umich.edu. Click on Human Resources and log in using your uniquename and Kerberos (UMICH) password. Then click on Personal Information, Address and Phone Number.
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.
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.