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About Medco
• In 2006, we processed more than 89 million mail order Rx’s.
• Medco employs over 16k. 6,200 of those are union members.
• Clients include BCBS plans, large employers, health plans, and
state and local government clients
• August 2007 – Medco purchases PolyMedica
• August 2005 – Medco purchases Accredo nation's largest
specialty/biotech pharmacy operation
• We have pharmacies in Columbus and Cincinnati, Ohio. Also in
Pittsburgh, Tampa, and Dallas. Automated pharmacies in Las
Vegas, and Willingboro, NJ. Specialty pharmacy in Memphis.
Opening a new automated pharmacy in Indiana.
• We have a 96% customer satisfaction rate
© 2007 Medco Health Solutions, Inc. All rights reserved.
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About BCBSM
• Michigan-based, non-profit company since 1939
• BCBSM employs over 3,100 union members. BCBSM currently
administers national PPO plans for UAW Ford, Chrysler and GM
• Blue Cross Blue Shield – most recognized and accepted insurance
card in the nation. One card for medical and prescription drug
benefit
• BCBSM Ford Service Center - dedicated toll-free customer service
numbers
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Medco’s National Call Center Network assures that
members always have access to customer service
 5 fully integrated call
centers in 3 different
time zones
 Available 24 hours a day
7 days a week
 Dedicated toll free
number
 All inquirees tracked and
reported
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Pharmacy Options
Retail Pharmacy
 Up to a 34-day supply of medication
 Use for short-term medications (example: antibiotics)
 Use in-network pharmacies
Medco By Mail (mail order) Pharmacy
 Up to a 90-day supply of medication
 Use for long-term, maintenance medications (example: drugs
used to treat high cholesterol)
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Medco By Mail – Getting Started
First time filling a prescription – ask the doctor for
two prescriptions
 A 34-day supply to obtain from in-network retail pharmacy
 A 90-day supply, plus refills up to one year (if appropriate),
for mail order
Ordering new prescriptions
 By mail
 By fax (physicians office only)
 Via internet (physicians office only)
Medication delivery within 8 days
 Standard shipping = no additional cost
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Medco By Mail - Refills
Order your refills when you have a two-week supply
remaining on your prescription
Order refills
 Via internet
 By phone
 By mail
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Member is Out of Medicine?
NEVER GO WITHOUT MEDICINE
If a member is low or out of meds, member should call Medco
 Medco will assist member in obtaining enough medicine from a
retail pharmacy until their prescription arrives
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Mandatory Mail
Maintenance drugs are those drugs taken on an on-going basis
(3 months or more). Examples – medicines to treat high blood
pressure, diabetes or high cholesterol.
If a drug is on the Mandatory Mail Drug List, the prescription
can be filled 3 times at their retail pharmacy.
On the 4th fill, the prescription must be filled through Medco
By Mail to avoid paying the full cost of the drug at retail
 Member receives a reminder letter after the 2nd fill at a retail
pharmacy
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Mandatory Generics
If member receives a brand-name drug when a generic version
is available, the member’s out-of-pocket costs may increase.
For prescriptions written as Dispense as Written or DAW:
 First fill, member pays brand co-payment, plus the cost
difference (up to a maximum of $10) between brand-name and
generic drug
 On subsequent fills, if a coverage review has not been initiated
and approved, the member will be responsible to pay the generic
co-payment, plus the entire cost difference between brand-name
and generic drug
Applies to both retail and home delivery
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Coverage Review Process
(In Order to Receive the Brand-name Drug at the Brand Co-pay)
If currently taking a brand-name drug when a generic version
is available, the member will receive a letter from Medco
Health encouraging them to discuss with their doctor the
reasons why they need to take the brand-name drug.
If the doctor believes that there are clinical reasons for the
member to take the brand-name drug, they should ask their
doctor to contact Medco Health at 1 800-841-5409 to initiate
a coverage review of their prescription.
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Non-sedating Antihistamines (NSA’s)
Effective January 1, 2008, there is no coverage for nonsedating antihistamines
Such NSA’s include Allegra®, Clarinex®, Xyzal®, Zyrtec®, and
fexofenadine (the generic version of Allegra®)
Members should talk to their doctor or pharmacist about all the
treatment options available, including over-the-counter (OTC)
medications
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Coverage for Vitamins and Essential Minerals
Effective January 1, 2008, coverage included & limited to:
•Prenatal vitamins for females under the age of 49
•Vitamin D derivatives only when prescribed to treat renal
disease
•Vitamin K only when prescribed for bleeding conditions
•Long-acting Niacin for treating heart conditions
•Potassium Chloride
•Talk to doctor or pharmacist about all the treatment options
available, including OTC medications
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Allergy Serums
Allergy Serums are covered under pharmacy benefit.
Enrollees will have to submit claims for Allergy Serums via
direct claim form.
Claim forms can be requested by calling Medco at 1 800-7780735.
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Insulin and Syringes/Needles
Members must order their Insulin and syringes/needles on the
same day
 Insulin has been added to the mandatory mail list effective
January 1, 2008
Diabetic Testing supplies, lancets, etc. are covered under the
durable medical supplier – Wright & Filippis.
