Benefits Plans - Prescription Drug Plan: Prescription Drug Plan Newsletter
Each section below provides a Web link for additional details. This issue includes updates on 2006 vendor changes, reminders, and helpful tips on medication use and costs.
2006 Drug Plan Update
The U-M Prescription Drug Plan transitioned to SXC and Walgreens Mail Service on January 1, 2006. From January through March of 2006 SXC received over 11,000 calls from U-M members regarding their prescription drug coverage. Some members may have experienced a disruption with mail pharmacy services during the transition, please accept our sincere apology. Like many U.S. pharmacies, Walgreens experienced a very high volume of calls about Medicare Part D. Unfortunately, this increased call volume affected customer wait times. As a result, quick access to reliable information from Walgreens customer service representatives was difficult to achieve during that transition period. The situation has been corrected.
The Benefits Office also requested that the Walgreens Web site be removed temporarily until improvements are completed. U-M members should NOT use the walgreens.com or the walgreensmail.com Web sites available to the general public. Instead, please call 1-800-745-7083 to order your mail prescriptions during the Walgreens Mail Service Web site upgrade. For more information on the upgrade, visit benefits.umich.edu/plans/drugs/walgreens.html.
In summary, over the past four months we have seen a dramatic drop in customer service requests and we continue to seek guidance and value input from our members.
BCBSM/United Plan Change
Members of the U-M BCBSM/United medical insurance plan who will be moving to HMO, PPO or POS health plans in 2007 will eliminate the annual deductible and 20% co-insurance and assume the standard tier co-pays. For many, this will mean lower out-of-pocket costs. More information on this plan change will be provided prior to Open Enrollment, which takes place October 9 - 20.
Pill Splitting Program Proves Successful
Effective January 1, 2006, U-M Prescription Drug Plan participants began participating in a voluntary pill-splitting program. The program is supported by recent research conducted at the University of Michigan College of Pharmacy. The research showed that U-M drug plan participants who pill split “statin” (cholesterol-lowering) medications did so in a safe manner and that pill splitting did not have an adverse effect on health or medical status.
The savings from pill splitting are shared with U-M drug plan members and help reduce future drug plan premiums for everyone. Members who split pills receive a 50% reduction in their co-pays or coinsurance. In addition, the University provides one pill-splitter device per year at no cost through the pharmacy where the medication is dispensed.
Pill splitting is not appropriate for every type of medication. Currently, the pill-splitting option at U-M is only for Lipitor, Zocor and Pravachol, which are cholesterol-lowering statins. You should not pill split if you do not feel you have the manual dexterity or vision to safely use a pill splitting device. Do not make any changes in your medications or the way you take your medications without first consulting your doctor.
If you want to participate in the voluntary statin pill-splitting program:
- Discuss the program with your physician at your next regularly scheduled appointment.
- Get a new prescription from your doctor for:
A. Half the usual supply of medications (for example, 15
pills for 30 days, or 45 pills for 90 days), and
B. Twice the usual dosage (for example 10mg doubled to 20mg)
Patient instructions should include: “take one-half tablet daily.” If your prescription is for a mail order supply then your physician needs to write a prescription to “dispense one pill splitter” or, if you are filling your prescription locally, ask your retail pharmacist to also dispense a pill splitter with your first pill-splitting prescription to receive the device at no cost.
Step-by-step instructions with photographs for ordering and splitting your pills are on the Benefits Office Web site at benefits.umich.edu/forms/Pill-Splitting-Instructions.pdf.
Expected Generic Drug Releases
The table below shows several brand named drugs and their expected market entry in the generic drug form. Generic drugs offer the best opportunity for members to lower their out-of-pocket cost while helping to reduce drug plan cost and member health care premiums. These products offer an opportunity to lower your out-of-pocket drug cost.
|Class||Generic Name||Brand Name||Estimated Market Entry*|
|Nasal Steroids||fluticasone||Flonase||April ‘06|
|High Blood Pressure||amlodipine besylate||Norvasc||Sept ‘07|
*Estimated dates are subject to change due to patent litigation.
Paper Claims Reimbursement
Effective January 1, 2006 all paper claims submitted to SXC must be within 90-days of the time of purchase in order to receive reimbursement. The change is required under the federal Medicare Part-D program.
