Benefits Plans - Prescription Drug Plan: Prescription Drug Plan Newsletter

Page last updated: Wednesday, 26-May-2010 20:51:16 EDT

Winter 2007

This newsletter is being sent to University of Michigan Prescription Drug Plan members. You may also view this newsletter and prior editions online on the Benefits Office Web site at:
benefits.umich.edu/plans/drugs/newsletter

Topics covered in this issue include:

Printable newsletter (PDF)

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SXC and Walgreens Mail Service for Members

Is My Drug Covered?
The U-M Prescription Drug Plan covers members participating in all U-M employee, retiree and graduate student medical plans. Please call SXC at 1-866-715-0874, not your medical plan, for drug coverage questions or visit the RxPortal Web site: https://umi.rxportal.sxc.com

When to Use Walgreens Mail Service
Walgreens Mail Service should only be used for 90-day supplies of maintenance medications on which the patient is already stabilized. Walgreens Mail Service co-pays are set up for 90-day supplies of medications for $14 generic / $28 preferred brand / $48 non-preferred brand co-pays. Any supplies less than 90 days will be charged the 90-day supply co-pay.

To register for Walgreens Mail Service, call Walgreens Mail Service at 800-745-7083 (TTY 800-573-1833), or print a mail-in Walgreens Mail Service Pharmacy Order Form from the Benefits Office Web site at:
benefits.umich.edu/forms/drugs.html

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2008 Plan Changes – What to Expect

There are several opportunities to lower your out-of-pocket cost for prescription drugs in 2008.

1. Member co-pays for prescription drugs remain unchanged for the sixth consecutive year (bargained-for employees refer to your contracts for co-pays). Co-pays for 2008 are $7 for generic (Tier1), $14 for preferred brand-name drugs (Tier2), and $24 for non-preferred brand-name drugs (Tier3).

2. Zyrtec available Over-the-Counter – The Food and Drug Administration (FDA) has approved another newer antihistamine medication for Over-the-Counter (OTC) use due to their safety for public use. The expected date of OTC sales is late January 2008. As a result, when OTC Zyrtec becomes available, U-M Drug Plan prescription Zyrtec will not be covered as our drug plan does not provide coverage for OTC products. This is a major change in the non-sedating antihistamine drug class and members should expect further changes in coverage in 2008. SXC Health Solutions will send letters to any member in advance where a change in antihistamine coverage is likely to occur.

3. Beginning February 1, 2008, outpatient specialty medications that are currently limited to a 60-day supply will be limited to 34-day supplies. See the article “U-M Specialty Drug Report” below.

4. If you take a statin cholesterol-lowering medication, consider talking to your physician about pill-splitting. Your co-pays will be reduced 50% for pill splitting higher doses of certain statins. To find out if your medication qualifies, see: www.umich.edu/~benefits/forms/Pill-Splitting-Instructions.pdf

5. The “MHealthy: Focus on Diabetes” program will extend co-pay discounts to active and LTD employees through December 31, 2008 during the program’s data evaluation phase. See:
http://hr.umich.edu/mhealthy/programs/disease/diabetes.html

6. Your pharmacist may offer you a generic medication with a lower co-pay if it is available. Several medications are expected to go off-patent and become available as generics in 2008. If you are taking a medication in the list below, you may want to discuss the generic with your physician.

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2008 Generic Drug Release Schedule

Brand Name Generic Name Common Use(s) Anticipated Generic Availability
Altace Ramipril Cartiovascular October 2008
Depakote ER divalproex Seizure disorders, certain psychiatric conditions July 2008
Fosamax® and Fosamax® Weekly alendronate Osteoporosis February 2008
Imitrex sumatriptan Migraines TBD
Kytril granisetron Nausea/Vomiting July 2008
Lamictal lamotrigine Seizures (epilepsy) TBD
Paxil CR Paroxetine hydrochoride Anxiety, depression October 2008
Requip ropinirole HCL Parkinson’s/RLS May 2008
Resperdal risperidone Mental/Mood Disorders June/July 2008
Topamax topiramate Seizures (epilepsy) September 2008

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U-M Specialty Drug Report

Specialty drugs are high cost oral and injectable medications that require close supervision and monitoring. Typical conditions include multiple sclerosis, rheumatoid arthritis and cancer. Specialty drugs are the fastest growing pharmaceutical costs in the U-M drug plan. Costs for this group of drugs have increased 13 times higher than traditional drugs. In the third quarter of 2007 the average specialty injectable cost was $1,875.

The U-M Benefits Office is planning for managing specialty drug costs to ensure appropriate use and eliminate waste. U-M commissioned a Specialty Rx Whitepaper from The U-M College of Pharmacy “Center for Medication Use, Policy and Economics,” available at: benefits.umich.edu/plans/drugs/reference.html.

This report details growing costs, recommendations for management and benchmarks to other health plans and employers.

Based on the Whitepaper recommendations, the Benefits Office hired a half-time pharmacist devoted to analyzing and implementing measures to manage cost and appropriateness of use. These include a change to 34-day supply limits and a new U-M drug plan supplier for specialty medications. Specialty medications on the list below are currently available at U-M Health Center pharmacies for no co-pay to plan members who qualify.

U-M Specialty Drug Program Criteria:
Prescriber must be a physician employed by U-M Hospitals and Health Centers
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

Tev-Tropin

 

Xeloda

 

Qualified U-M drug plan members 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 pharmacist at 734-647-5705. Please mention the “Specialty Drug Program.” The program pharmacist 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.

You may choose to continue to fill your prescriptions at any pharmacy, however the co-pay waiver and enhanced services are only available at U-M pharmacies in the program.

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Safety Tips - Proper Disposal of Prescription Medications Drugs

Always take your medications as prescribed by your physician. Prescription medications no longer needed should be disposed of in a manner that reduces harmful effects on our environment. The Office of National Drug Control Policy recommends:

  • Take unused, unneeded, or expired prescription drugs out of their original containers and throw them in the trash.
  • Mixing prescription drugs with an undesirable substance, such as used coffee grounds or kitty litter, and putting them in impermeable, non-descript containers, such as empty cans or sealable bags. This ensures the drugs are not diverted.
  • Flush prescription drugs down the toilet only if the label or accompanying patient information specifically instructs you to use this method of disposal.
  • Participate in community pharmaceutical ‘take-back’ programs. Some communities have pharmaceutical take-back programs or community solid-waste programs that allow the public to bring unused drugs to a central location for proper disposal.

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Complete Your Pocket Medication Record

Click here to download a convenient Pocket Medication Record you can fill out and carry with you. (PDF)

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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.