Transcript Cox HealthPlans - William F. Laman Public Library

William F. Laman Public Library
Training Seminar
An Overview of Your Prescription Drug Benefit
February 8, 2008
Proprietary & Confidential
1
Overview






Co-pay Structure
Over the Counter Program
Coordination of Benefits
Diabetic Sense Program
Specialty Program
Website
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
Proprietary and Confidential
.
Formulary Communications
• Additions to the formulary occur
quarterly
•
Medications placed in the 3rd 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
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
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) 869-4600
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 877-852-3512
• 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
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
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
Proprietary and Confidential
•
•
•
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
.
Enrolling in the Specialty Program
 Call Walgreen’s at 888-782-8443
 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
Proprietary and Confidential
.
The World Wide Web
Proprietary and Confidential
.
Web Site Solutions
Catalyst Rx provides plan specific web sites which offer members,
clients, and physicians convenient access to:
 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
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 www.catalystrx.com to learn more about a
member’s specific formulary or obtain prior authorization information
Proprietary and Confidential
.
Logging on to the Site
Follow 4 easy steps to log on:
1. Go to www.catalystrx.com
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”
Proprietary and Confidential
.
Quick Links
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
Proprietary and Confidential
.
Quick Link Features
Useful tools which you can access via www.catalystrx.com include:





Feature / Tool
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
Proprietary and Confidential
Quick Link
Common Questions
Common Questions
Healthy Links
Drug Information
Mail Order Refills
.
Pharmacy Locator
By clicking on the “Pharmacies” Quick Link, you can search your
participating pharmacy network by city and state or zip code.
Proprietary and Confidential
.
What’s Covered
“What’s Covered” provides an overview of your plan’s covered items
and exclusions.
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.
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)
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.
Proprietary and Confidential
.
Questions
Proprietary and Confidential
.