© 2007 medco health solutions, inc. all rights reserved. 1 about medco in 2006, we processed more...

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© 2007 Medco Health Solutions, Inc. All rights reserved.

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

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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

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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

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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)

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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

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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

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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

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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

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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

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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.

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Non-sedating Antihistamines (NSA’s)

Effective January 1, 2008, there is no coverage for non-sedating 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

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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

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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 1 800-778-0735.

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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.

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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

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Pharmacy Management Tools – New Tools Effective March 17, 2008

Growth HormoneMutliple Sclerosis Therapy Betaserone®, Copaxone®, Rebif®

Appetite Suppressants & Weight LossAdipex®, Bontril®, Didrex®, Fastin®, Meridia®, Sanorex®, Tenuate®

Smoking Deterrents Nicotine, Chantix®

Anti Narcoleptic Agent - Provigil Provigil®

Select Androgens & Anabolic Steroids

IVIG (intraveneous immune globulins) Gamimune®, Gammagard®, Gammar®-IV, Sandoglobulin®, Flebogamma®, Octagam®, Carimune®, Iveegam®, Panglobulin®, Polygam®, Venoglobulin®

Narcotic Analgesics Lidoderm® patch

Interferons (Hepatitis)

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®)

Peginterferon alfa-2a (Pegasys®)Psoriasis Therapy Amevive®, Raptiva®,

CNS Stimulants and AmphetaminesConcerta, Daytrana, Focalin, Ritalin, Strattera, Adderall, Desoxyn, Dexedrine, Vyvanse, etc

Traditional Prior Authorization

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Pharmacy Management Tools – New Tools Effective March 17, 2008

COX-I I Inhibitors Celebrex

Osteoporosis therapy (Forteo) Forteo®

Inhaled short acting Beta agonists Xopenex®

Ribavirin Rebetol®, Copegus®

Step-Therapy

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®,

Narcotic Analgesics Lidoderm® patch

Inhaled Bronchodilator - Spiriva® Spiriva®

Anti-Narcoleptic Agent Provigil®

Erythroid Stimulants Epogen, Procrit, Aranesp

Osteoporosis therapy (Forteo) Forteo®

Psoriasis Therapy Amevive®, Raptiva®,

Quantity-Duration

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Pre-notification:

Letters are mailed to members who are taking one or more of these drugs one month prior to implementation.

Pharmacy Management Tools – New Tools Effective Date TBD

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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.

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Co-Pays Effective January 1, 2008

National PPO & Blue Preferred Plus PPO Plans

Mail Retail

Actives Generic $10 $5

Brand $15 $11

ED $19 $16

Mail Retail

Retirees Generic $7 $5

Brand $13 $11

ED $19 $16

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National PPO Protected Retirees Mail Retail

Prior 1/1/04 Generic $2 $5

Brand $2 $5

ED $2 $5

Mail Retail

On or After 1/1/04 Generic $2 $5

Brand $2 $10

ED $2 $10

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Blue Preferred Plus PPO Protected Retirees Mail Retail

Prior 1/1/04 Generic $5 $5

Brand $5 $5

ED $5 $5

Mail Retail

On or After 1/1/04 Generic $5 $5

Brand $5 $10

ED $5 $10

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National PPO - Catastrophic

Mail Retail

Generic $32 $16

Brand $74 $37

ED $106 $53

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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 1-800-482-5146, 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 1-800-778-0735

Automated Refills at Mail: 1-800-473-3455

© 2007 medco health solutions, inc. all rights reserved. 1 about medco in 2006, we processed more...

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