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© 2007 Medco Health Solutions, Inc. All rights reserved. 1 About Medco In 2006, we processed more than 89 million mail order Rxs. Medco employs over 16k. 6,200 of those are union members. Clients include BCBS plans, large employers, health plans, and state and local government clients August 2007 – Medco purchases PolyMedica August 2005 – Medco purchases Accredo nation's largest specialty/biotech pharmacy operation We have pharmacies in Columbus and Cincinnati, Ohio. Also in Pittsburgh, Tampa, and Dallas. Automated pharmacies in Las Vegas, and Willingboro, NJ. Specialty pharmacy in Memphis. Opening a new automated pharmacy in Indiana. We have a 96% customer satisfaction rate
© 2007 Medco Health Solutions, Inc. All rights reserved. 2 About BCBSM Michigan-based, non-profit company since 1939 BCBSM employs over 3,100 union members. BCBSM currently administers national PPO plans for UAW Ford, Chrysler and GM Blue Cross Blue Shield – most recognized and accepted insurance card in the nation. One card for medical and prescription drug benefit BCBSM Ford Service Center - dedicated toll-free customer service numbers
© 2007 Medco Health Solutions, Inc. All rights reserved. 3 Medcos National Call Center Network assures that members always have access to customer service 5 fully integrated call centers in 3 different time zones Available 24 hours a day 7 days a week Dedicated toll free number All inquirees tracked and reported
© 2007 Medco Health Solutions, Inc. All rights reserved. 4 Pharmacy Options Retail Pharmacy Up to a 34-day supply of medication Use for short-term medications (example: antibiotics) Use in-network pharmacies Medco By Mail (mail order) Pharmacy Up to a 90-day supply of medication Use for long-term, maintenance medications (example: drugs used to treat high cholesterol)
© 2007 Medco Health Solutions, Inc. All rights reserved. 5 Medco By Mail – Getting Started First time filling a prescription – ask the doctor for two prescriptions A 34-day supply to obtain from in-network retail pharmacy A 90-day supply, plus refills up to one year (if appropriate), for mail order Ordering new prescriptions By mail By fax (physicians office only) Via internet (physicians office only) Medication delivery within 8 days Standard shipping = no additional cost
© 2007 Medco Health Solutions, Inc. All rights reserved. 6 Medco By Mail - Refills Order your refills when you have a two-week supply remaining on your prescription Order refills Via internet By phone By mail
© 2007 Medco Health Solutions, Inc. All rights reserved. 7 Member is Out of Medicine? NEVER GO WITHOUT MEDICINE If a member is low or out of meds, member should call Medco Medco will assist member in obtaining enough medicine from a retail pharmacy until their prescription arrives
© 2007 Medco Health Solutions, Inc. All rights reserved. 8 Mandatory Mail Maintenance drugs are those drugs taken on an on-going basis (3 months or more). Examples – medicines to treat high blood pressure, diabetes or high cholesterol. If a drug is on the Mandatory Mail Drug List, the prescription can be filled 3 times at their retail pharmacy. On the 4th fill, the prescription must be filled through Medco By Mail to avoid paying the full cost of the drug at retail Member receives a reminder letter after the 2nd fill at a retail pharmacy
© 2007 Medco Health Solutions, Inc. All rights reserved. 9 Mandatory Generics If member receives a brand-name drug when a generic version is available, the members out-of-pocket costs may increase. For prescriptions written as Dispense as Written or DAW: First fill, member pays brand co-payment, plus the cost difference (up to a maximum of $10) between brand-name and generic drug On subsequent fills, if a coverage review has not been initiated and approved, the member will be responsible to pay the generic co-payment, plus the entire cost difference between brand-name and generic drug Applies to both retail and home delivery
© 2007 Medco Health Solutions, Inc. All rights reserved. 10 Coverage Review Process (In Order to Receive the Brand-name Drug at the Brand Co-pay) If currently taking a brand-name drug when a generic version is available, the member will receive a letter from Medco Health encouraging them to discuss with their doctor the reasons why they need to take the brand-name drug. If the doctor believes that there are clinical reasons for the member to take the brand-name drug, they should ask their doctor to contact Medco Health at to initiate a coverage review of their prescription.
