Download teamsters local no. 1150 prescription drug benefit

TEAMSTERS LOCAL NO. 1150 PRESCRIPTION DRUG BENEFIT FUND
OVERVIEW
Effective January 1, 2015, the plan provisions summarized below will apply to your pharmacy
benefit.
Also effective January 1, 2015, TeamstersRx (ESI) will provide the pharmacy benefit for the
High Deductible Health Plans (HDHP’s). Currently the health plans (e.g. CIGNA) provide
pharmacy benefits for the HDHP plans.
PRIOR AUTHORIZATION
Express Scripts prior authorization drives plan savings and patient safety by monitoring the
dispensing of high-cost medications and those with the potential for misuse. Our program
ensures drug coverage consistent with the client's intent for the prescription benefit, while
maintaining member and physician satisfaction. Twenty-four hours a day, personnel specially
trained on our PA program’s diseases, drugs, and coverage criteria provide review services,
giving physicians and pharmacists quick, easy access to information and ensuring effective
treatment by monitoring patient response to therapy.
PREVENTIVE MEDICATIONS (HDHP only)
Express Scripts' Preventive Medication program supports consumer directed healthcare (CDH)
plans that are comprised of Health Savings Accounts (HSA) with a high deductible. This
optional program allows certain drugs to bypass the deductible in accordance with the U.S.
Internal Revenue Service’s “safe harbor” provision for preventive medications. The drug classes
included are: Smoking Cessation agents, Weight loss agents, Vaccines, Certain vitamins and
fluoride supplements, Blood pressure lowering medications, Cholesterol lowering medications,
certain antiviral agents and Agents to prevent osteoporosis.
STEP THERAPY
Within specific therapy classes, multiple drugs are available to treat the same condition. Step
Therapy manages drug costs by ensuring that patients try frontline (first step), clinically
effective, lower-cost medications before they “step up” to a higher-cost medication.
DRUG QUANTITY MANAGEMENT
The Drug Quantity Management program manages prescription costs by ensuring that the
quantity of units supplied for each copayment are consistent with clinical dosing guidelines.
The program is designed to support safe, effective, and economic use of drugs while giving
patients access to quality care. Express Scripts clinicians maintain a list of quantity limit
drugs, which is based upon manufacturer-recommended guidelines and medical literature.
FORMULARY EXCLUSIONS
The National Preferred Formulary, our standard commercial formulary, provides exceptional
value for clients wishing to maximize member choice and access to single source brand drugs.
Approximately 20 million Americans obtain their pharmacy benefit coverage through the
Express Scripts National Preferred Formulary. Annual updates to the National Preferred
Formulary will go into effect on Jan. 1, 2015. Updates will include formulary status changes
(preferred to non-preferred and exclusions). Each impacted product has one or more alternative
medications, including preferred brands and generics.