Transcript pharmacy - City of Palm Coast

PRESENTATION
OF
ANNUAL INSURANCE CONTRACTS
October 25, 2011
HEALTH INSURANCE TEAM
“HIT” MEMBERS
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Human Resources
Finance
Contracts
Purchasing
Utility
Fire
Insurance Broker
Recreation & Parks
Last, but not least …. YFCM
GROUP HEALTH INSURANCE
PROGRAM OVERHAUL
2010 – 2011 ACCOMPLISHMENTS
 Entered into Flat-Fee contract with insurance broker
Brown & Brown
 Converted from fully-insured to self-insured
 Implemented Employee Clinic
 Implemented New Plan Designs
 Added High-Deductible Plan Option
Created Wellness Sub-Committee to promote
healthy workforce through enhanced wellness
programs
2012 QUOTES
HEALTH INSURANCE
Received 3 competitive quotes for the self-insured
product
1. Aetna
2. Blue Cross Blue Shield of Florida (BCBSFL)
3. United Health Care (UHC)
Florida Health Care submitted a competitive
quote; however, it is a fully insured plan
(contradictory to our long term goal).
HEALTH INSURANCE QUOTES
AETNA
AETNA
CURRENT RENEWAL
Stop Loss Insurance
UHC
BCBSFL
$184,256
$235,284 $228,851
$203,476
Annual
Administration Fee
$146,893
$165,035 $133,426
$215,784
Credits
n/a
NET COST
$331,149
n/a
n/a
$400,319 $362,277
- $50,000
$369,260
2012 RESULTS
ANCILLARY INSURANCES
MUTUAL OF OMAHA
Dental Insurance
Short Term Disability
Voluntary Life Insurances
Long Term Disability
AD&D
Employee Life Insurance
EAP Services
2011
2012
Employee Paid
Employee Paid
Employee Paid
$ 3,307
$ 300
Rate Constant
Rate Constant
Rate Constant
Rate Constant
Rate Constant
$ 2,329
$ 1,803
Rate Decrease
6 visits per family
3 visits per family
Rate Constant
HIT RECOMMENDATIONS for 2012
HEALTH INSURANCE ADMINISTRATION
& STOP LOSS
Change to BLUE CROSS BLUE SHIELD
DENTAL and ANCILLARY INSURANCES
Stay with MUTUAL OF OMAHA
PHARMACY
In current health care plan discrepancies exist
between retail and mail order pharmacy
pricing
• Common Cholesterol Medication
30 Day
Retail
30 Day
Mail Order
90 Day
Retail
90 Day
Mail Order
$12.74
$47.71
$34.72
$143.12
• Common High Blood Pressure Medication
30 Day
Retail
30 Day
Mail Order
90 Day
Retail
90 Day
Mail Order
$ 3.39
$ 7.42
$ 6.67
$ 22.27
PHARMACY ???
NEXT UP: Conduct review of pharmacy benefit to
ensure best practice.
• Pharmacy included with group health insurance is
non-transparent
• Data is considered “proprietary”
• City desires transparency in cost to reduce drug
costs
• Proposals from PBMs may be transparent, thus
providing savings to both City and the employees
2012 ADJUSTMENTS
Maintain status quo except for:
PHARMACY:
• Local Preference – Addition of 90 day local retail
and no mail order incentives
• Step Therapy for name brand prescriptions
• Mandatory Generic or employee pays the difference
OTHER:
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Combined the 2 network plans into 1 network plan
Colonoscopy covered 100% (Diagnostic & preventative)
Convenience Clinics (at Primary Care Physician co-pay)
Eye & Hearing exams (1 per year vs. every 24 months)
Questions and Discussion
THANK YOU!