Transcript Lower Kuskokwim School District Prescription Benefit Program

Prepared by: David Frazier & Associates, Inc.
(907) 561-9700
1
Prescription Benefit Program
Summary of benefits
 Additional features
 Customer service center
 Participating pharmacies
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Prepared by: David Frazier & Associates, Inc.
(907) 561-9700
2
Summary of Benefits
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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.
Prepared by: David Frazier & Associates, Inc.
(907) 561-9700
3
Summary of Benefits
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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.
Prepared by: David Frazier & Associates, Inc.
(907) 561-9700
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Summary of Benefits
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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.
Prepared by: David Frazier & Associates, Inc.
(907) 561-9700
5
Summary of Benefits
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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.
Prepared by: David Frazier & Associates, Inc.
(907) 561-9700
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Summary of Benefits
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Maintenance medication drug class
examples:
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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
Prepared by: David Frazier & Associates, Inc.
(907) 561-9700
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Prescription Benefit Program
Summary of benefits
 Additional features
 Customer service center
 Participating pharmacies

Prepared by: David Frazier & Associates, Inc.
(907) 561-9700
8
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
Prepared by: David Frazier & Associates, Inc.
(907) 561-9700
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Additional Features
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The following medications will be
available for the tablet splitting program:
○ Aceon
○ Lexapro
○ Lipitor
○ Norvasc / Amlodipine
○ Pravachol / Pravastatin
○ Toprol XL
○ Zocor / Simvastatin
○ Zoloft / Sertraline
Prepared by: David Frazier & Associates, Inc.
(907) 561-9700
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Additional Features
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Over the counter (OTC) medications
○ The plan will also offer coverage for Prilosec
OTC .
○ Prilosec OTC will be covered at the generic
copayment.
Prepared by: David Frazier & Associates, Inc.
(907) 561-9700
11
Prescription Benefit Program
Summary of benefits
 Additional features
 Customer service center
 Participating pharmacies

Prepared by: David Frazier & Associates, Inc.
(907) 561-9700
12
Customer Service Center
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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
Prepared by: David Frazier & Associates, Inc.
(907) 561-9700
13
Prescription Benefit Program
Summary of benefits
 Additional features
 Customer service center
 Participating pharmacies

Prepared by: David Frazier & Associates, Inc.
(907) 561-9700
14
Participating Pharmacies
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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 (800-546-5677) or via
the NPS website at www.pti-nps.com.
Prepared by: David Frazier & Associates, Inc.
(907) 561-9700
15
Participating Pharmacies
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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 (800-633-7928), fax, email or
even via our website http://ihmo.pti-nps.com/
Prepared by: David Frazier & Associates, Inc.
(907) 561-9700
16