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MTM Discussion Topics UPlan Pharmacy Program UPlan decision to add MTM

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Presentation on theme: "MTM Discussion Topics UPlan Pharmacy Program UPlan decision to add MTM"— Presentation transcript:

1 UPlan Medication Therapy Management (MTM) MTM Marketing Seminar – 3/15/2011

2 MTM Discussion Topics UPlan Pharmacy Program UPlan decision to add MTM
MTM program and structure MTM communications and target marketing MTM Preliminary Information

3 UPlan Pharmacy Program
3

4 UPlan Medical Program Two Medical Administrators — Medica & HealthPartners / Five Plan Types Carve Out Pharmacy Program — Prime Therapeutics (originally RxAmerica/CVS Caremark) Wellness Program — through Healthways and StayWell

5 UPlan Pharmacy Program
Pharmacy Contract is completely pass through / transparent Formulary Development Utilize PBM formulary with University input Rely on College of Pharmacy Expertise New Specialty Program effective 1/1/2011 High cost medications for complex conditions Fairview Specialty Pharmacy, Fairview hospital or clinic pharmacies SMDC or St. Luke’s in Duluth

6 Pharmacy Program Statistics
39,000 Members 30,300 Members with Prescriptions 370,800 Prescriptions $33 Million Total Drug Cost Focus on Generic Medications 50.4% : January – December 2005 74.2% : January – December 2010 75.1% : December 2010

7 Pharmacy Benefit Design
Copay Structure Generic Plus $8 Brand Formulary $25 Non-Formulary $50 Non-Covered Full Cost

8 UPlan Decision to Add MTM

9 Decision to Add MTM UPlan decisions:
Made by administration committee — AWG Reviewed with employee committee — BAC UPlan focus on evidence-based medicine Outcomes & ROI Ashville, NC Results 2008 U of M Study — Isetts, Schondelmeyer et al BCBS/Fairview MTM Patients Pilot Program: UMD, November 2007 to February 2009 Helped determine structure & operation of new MTM program All UPlan MTM program — March 2009

10 MTM Program & Structure

11 MTM Eligibility UPlan active employees, early retirees, dependents
Four or more UPlan covered medications Not specific disease focused but most patients have chronic conditions 10,000 Eligible Members Physician Referral

12 $8 MTM Copay Reductions Without MTM With MTM - 6 Months Generic Plus
$0 Brand Formulary $25 $17 Non-Formulary $50 $34 Not Covered Full Cost

13 Participating in MTM Participants select MTM pharmacist from Directory and make appointment Participants sign Participation Agreement and enroll through PBM Pharmacy visits are face-to-face Option for tele-med visits for out of area participants Encourage three or more visits first year / two or more visits subsequent years No cost to member for Pharmacy visits Pharmacist claims paid by two medical plans using MTM procedure codes

14 UPlan MTM Network Developed internally with College of Pharmacy
Same MTM network for both Medical Plans 101 Pharmacists, 146 locations, 30 contracting entities Includes pharmacists for U of M, major local care systems, and local chain & independent pharmacies

15 MTM Program Structure MTM Network Manager & Coordinator
Credential and contract network pharmacists for the University Manage activities of Peer Advisory Committee MTM pharmacist coaching Peer Review process MTM Executive Committee College of Pharmacy and Employee Benefits Responsible for: MTM program operations Communications and target marketing, Program evaluation

16 MTM Communications & Target Marketing
16

17 MTM General Communications
Written Communications Newsletters, brochures, letters s Employee Benefits website Network Directory, Enrollment Form, PowerPoint Presentation Customer Service Communications Employee Benefits, Health Plans, PBM Pharmacy Network Communications s, newsletters, website

18 MTM Target Marketing Target Marketing — Pilot Program
University of MN — Duluth Letters & brochures, plus 2 follow-up phone calls Handled by RxAmerica as PBM Target Marketing — UPlan-wide Program Handled by each member’s medical plan Better response through medical plan target marketing Enrollment results 722 members (about half from target marketing) 10,000 eligible / 7% overall participation 56 of 722 still have incentives remaining

19 MTM Preliminary Information (data from Medica members only)

20 Comparative Predicted Risk Score
+340% Last updated on: Data source confirmed on: Source: Johns Hopkins Adjusted Clinical Group Analysis 20

21 Chronic Disease Comorbidity
% of members with multiple chronic conditions Last updated on: Data source confirmed on: number of chronic conditions Source: Johns Hopkins Adjusted Clinical Group Analysis 21

22 Types of Visits Last updated on: 09172010
Data source confirmed on: Source: Claims review Jan – Aug 2010

23 MTM – from a Patient’s Perspective
Initially enrolled due to copay reductions True value — excellent advice from MTM pharmacist Helped me understand how medications work Side-effects Interaction with over-the-counter medications Communicated regularly with my physician Helped me make important decisions about my medications and my health care 23

24 UPlan Medication Therapy Management (MTM) MTM Marketing Seminar – 3/15/2011
24

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