Download Pharmacy Products, Programs and Services for Groups

Pharmacy Products, Programs and Services for Groups
As of May 2005
1
BlueScript
Product Features
Preferred Medication List
2
BlueCare Rx
Description
A listing of drugs that have been carefully selected and reviewed by a panel of
doctors and pharmacists. Members pay less for drugs on the Preferred Medication
List than for drugs that are not on the list. Available at www.bcbsfl.com>Members>
Products, Plans & Services>Pharmacy Coverage>Medication Guide.
x
x
Benefit Options:
Three-tier benefit options –
small group
$7/$20/$35 (not available with BlueOptions); $10/$25/$40; $15/$30/$50
x
x
Three-tier benefit options – 51+
$7/$20/$35; $10/$25/$40; $15/$30/$50
x
Three-tier benefit options
with deductible – 51+
$50 deductible with $7/$20/$35, $10/$25/$40, or $15/$30/$50
(also available with BlueOptions Small Group)
x
x
Two-tier benefit options – 300+
$10/$20; $10/$25; $15/$30 (two-tier plans not available with BlueOptions)
x
x
Deductible/coinsurance
benefit options – small group
$100, $200, $300, or $400 deductible with 50% coinsurance
Deductible/coinsurance
benefit options – 51+
$100 deductible with 80% or 50% coinsurance; $250 deductible with 60%
coinsurance available with BlueOptions only
Deductible/copayment
benefit options – 51+
$100, $200, $300, $500 deductible with $15/$30/$50
(also available with all three-tier plans for groups 300+)
BlueOptions generic only plan –
51+
$15 generic only, no mail order
x
BlueOptions specific plan – 51+
$15 generic with $500 deductible + 50% brand and non-preferred; no mail order
x
Retail
One month (up to 31 days) for one (1) copay
Mail order
90-day supply for two (2) copays
Vendor: Walgreens Healthcare Plus, Orlando, Florida
x
x
x
x
x
Days Supply:
x
x
All programs may not apply to MediScript members.
1 Sold with BlueOptions and BlueChoice PPO plans.
2 Sold with BlueCare HMO plans. BlueCare HMO is offered by Health Options, Inc. (HOI).
HOI is a subsidiary of Blue Cross and Blue Shield of Florida.
63652-0505
Pharmacy Products, Programs and Services for Groups
As of May 2005
Pharmacy and Medical
Integrated Management
Through timely analysis of pharmacy and medical (including lab, as appropriate)
claims data, identify potential areas of health and cost improvement opportunities
related to:
• frequently prescribed drugs
• high risk drugs/drugs with medication safety concerns, and
• most costly drugs.
1
BlueScript
2
BlueCare Rx
Educational Initiatives:
Identify target areas of health experience and cost improvement opportunities
Congestive heart failure
education
WHAT: Improve compliance to ACE inhibitor or ARB medicines in order to
improve heart failure outcomes
HOW: Notify physicians about potential gaps in prescription therapy
x
x
Asthma therapy education
WHAT: Increase compliance to asthma controller medicine to potentially prevent
or decrease hospital visits due to asthma
HOW: Send educational letters and motivational reminders to physicians and members
x
x
Diabetes glucometer program
WHAT: Free glucometer program
HOW: Patient or physician calls the number listed based on health plan
• For BlueOptions:
FREE glucometers must
be obtained through the
pharmacy benefit.
• For BlueCare:
FREE glucometers
are obtained through
the medical benefit.
• For BlueChoice:
FREE glucometers
are obtained through
the medical benefit.
Anti-inflammatory/Arthritis
medication prescribing profile
initiative
WHAT: Encourage appropriate use of Cox-2 inhibitors (high cost medications used
to treat musculoskeletal inflammation and arthritis), per national guidelines,
for patients with pain or arthritis
HOW: Notify physicians about potential gaps in prescription therapy
Cholesterol management
initiative
x
x
WHAT: Increase the number of diabetic members who receive appropriate
cholesterol screening, treatment, and goal attainment
HOW: Through mail-based educational letters to physicians and patients
x
x
Blood thinner awareness
initiative
WHAT: Increase compliance to laboratory blood testing to potentially prevent
complications to therapy
HOW: Through monthly educational letters to patients
x
x
Medication compliance
initiative
WHAT: Increase compliance to medicines that can be taken in a single daily dose
HOW: Every-other-month mailing to request physicians and patients
consider a change to a once-a-day dose
x
x
All programs may not apply to MediScript members.
1 Sold with BlueOptions and BlueChoice PPO plans.
2 Sold with BlueCare HMO plans. BlueCare HMO is offered by Health Options, Inc. (HOI).
HOI is a subsidiary of Blue Cross and Blue Shield of Florida.
