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Proprietary & Confidential1 Training Seminar An Overview of Your Prescription Drug Benefit February 8, 2008 William F. Laman Public Library.

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Presentation on theme: "Proprietary & Confidential1 Training Seminar An Overview of Your Prescription Drug Benefit February 8, 2008 William F. Laman Public Library."— Presentation transcript:

1 Proprietary & Confidential1 Training Seminar An Overview of Your Prescription Drug Benefit February 8, 2008 William F. Laman Public Library

2 Proprietary and Confidential. Overview  Co-pay Structure  Over the Counter Program  Coordination of Benefits  Diabetic Sense Program  Specialty Program  Website

3 Proprietary and Confidential. Co-Pay Structure  $10 for Generic Medications  $30 for Brand Medications  $50 for Brand Medications with Generics available  $50 for Non-Preferred Medications Days Supply Retail: 30 days for non-maintenance meds Retail: up to 90 day supply for maintenance meds for 1 co-pay Mail: 90 day supply Retail Pharmacy Network: Comprised of over 59,000 pharmacies in all 50 states, including all major chains Mail Order: Walgreens Tempe, Arizona

4 Proprietary and Confidential. Formulary Communications Additions to the formulary occur quarterly Medications placed in the 3 rd tier category generally have generic alternatives or brand alternatives that are equally effective Deletions occur annually Proactively communicate deletions for standard and client-specific formulary clients: – Formulary change letter – Web site tools – Pocket preferred drug list – Physician formulary

5 Proprietary and Confidential. Coverage of Over the Counter (OTC) Products  Municipal Health Benefit Fund offers coverage for OTC products at a $5.00 co-pay in two classes: – Anti-Ulcer Medications Prilosec OTC, Pepcid AC, Tagamet HB, Zantac-75, Zantac-150, and Axid AR – Non-Sedating Antihistamines Claritin, Claritin-D, Alavert, Alavert-D  Coverage requirements for the OTC medications: – Member must have a valid prescription from their primary physician – The co-payment of $5.00 for covered OTC medications will be charged for each prescription for up to a 30 day supply

6 Proprietary and Confidential. Coordination of Benefits  As applies to Medicare – Part D – Present your Medicare Discount Card and your Catalyst RX card to the pharmacy – The pharmacy will submit the full cost of the prescription to your Medicare Discount Card. – The pharmacy will then submit the portion that Medicare did not pay to Catalyst for payment. – You should never pay more than your co-pay ($10, $30, or $50) – If the pharmacy is unable to submit to Catalyst as secondary: Obtain DMR form off internet or from Benefits Office and submit to Catalyst RX for reimbursement If you have any questions, call Catalyst customer service at (888)

7 Proprietary and Confidential. Catalyst Rx Diabetic Sense Program  Diabetic Sense is a compliance program offered at no cost to clients and provides testing supplies for zero co-pay to members – Easy enrollment: Call Log on to the Catalyst website and enroll on-line – Includes a free glucose monitor – Items covered at zero co-pay include strips, lancets, needles, alcohol swabs, etc. (medications not included) – 90 day supply mailed to member’s home – Access to certified diabetes educators and a variety of educational materials – Refill reminders and compliance reporting

8 Proprietary and Confidential. Specialty Program  Offers access and management of injectable, infusible, and certain oral therapies used to treat complex, sometimes chronic & rare disease states  May use Walgreen’s Retail or Walgreens Specialty Pharmacy through mail.  Specialty drugs are those that may have the following characteristics: – High Cost of Treatment – Clinical Indications – Limited access – Complicated treatment regimens – Compliance issues – Special Storage Requirements – Manufacturer reporting requirements  Examples include: – Enbrel & Humira for Rheumatic Diseases – Lovenox & Procrit for Hematologic Diseases

9 Proprietary and Confidential. Catalyst Rx Specialty Pharmacy Offering 5,100 Walgreens stores; 1,540 are 24 hour stores Pharmacy locator capability to find local pharmacy with product in stock Specialized software to monitor history and track refill compliance to reduce waste Specialized pharmacist counseling, side-effect management, educational support, adherence monitoring Pharmacists available 24 hours a day, seven days a week Nurses on staff to answer questions about prescriptions and injection techniques and training Routine letters of encouragement and disease-specific educational materials that contain valuable information for patients

10 Proprietary and Confidential. Enrolling in the Specialty Program  Call Walgreen’s at  Provide the Walgreen’s Representative with the following: – Your personal information (i.e. name, address, etc) – Insurance I.D. number (off your card) – Name of medication – Prescribing Doctor’s Name and phone number  Once RX is verified with doctor, a Walgreen’s Representative will contact you to set up delivery time and date – These medications are not left at delivery address and must be signed for

11 Proprietary and Confidential. The World Wide Web

12 Proprietary and Confidential. Web Site Solutions  Member Co-payments and Possible Brand and Generic Alternatives  Formulary Lookup Tool  Pharmacy Locator with Maps and Directions  Drug Dictionary  Mail Service Information  Member-specific Prescription History  Printable Claims Form  Printable Temporary ID Cards Catalyst Rx provides plan specific web sites which offer members, clients, and physicians convenient access to:

13 Proprietary and Confidential. Providers Resource Center  Physicians have access to: – Formulary information Download printable version of the Catalyst Rx full formulary in PDF format – Prior Authorization forms – Rx Updates What is going on in the recent news that may affect you? – Rx Watch Catalyst Rx newsletter with industry news – Drug Pipeline Report Detailed information about new products –New brands on the market –New generic availability Physicians can utilize to learn more about a member’s specific formulary or obtain prior authorization information

14 Proprietary and Confidential. Logging on to the Site Follow 4 easy steps to log on: 1.Go to 2.Locate the “Members Login” box on the right side of the screen 3.Enter your Member ID number (printed on your ID card) including the person code (“01”, “02”, etc.), your date of birth, and your Rx Group # 4.Click “Login”

15 Proprietary and Confidential. Access Quick Links including: Pharmacy locator What’s covered Mail order refills Drug information and possible alternatives Co-pay information Healthy links: Asthma Diabetes View your on-line history Common questions Quick Links

16 Proprietary and Confidential. Quick Link Features  Print a temporary ID Card  Print a direct member reimbursement form  Access health related content  Print your preferred drug list  Access information related to your mail order program Useful tools which you can access via include: Common Questions Healthy Links Drug Information Mail Order Refills Feature / ToolQuick Link

17 Proprietary and Confidential. Pharmacy Locator By clicking on the “Pharmacies” Quick Link, you can search your participating pharmacy network by city and state or zip code.

18 Proprietary and Confidential. What’s Covered “What’s Covered” provides an overview of your plan’s covered items and exclusions.

19 Proprietary and Confidential. Co-pay Information “Co-Pay Information” provides an overview of your plan’s retail and mail order co-pays as well as deductibles.

20 Proprietary and Confidential. Drug Information Query by drug name to identify the corresponding co-pays, view possible cost-saving alternatives, and review drug information (including indications, directions for use, and possible side effects)

21 Proprietary and Confidential. View Your On-Line Drug History Your prescription drug history (“Online Drug Profile”) can be viewed and printed by establishing an account in the See My Prescriptions section of the member portal.

22 Proprietary and Confidential. Questions


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