Is Mail Order Service Right For You?
Approximately 9% of prescriptions for the U-M Prescription Drug Plan are filled by mail order. Members who use mail order have the convenience of home delivery and can receive a 90-day supply of medication for two co-pays. On average, 500 more prescriptions per month are now being filled by mail order than last year. We believe there are several factors that contribute to a successful mail order prescription experience:
- The prescription is written for 90 days with three refills for a one year supply. (High-cost specialty injection medications are limited to 60 days per fill.)
- The patient has been stabilized on the medication, understands the doctor’s instructions, and does not need face-to-face consultation with a pharmacist.
- The prescription is written within the coverage limits of the U-M Prescription Drug Plan. Information on coverage limitations and exclusions is available on the Benefits Office Web site at benefits.umich.edu/plans/drugs/exclusions.htm
- Your mail box is safe and secure or you have made other arrangements for the secure receipt of your medications.
- You are comfortable ordering your prescriptions on a schedule set by the refill date (not too early) and your supply level (not too late). Mail service deliveries take 14 days for new prescriptions or 10 days for refills.
Cautions about Compounded Medication Reimbursement
For the lowest out-of -pocket costs, use your U-M prescription drug ID card and have your prescriptions filled at a participating U-M / SXC network pharmacy. Call the pharmacy before you fill your first prescription to make sure they will accept your University of Michigan prescription drug coverage. If your compounding pharmacy does not participate in the plan, ask the pharmacist to call SXC at 1-866-715-0874 to be added to our U-M / SXC network.
Paying full cost at the pharmacy and sending in a paper reimbursement claim can result in reduced reimbursement amounts. When a pharmacy does not accept your drug insurance card, you will be responsible for the full cost of any drug not covered by the U-M plan. For covered drugs, you will only receive reimbursement at the discount contract rate that would have been charged had you used the U-M prescription drug ID card at a participating pharmacy.
For more information on the using the U-M drug ID card and directions for paper claim processing, go to benefits.umich.edu/drugs/idcard.html. If you are filing a paper claims, you have 90 days from date of fill to file the claim. Claims older than 90 days will not be reimbursed.
|Facts About the U-M Prescription Drug Plan (for 2005)|
|Total # of dispensed prescriptions in 2005||
|# of prescriptions dispensed as generic drugs (tier 1)*||
|# of prescriptions dispensed as brand preferred drugs (tier 2)*||
|# of prescriptions dispensed as brand non-preferred drugs (tier 3)*||
|Average # of prescriptions filled per active faculty, staff or dependent drug plan member||
|Average # of prescriptions filled per retiree||
|Total U-M drug cost||
|Total member drug cost||
|Average cost of a generic prescription||
|Average cost of a brand drug prescription||
|Average member cost share per prescription||
* for March, April and May of 2006
When do prescriptions expire?
By law, a non-controlled prescription is only valid for a maximum of 365 days from the date written by a physician. At that point a new prescription must be written even if there are refills remaining. Members can check the “Refill By: --- ” date on the bottle to determine the prescription expiration date.
90-day supplies of covered medications can be filled at any participating pharmacy, as long as your prescription is written to allow a 90-day supply. You may request up to an additional 34 days of your medication supply by calling SXC directly at 1-866-715-0874. For larger supplies, please call the Benefits Office.
Prior Authorization (not to be confused with a prescription renewal).
A prior authorization, or “PA,” is granted or denied for certain prescriptions based on your physician’s answers to questions on a PA form based on FDA criteria for the use of the medications. You can view a list of medications that require a PA on the Benefits Office Web site at benefits.umich.edu/plans/drugs/exclusions.htm.
Your physician can obtain a PA form by calling SXC at 1-866-715-0874. If your physician works at the University of Michigan Hospitals and Health Centers, PA forms are available from the University Hospital “CareWeb” Pharmacy home page.
If your condition and treatment plan meet the criteria established by the U-M prescription drug plan, your doctor will be notified that the PA has been approved and your medication will be covered at the drug store or Walgreens Mail Service pharmacy. If you do not meet the criteria, both you and your doctor will be notified. You may appeal a PA denial. For more information on the PA and appeal process, go to benefits.umich.edu/plans/drugs/paappeal.html.
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.