Washington State Rx Services:Prescription Benefit Update

Elizabeth James, PharmDOctober 16, 2007

Outline

Identify Washington State Rx Services

UMP vs. Aetna Prescription Benefits

Major Changes for 2008 Q & A

What is Washington State Rx Services? Prescription drug benefit of two

Washington State self-insured products – Uniform Medical Plan (UMP)– Aetna Public Employees Plan of

Washington (Aetna) Administered by the HCA via the

partnership of:– The ODS Companies– MedImpact Healthcare Systems, Inc.– Wellpartner, Inc.– BioScrip

Why? Senate Bill 5471 directing the HCA to

create the prescription drug consortium (WPDP)

In summer 2006, Oregon & Washington together released the RFP for the drug discount card program

In the state of Oregon, The ODS Companies & MedImpact do not compete for business

UMP joined when its contract with Express Scripts would expire at the end of calendar year 2007, as UMP does not meet exemption criteria

Who Does What for WSRXS?

The ODS Companies– Plan administration– Customer service

MedImpact Healthcare Systems, Inc.– Network pharmacy management – Prescription drug claims processing

Wellpartner, Inc.– Mail order pharmacy

BioScrip– Specialty drug pharmacy

UMP vs. Aetna Benefit

Retail Pharmacy BenefitUMP Deductible:

$100/person or $300/family

Up to a 90-day supply Enrollee cost-share

– Tier 1: Lesser of 10% coinsurance or enrollee cost-share limit

– Tier 2: Lesser of 30% coinsurance or enrollee cost-share limit

– Tier 3: 50% coinsurance (For drugs with a generic equivalent, the enrollee pays the tier 1 coinsurance plus the ancillary charge. Maximum cost-share limit does not apply.

Aetna NO DEDUCTIBLE 30-day supply for 1

copay 90-day supply for 3

copays Enrollee cost-share

– Tier 1: $10– Tier 2: $25– Tier 3: $40 (For drugs

with a generic equivalent, the enrollee pays the tier 1 copay plus the ancillary charge)

Mail Order BenefitUMP Enrollee cost-share

for up to a 90-day supply– Tier 1: $10– Tier 2: $50– Tier 3: $100 (For

drugs with a generic equivalent, the enrollee pays the tier 1 copay plus the ancillary charge)

Aetna NO DEDUCTIBLE Enrollee cost-share

for up to a 90-day supply– Tier 1: $20– Tier 2: $50– Tier 3: $80 (For

drugs with a generic equivalent, the enrollee pays the tier 1 copay plus the ancillary charge)

Specialty Benefit Must Purchase from BioScrip Pre-authorization required Limited to a 30-day supply Copays same as mail order by tier; ancillary

charges apply to some tier 3 specialty drugs Preferred Specialty Drugs Copay (tier 1)

– $10 for UMP– $20 for Aetna

Non-Preferred Specialty Drugs Copay (tier 3)– $100 for UMP– $80 for Aetna

UMP vs. Aetna

Otherwise, both plans…– Same cost-share tiers– Same preferred drug list– Same quantity level limits, step therapy

programs, and prior authorizations– Same vacation/travel policy– Subject to Washington State Preferred

Drug List and Therapeutic Interchange Program

Major Changes to Benefit

Cost Share Tiers

Tier 1: Generic drugs, injectable insulin, & preferred specialty drugs, preferred diabetes supplies

Tier 2: Preferred brand drugs, non-preferred diabetes supplies

Tier 3: Non-preferred brand drugs, non-preferred specialty drugs & compounded drugs

Diabetes Supplies

Injectable insulin is covered under Tier-1

Glucometers– Those in Tier-1 are at no cost to

enrollees– All others are covered under Tier-2

Test strips & lancets covered according to the tier listed on the PDL

Tobacco Cessation Program OTC nicotine products provided directly

to enrollees by Free & Clear– Covered products at no cost to

enrollees: lozenges, gum, and patches– Excluded products: nasal spray, oral

inhalers Prescription products will continue to be

obtained through the prescription benefit at either the Wellpartner mail order pharmacy or network retail pharmacies at no cost to enrollees

Specialty Drug Program

BioScrip exclusive Pre-authorization required for most

drugs

UMP Vaccine Program

Vaccine services coverage– Beginning in 2008, Uniform Medical Plan

will have contracts with retail pharmacies to allow pharmacists to administer vaccines to enrollees

– This benefit will NOT be administered through the prescription benefit but through the medical benefit

Minor Changes Some PDL changes New generics available New drugs added to QLL More drugs with Step or PA Some drugs removed from specialty

pharmacy

Current UMP enrollees affected by these changes will receive notification or be grandfathered to changes

Washington State Rx Services ContactsUMP Customer Service:

(888) 361-1611 Wellpartner Mail

Order Pharmacy: (800) 417-8590

BioScrip: (877) 316-8921

Aetna Customer Service:

(888) 361-1612 Wellpartner Mail

Order Pharmacy: (800) 815-3539

BioScrip: (877) 316-8921

Q & A