UPlan Medication Therapy Management (MTM)

MTM Marketing Seminar – 3/15/2011

MTM Discussion Topics

UPlan Pharmacy Program UPlan decision to add MTM MTM program and structure MTM communications and target

marketing MTM Preliminary Information

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UPlan Pharmacy Program

UPlan Medical Program

1. Two Medical Administrators — Medica & HealthPartners / Five Plan Types

2. Carve Out Pharmacy Program — Prime Therapeutics (originally RxAmerica/CVS Caremark)

3. Wellness Program — through Healthways and StayWell

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UPlan Pharmacy Program Pharmacy Contract is completely pass through /

transparent Formulary Development

• Utilize PBM formulary with University input• Rely on College of Pharmacy Expertise

New Specialty Program effective 1/1/2011• High cost medications for complex conditions

• Fairview Specialty Pharmacy, Fairview hospital or clinic pharmacies

• SMDC or St. Luke’s in Duluth

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Pharmacy Program Statistics 39,000 Members 30,300 Members with Prescriptions 370,800 Prescriptions $33 Million Total Drug Cost Focus on Generic Medications

• 50.4% : January – December 2005• 74.2% : January – December 2010 • 75.1% : December 2010

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Pharmacy Benefit Design

Copay Structure

Generic Plus $8

Brand Formulary $25

Non-Formulary $50

Non-Covered Full Cost

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UPlan Decision to Add MTM

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Decision to Add MTM UPlan decisions:

• Made by administration committee — AWG• Reviewed with employee committee — BAC

UPlan focus on evidence-based medicine Outcomes & ROI

• Ashville, NC Results• 2008 U of M Study — Isetts, Schondelmeyer et al

• BCBS/Fairview MTM Patients Pilot Program: UMD, November 2007 to February

2009 • Helped determine structure & operation of new MTM

program All UPlan MTM program — March 2009 9

MTM Program & Structure

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MTM Eligibility

UPlan active employees, early retirees, dependents

Four or more UPlan covered medications• Not specific disease focused but most

patients have chronic conditions• 10,000 Eligible Members

Physician Referral

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$8 MTM Copay Reductions

Without MTM With MTM -

6 Months

Generic Plus $8 $0

Brand Formulary $25 $17

Non-Formulary $50 $34

Not Covered Full Cost Full Cost

Participating in MTM Participants select MTM pharmacist from

Directory and make appointment Participants sign Participation Agreement and

enroll through PBM Pharmacy visits are face-to-face

• Option for tele-med visits for out of area participants

Encourage three or more visits first year / two or more visits subsequent years

No cost to member for Pharmacy visits • Pharmacist claims paid by two medical plans using

MTM procedure codes

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UPlan MTM Network Developed internally with College of

Pharmacy • Same MTM network for both Medical

Plans 101 Pharmacists, 146 locations, 30

contracting entities• Includes pharmacists for U of M, major

local care systems, and local chain & independent pharmacies

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MTM Program Structure MTM Network Manager & Coordinator

• Credential and contract network pharmacists for the University

• Manage activities of Peer Advisory Committee• MTM pharmacist coaching• Peer Review process

MTM Executive Committee• College of Pharmacy and Employee Benefits • Responsible for:

• MTM program operations• Communications and target marketing, • Program evaluation

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MTM Communications & Target Marketing

MTM General Communications Written Communications

• Newsletters, brochures, letters• Emails

Employee Benefits website • www.umn.edu/ohr/benefits/pharmacy/mtm/• Network Directory, Enrollment Form, PowerPoint

Presentation Customer Service Communications

• Employee Benefits, Health Plans, PBM Pharmacy Network Communications

• Emails, newsletters, website• www.umn.edu/ohr/benefits/pharmacy/mtmproviders/

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MTM Target Marketing Target Marketing — Pilot Program

• University of MN — Duluth• Letters & brochures, plus 2 follow-up phone calls• Handled by RxAmerica as PBM

Target Marketing — UPlan-wide Program • Letters & brochures, plus 2 follow-up phone calls• Handled by each member’s medical plan• Better response through medical plan target

marketing Enrollment results

• 722 members (about half from target marketing)• 10,000 eligible / 7% overall participation• 56 of 722 still have incentives remaining

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MTM Preliminary Information

(data from Medica members only)

Comparative Predicted Risk Score

Members not in MTM Members in MTM

+340%

Source: Johns Hopkins Adjusted Clinical Group Analysis

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Chronic Disease Comorbidity

43%

24%

10%13%

24%22%

24%

16%

2%2%5%0%

0%

20%

40%

0 1 2 3 4 5+

Members not in MTM

Members in MTM

number of chronic conditions

Source: Johns Hopkins Adjusted Clinical Group Analysis

% o

f mem

bers

with

mul

tiple

chr

onic

co

nditi

ons

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Types of Visits

43%

57%

1st Visit

Follow Up

Source: Claims review Jan – Aug 2010

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MTM – from a Patient’s Perspective

Initially enrolled due to copay reductions True value — excellent advice from MTM

pharmacist Helped me understand how medications work

• Side-effects • Interaction with over-the-counter medications

Communicated regularly with my physician Helped me make important decisions about my

medications and my health care

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UPlan Medication Therapy Management (MTM)

MTM Marketing Seminar – 3/15/2011