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Pharmacy Management Tools
Value – To bring greater patient safety by protecting against
potentially dangerous dosing that does not meet FDA-approved
guidelines or national physician best practice guidelines
Definitions:
 Prior authorization (PA): Medication not covered unless
approval obtained through coverage review. 1 800-417-1764.
 Step therapy (ST): Part of PA process, may include use of
preferred products as first step/therapy requirement
 Quantity limit (QL): Allows for a certain number of pills or
tablets for use for a certain amount of time
The review uses plan rules based on FDA-approved prescribing and
safety information, clinical guidelines, and uses that are considered
reasonable, safe, and effective
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Pharmacy Management Tools – New Tools
Effective March 17, 2008
Traditional Prior Authorization
Growth Hormone
Mutliple Sclerosis Therapy
Betaserone®, Copaxone®, Rebif®
Smoking Deterrents
Adipex®, Bontril®, Didrex®, Fastin®, Meridia®, Sanorex®,
Tenuate®
Nicotine, Chantix®
Anti Narcoleptic Agent - Provigil
Provigil®
Appetite Suppressants & Weight Loss
Select Androgens & Anabolic Steroids
IVIG (intraveneous immune globulins)
Gamimune®, Gammagard®, Gammar®-IV, Sandoglobulin®,
Flebogamma®, Octagam®, Carimune®, Iveegam®,
Panglobulin®, Polygam®, Venoglobulin®
Narcotic Analgesics
Lidoderm® patch
Psoriasis Therapy
Interferon alpha – 2b (Intron® A)
Interferon alpha – 2a (Roferon®)
Interferon alfacon-1 (Infergen®)
Interferon alpha - 2b (Intron® A) and ribavirin (Rebetol®)
[Rebetron®]
Peginterferon alfa-2b (PEG-Intron®)
®
® (Pegasys )
alfa-2a
Peginterferon
,
Amevive®, Raptiva
CNS Stimulants and Amphetamines
Concerta, Daytrana, Focalin, Ritalin, Strattera, Adderall,
Desoxyn, Dexedrine, Vyvanse, etc
Interferons (Hepatitis)
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Pharmacy Management Tools – New Tools
Effective March 17, 2008
Step-Therapy
COX-II Inhibitors
Celebrex
Osteoporosis therapy (Forteo)
Forteo®
Inhaled short acting Beta agonists
Xopenex®
Ribavirin
Rebetol®, Copegus®
Quantity-Duration
Migraine therapy
Imitrex, Maxalt, Zomig
Hypnotic Agents
Ambien, Ambien CR, Lunesta, Sonata, Rezurem
Antibiotics - Zyvox
Zyvox®
Antiemetic Agents
Anzemet®, Kytril®, Zofran®, Emend®
Antiviral Agents
Zovirax®, Famvir®, Valtrex®,
Lidoderm® patch
Spiriva®
Narcotic Analgesics
Inhaled Bronchodilator - Spiriva®
Anti-Narcoleptic Agent
Erythroid Stimulants
Provigil®
Epogen, Procrit, Aranesp
Osteoporosis therapy (Forteo)
Forteo®
Psoriasis Therapy
Amevive®, Raptiva®,
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Pharmacy Management Tools – New Tools
Effective Date TBD
Pre-notification:
Letters are mailed to members who are taking one or more of
these drugs one month prior to implementation.
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Proton Pump Inhibitors (PPI’s)
As of 12/4/06, brand PPI’s are no longer covered without a
coverage review.
PPI’s include: Nexium®, Aciphex®, Prevacid®, Prilosec®
40mg, Protonix®, and Zegerid®.
Omeprazole (the generic version of Prilosec®) is the preferred
medication.
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Co-Pays Effective January 1, 2008
National PPO & Blue Preferred Plus PPO Plans
Actives
Retirees
Mail
Retail
Generic
$10
$5
Brand
$15
$11
ED
$19
$16
Mail
Retail
Generic
$7
$5
Brand
$13
$11
ED
$19
$16
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Co-Pays Effective January 1, 2008
National PPO Protected Retirees
Mail
Prior 1/1/04
Generic
$2
$5
Brand
$2
$5
ED
$2
$5
Mail
On or After 1/1/04
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Retail
Retail
Generic
$2
$5
Brand
$2
$10
ED
$2
$10
Co-Pays Effective January 1, 2008
Blue Preferred Plus PPO Protected Retirees
Mail
Prior 1/1/04
Generic
$5
$5
Brand
$5
$5
ED
$5
$5
Mail
On or After 1/1/04
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Retail
Retail
Generic
$5
$5
Brand
$5
$10
ED
$5
$10
Co-Pays Effective January 1, 2008
National PPO - Catastrophic
Mail
Retail
Generic
$32
$16
Brand
$74
$37
ED
$106
$53
© 2007 Medco Health Solutions, Inc. All rights reserved.
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Important Phone Numbers
BCBSM Ford Service Center: For questions about the Prescription Drug
Program, such as benefits, co-pays, and eligibility, Actives call 1-800-4825146, Retirees/Surviving Spouses call 1-800-426-4610
Medco: For questions about your Medco By Mail prescriptions, such as order
status, account balances, or when and how an order was shipped, call 1-800778-0735
Automated Refills at Mail: 1-800-473-3455
© 2007 Medco Health Solutions, Inc. All rights reserved.
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