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1 Prepared by: David Frazier & Associates, Inc. (907) 561-9700.

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Presentation on theme: "1 Prepared by: David Frazier & Associates, Inc. (907) 561-9700."— Presentation transcript:

1 1 Prepared by: David Frazier & Associates, Inc. (907)

2 Prescription Benefit Program  Summary of benefits  Additional features  Customer service center  Participating pharmacies 2 Prepared by: David Frazier & Associates, Inc. (907)

3 Summary of Benefits  Retail Pharmacies ○ Copay Plan Design Non-Preferred Brands: $40 Preferred Brands: $20 Generics: $10 ○ You can receive up to a 4 month supply of medication at a time but you will pay a copay for each month. 3 Prepared by: David Frazier & Associates, Inc. (907)

4 Summary of Benefits  Mail Order Pharmacy ○ Copay Plan Design Non-Preferred Brands: $0 Preferred Brands: $0 Generics: $0 ○ You will need to order at least a 3 month supply when ordering through mail order and can get up to 4 months. 4 Prepared by: David Frazier & Associates, Inc. (907)

5 Summary of Benefits  Maintenance medications ○ You should note that you will be able to get non-maintenance medications at your local pharmacy. Maintenance medications can be filled ONCE locally, but after the initial fill you will be required to utilize mail order services. If you are taking a maintenance medication it is mandatory to utilize mail order services. 5 Prepared by: David Frazier & Associates, Inc. (907)

6 Summary of Benefits  What is a maintenance medication? 1. Anything taken on a “long term” basis, and 2. Is on the NPS list of maintenance medications Criteria for a Maintenance Medication ○ The medication has a low probability for dosage or therapy changes due to side effects, serum drug concentration monitoring, or therapeutic response over a course of prolonged therapy. ○ The medication’s most common use is to treat a chronic disease state. A drug may have an indication for maintenance therapy but lacks the maintenance drug code if that indication is its most common use. ○ Therapy with the medication is not considered curative or promoting of recovery. ○ The medication is administered continuously rather than intermittently or as needed. 6 Prepared by: David Frazier & Associates, Inc. (907)

7 Summary of Benefits  Maintenance medication drug class examples: ○ Cholesterol lowering drugs ○ Diabetes medications ○ Digestive aid medications ○ Diuretics (water-pills) ○ Estrogen therapies ○ Heart medications ○ High blood pressure medications ○ Osteoporosis medications ○ Potassium chloride supplements ○ Prostrate medications ○ Seizure medications ○ Some multivitamins ○ Thyroid dysfunction medications 7 Prepared by: David Frazier & Associates, Inc. (907)

8 Prescription Benefit Program  Summary of benefits  Additional features  Customer service center  Participating pharmacies 8 Prepared by: David Frazier & Associates, Inc. (907)

9 Additional Features  Tablet splitting ○ Tablet splitting is the practice of splitting a higher dose of your medication in order to achieve the correct dose ○ As an example if you are currently taking a 20mg tablet, then a 40mg tablet could be prescribed and split in half to achieve the correct dose ○ Tablet splitting is a tremendous way to save money on your out of pocket expenses! Members who split their tablets will be rewarded by having their copay split in half! ○ As an example if your current copay is $40 and the medication you are taking falls under the tablet splitting program your copay will be $20 9 Prepared by: David Frazier & Associates, Inc. (907)

10 Additional Features  The following medications will be available for the tablet splitting program: ○ Aceon ○ Lexapro ○ Lipitor ○ Norvasc / Amlodipine ○ Pravachol / Pravastatin ○ Toprol XL ○ Zocor / Simvastatin ○ Zoloft / Sertraline 10 Prepared by: David Frazier & Associates, Inc. (907)

11 Additional Features  Over the counter (OTC) medications ○ The plan will also offer coverage for Prilosec OTC. ○ Prilosec OTC will be covered at the generic copayment. 11 Prepared by: David Frazier & Associates, Inc. (907)

12 Prescription Benefit Program  Summary of benefits  Additional features  Customer service center  Participating pharmacies 12 Prepared by: David Frazier & Associates, Inc. (907)

13 Customer Service Center  The customer service center is located in Omaha, NE  Committed to guarantee high quality customer service performance on an on–going basis.  Toll free 800–546–5677  Translation services available  Hearing impaired services available  Call center hours of operation  24 hours a day, 7 days a week, 365 days a year 13 Prepared by: David Frazier & Associates, Inc. (907)

14 Prescription Benefit Program  Summary of benefits  Additional features  Customer service center  Participating pharmacies 14 Prepared by: David Frazier & Associates, Inc. (907)

15 Participating Pharmacies  The NPS pharmacy network has over 63,500 pharmacies nationwide including all major chain and most independent pharmacies ○ You can locate a pharmacy by contacting the customer service center ( ) or via the NPS website at 15 Prepared by: David Frazier & Associates, Inc. (907)

16 Participating Pharmacies  Integrated Home Mail Order (IHMO) Pharmacy ○ Located in Omaha, NE ○ Pharmacists are available for consultation and to answer questions ○ Member can contact IHMO Pharmacy via mail, phone ( ), fax, or even via our website 16 Prepared by: David Frazier & Associates, Inc. (907)


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