Transcript Slide 1

Montana University System
URx: Rethinking our Rx program:
A New Strategic Approach
WHY URx
 Prescription drugs are the largest and fastest rising cost
component of “our plan”.
 Our Plan = our self insured offerings – Medical, Pharmacy, and Dental.
 We pay 100% of our pharmacy costs through our premiums and out-ofpocket cost sharing.
 Prescription drugs account for roughly 31% of our health
care expenditure.
 We spend approximately $69,500 per day for prescription drugs.
 We spend more for prescription drugs than doctors or hospitalizations.
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 URx is a Pharmacy Benefit program “owned” by Montana University
System
 The “U” originally stood for University Rx
 State Of Montana quickly partnered with MUS on the build of URx
 URx went live 1/1/2010 for State Of Montana
 URx goes live 7/1/2010 for MUS
 Some major players helped in the design/development of URx.
 Pharmacy Benefit Administrator (MedImpact)
 Skaggs School of Pharmacy (University of Montana)
 University of Massachusetts Medical School (MedMetrics)
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Clinical Monographs From
MedMetrics
PTAC (Pharmacy & Therapeutics Advisory Committee)
Independent Committee consisting of the following:
Chair - Mark Eichler, RP
• 3 Montana based Physicians
• 3 Montana based Pharmacists
• 3 Consumers - Plan Members / Union Reps
Drug is tiered A,B,C,D, or F
 Efficacy evaluated first
 Cost evaluated second
The Higher the Value,
The Higher the Drug is tiered.
 Efficacy + Cost = Drug Value
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URx Benefit Design
URx Drug Classification
Drug
Class
Deductible
Excellent level of value based on best medical evidence, best opportunity for
improved health outcomes, and best overall net cost.
Tier A
High level of value based on medical evidence of outcomes and lower overall
net cost. Includes generic and brand drugs compared to higher cost brand
name counterparts.
Retail Rx
Mail Rx
(30-day supply)
(90-day supply)
$0
$0 Copayment
$0 Copayment
Tier B
$0
$15 Copayment
$30 Copayment
Good level of value based on fair medical evidence grading, but displaying
higher overall net cost relative to generic or brand name drug counterparts.
Tier C
$0
$40 Copayment
$80 Copayment
Lower level of value based on evidence of outcomes relative to other clinical
alternatives. Generally have much higher overall net costs.
Tier D
$0
50% Coinsurance
(You will pay half of
the discounted
price)
50% Coinsurance
(You will pay half of
the discounted
price)
100% Coinsurance
(You will pay 100%
of the discounted
price)
100% Coinsurance
(You will pay 100%
of the discounted
price)
(Based on medical evidence of impact to health and overall net cost)
These drugs have the lowest level of value (based on clinical evidence) or the
highest overall net cost in relation to generic or other brand alternatives. Class
F includes drugs that were not previously covered, allowing members to purchase
them at a substantial discount, if they choose.
Tier F
$0
A copayment is a flat dollar amount you pay for Rx services. Coinsurance is a percentage of the total discounted cost you pay for Rx services.
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2009 - 2010
2010 - 2011
2010 - 2011
Present Plan
Without URx
With URx
 Retail
 $100 Deductible
$10 or 20%
Greater of $20 or 30%
$30 or 40%
 Retail
 $150 Deductible
$17 or 20%
Greater of $35 or 30%
$45 or 50%
 Retail
 No Deductible
A = $0
B = $15
C = $40
 Mail
 No Deductible
$20
$40
$60
 Mail
 $100 Deductible
$33
$66
$100
 Mail
 No Deductible
A = $0
B = $30
C = $80
D=50%
F=100%
D=50%
F=100%
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How Will URx Work For Me??? THE URx 4 STEP
STEP 1
Review Your Medications – Know what they are………..
 Complete Name
 Dosage – i.e. 10mg, 20mg. etc
 Frequency – i.e. Once daily, Twice daily, etc.
STEP 2
Find out what tier your drugs received under the URx
drug list.
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How Will URx Work For Me??? THE URx 4 STEP
STEP 3
 If they are D or F, you can find out about potential alternatives in
classes A through C to discuss with your doctor. Call Ask-aPharmacist at 1-888-5-ASK-URX (527-5879) for assistance if
needed.
 We will be mailing letters to members who have D and F drugs beginning
in April and again throughout the year to assist you with learning about
your drugs and potential alternative drugs.
STEP 4
 If there are documented medical reasons why you cannot take one of the
alternative drugs with a higher grade, MUS Benefits staff can work with you to
see if you are eligible to receive a better benefit for a lower grade drug. Have
your PROVIDER complete and submit a Plan Exception Request form
(available on-line, campus HR, or call MUS Benefits).
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How do I find out
my drug tier?
There are several
ways to look up the tier
of your drugs and
potential alternatives:
• Call general
information at URx
1-877-501-1064
• On the internet go to
www.mus.edu/choices
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If you are established on certain types of drugs, you can
remain on those drugs with an enhanced benefit. Examples
include specialty drugs, transplant drugs, and certain
neurological drugs such as anti-depressants (Grandfathering).
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Where do I go to fill my prescriptions ???
You can still use all of the same retail pharmacies and
Ridgeway mail-order pharmacy. A new mail-order
pharmacy called URx MedVantx will also be available
for you to use. (MedVantx is located in South Dakota.)
Diplomat Specialty Pharmacy is the URx provider for
Specialty Drug Services. If you are currently in the
specialty drug program, Diplomat will be in contact with
you prior to July 1, 2010. We will maintain our current
$0 Protocall program through Diplomat.
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With URx we can;
Reduce pharmaceutical costs to both
members and the plan. We expect
costs to be reduced by 20% for the
plan and save members on average
20% of their overall out-of-pocket
costs.
If you do your part (Steps 1 – 4)…..
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Questions?
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