© 2007 Medco Health Solutions, Inc. All rights reserved. 11 Non-sedating Antihistamines (NSAs) Effective January 1, 2008, there is no coverage for non- sedating antihistamines Such NSAs include Allegra®, Clarinex®, Xyzal®, Zyrtec®, and fexofenadine (the generic version of Allegra®) Members should talk to their doctor or pharmacist about all the treatment options available, including over-the-counter (OTC) medications
© 2007 Medco Health Solutions, Inc. All rights reserved. 12 Coverage for Vitamins and Essential Minerals Effective January 1, 2008, coverage included & limited to: Prenatal vitamins for females under the age of 49 Vitamin D derivatives only when prescribed to treat renal disease Vitamin K only when prescribed for bleeding conditions Long-acting Niacin for treating heart conditions Potassium Chloride Talk to doctor or pharmacist about all the treatment options available, including OTC medications
© 2007 Medco Health Solutions, Inc. All rights reserved. 13 Allergy Serums Allergy Serums are covered under pharmacy benefit. Enrollees will have to submit claims for Allergy Serums via direct claim form. Claim forms can be requested by calling Medco at
© 2007 Medco Health Solutions, Inc. All rights reserved. 14 Insulin and Syringes/Needles Members must order their Insulin and syringes/needles on the same day Insulin has been added to the mandatory mail list effective January 1, 2008 Diabetic Testing supplies, lancets, etc. are covered under the durable medical supplier – Wright & Filippis.
© 2007 Medco Health Solutions, Inc. All rights reserved. 15 Pharmacy Management Tools Value – To bring greater patient safety by protecting against potentially dangerous dosing that does not meet FDA-approved guidelines or national physician best practice guidelines Definitions: Prior authorization (PA): Medication not covered unless approval obtained through coverage review Step therapy (ST): Part of PA process, may include use of preferred products as first step/therapy requirement Quantity limit (QL): Allows for a certain number of pills or tablets for use for a certain amount of time The review uses plan rules based on FDA-approved prescribing and safety information, clinical guidelines, and uses that are considered reasonable, safe, and effective
© 2007 Medco Health Solutions, Inc. All rights reserved. 16 Pharmacy Management Tools – New Tools Effective March 17, 2008
© 2007 Medco Health Solutions, Inc. All rights reserved. 17 Pharmacy Management Tools – New Tools Effective March 17, 2008
© 2007 Medco Health Solutions, Inc. All rights reserved. 18 Pre-notification: Letters are mailed to members who are taking one or more of these drugs one month prior to implementation. Pharmacy Management Tools – New Tools Effective Date TBD
© 2007 Medco Health Solutions, Inc. All rights reserved. 19 Proton Pump Inhibitors (PPIs) As of 12/4/06, brand PPIs are no longer covered without a coverage review. PPIs include: Nexium®, Aciphex®, Prevacid®, Prilosec® 40mg, Protonix®, and Zegerid®. Omeprazole (the generic version of Prilosec®) is the preferred medication.
© 2007 Medco Health Solutions, Inc. All rights reserved. 20 Co-Pays Effective January 1, 2008 National PPO & Blue Preferred Plus PPO Plans MailRetail Actives Generic $10 $5 Brand$15 $11 ED$19 $16 MailRetail RetireesGeneric $7 $5 Brand$13 $11 ED$19 $16
© 2007 Medco Health Solutions, Inc. All rights reserved. 21 Co-Pays Effective January 1, 2008 National PPO Protected Retirees MailRetail Prior 1/1/04 Generic $2 $5 Brand$2 $5 ED$2 $5 MailRetail On or After 1/1/04Generic $2 $5 Brand$2 $10 ED$2 $10
© 2007 Medco Health Solutions, Inc. All rights reserved. 22 Co-Pays Effective January 1, 2008 Blue Preferred Plus PPO Protected Retirees MailRetail Prior 1/1/04 Generic $5 $5 Brand$5 $5 ED$5 $5 MailRetail On or After 1/1/04Generic $5 $5 Brand$5 $10 ED$5 $10
© 2007 Medco Health Solutions, Inc. All rights reserved. 23 Co-Pays Effective January 1, 2008 National PPO - Catastrophic MailRetail Generic $32 $16 Brand$74 $37 ED$106 $53
© 2007 Medco Health Solutions, Inc. All rights reserved. 24 Important Phone Numbers BCBSM Ford Service Center: For questions about the Prescription Drug Program, such as benefits, co-pays, and eligibility, Actives call , Retirees/Surviving Spouses call Medco: For questions about your Medco By Mail prescriptions, such as order status, account balances, or when and how an order was shipped, call Automated Refills at Mail:
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