63652-0505
Pharmacy Products, Programs and Services for Groups
As of May 2005
Pharmacy and Medical Integrated Management (continued)
1
BlueScript
2
BlueCare Rx
Patient Safety Initiatives:
Point of service drug safety edits
WHAT: Pharmacists receive on-line warning messages (edits) when entering
a prescription into their computer systems regarding: drug interactions,
duplicate medication, unusual high dose, or refill-too-soon
HOW: Pharmacists use professional judgment and communicate with the
physician and member, as needed
x
x
Retrospective medication
safety education
WHAT: Prevent unwanted drug effects, i.e., drug interactions, duplicate therapy,
appropriate dosage, or drug-pregnancy issues
HOW: Through mail-based education to physicians
x
x
Drug safety and recall
notification education
WHAT: For all members with a prescription claim for a drug that is removed
from marketing
HOW: Notify physicians and members in a timely fashion of any drug
removed from the market
x
x
Responsible Rx –
coverage maximum initiative
WHAT: Focus on maximum recommended dose of specific medications based
on established dosing guidelines
HOW: Through monthly coverage maximums for specific medicines
x
x
High drug utilization
notification
WHAT: Identify potential inappropriate and excessive use of specific medications
prone to abuse to minimize risk to patients
HOW: Notify and inform physicians regarding at-risk members
x
x
Medication safety education
campaign
WHAT: Increase members’ knowledge about overall medication safety and
prevention of medication errors
HOW: Distribute newsletters, educational leaflets, and BCBSF internet site
information to members
x
x
Poly pharmacy – poly physician
education (under development)
WHAT: Provide education to select members and prescribers concerning the use of
multiple medicines and warn against potential safety risks associated with
receiving prescriptions from multiple providers; in select areas,
direct counseling is available
HOW: Through educational mailings to prescribers and patients, and educational
sessions for select patients
x
x
All programs may not apply to MediScript members.
1 Sold with BlueOptions and BlueChoice PPO plans.
2 Sold with BlueCare HMO plans. BlueCare HMO is offered by Health Options, Inc. (HOI).
HOI is a subsidiary of Blue Cross and Blue Shield of Florida.
63652-0505
Pharmacy Products, Programs and Services for Groups
As of May 2005
1
BlueScript
Pharmacy and Medical Integrated Management (continued)
2
BlueCare Rx
Prescription Drug Optimization Initiatives:
Generic drug promotion and
enhancement program
WHAT: Reminder program for physicians and members regarding availability of
generic medications that will reduce out-of-pocket costs
HOW: Through quarterly, mail-based education to pharmacies, physicians, & members
“High Dollar” report and review
WHAT: Identify high dollar claim amounts per quarter for potential error
HOW: Take action to correct identified errors
Over-the-counter coupon
mailing initiative
WHAT: Reduce out-of-pocket costs for medicines used for heartburn and
allergy symptoms
HOW: Send high dollar coupons to members for Advil, Alavert and Prilosec OTC
Pharmacy Provider Network
x
x
x
x
x
x
Description
Florida
Retail pharmacy chains in our network include Albertsons, CVS/pharmacy, Kmart,
Publix, Walgreens, Wal-Mart, Target, The Medicine Shoppe, and Winn-Dixie.
Walgreens Healthcare Plus in Orlando is the BCBSF mail order pharmacy.
National
The National Pharmacy Network of Medco Health Solutions, Inc. is available for
members residing or traveling outside the state of Florida.
Service and Support
3,331 participating
pharmacies
statewide
3,480 participating
pharmacies
statewide
Comprised of over 55,000 pharmacies
nationwide, and includes most of the
major chains within each state
Description
Audit Programs
On-site and desk audit program of prescription claims with savings resulting from:
• Identification of Rx’s returned to stock that weren’t picked up
• Prescriptions billed with quantities in excess of prescribed amount or plan limits
x
x
Volume discounts
(retail pharmacy reimbursement)
Due to our strong presence in Florida, we’re able to negotiate discounts with
pharmacies to provide our members with even greater savings. Industry comparisons
indicate that BCBSF brand and generic discounts off Average Wholesale Pricing are
extremely competitive in the marketplace.
Specific discount averages can be provided upon request
x
x
BCBSF Customer Service
Our Customer Service Representatives (CSRs) answer questions regarding benefits,
participating pharmacies, drugs on the preferred medication list, and fill such member
needs as providing mail order forms. CSRs are able to access the prescription claims
processor’s on-line claims system in order to respond to inquiries.
x
x
All programs may not apply to MediScript members.
1 Sold with BlueOptions and BlueChoice PPO plans.
2 Sold with BlueCare HMO plans. BlueCare HMO is offered by Health Options, Inc. (HOI).
HOI is a subsidiary of Blue Cross and Blue Shield of Florida.
63652-0505
Pharmacy Products, Programs and Services for Groups
As of May 2005
Service and Support (continued)
Website information
Description
At www.bcbsfl.com , members have access to:
• A description of their pharmacy product
• The Preferred Medication List (formulary)
• Costs associated with common conditions
• Generic equivalents, and
• The value of generic medication
Development of an interactive member web capability is underway with
expected availability in late 2005 which will allow members to:
• View personal medication history
• Obtain medication cost information, and
• View other helpful information on prescription drugs
Customer newsletters
(Florida Blue)
Includes a regular educational piece on medication safety as well as revisions
or updates to the Preferred Medication List
Injectable drug supplier program
Participating suppliers for injectable drugs
OptionMed (1-800-720-7522) for BlueOptions, BlueChoice and BlueCare
Priority Healthcare Corporation (1-800-504-9265) for BlueOptions and BlueChoice
1
BlueScript
2
BlueCare Rx
x
x
x
x
x
x
All programs may not apply to MediScript members.
1 Sold with BlueOptions and BlueChoice PPO plans.
2 Sold with BlueCare HMO plans. BlueCare HMO is offered by Health Options, Inc. (HOI).
HOI is a subsidiary of Blue Cross and Blue Shield of Florida.
63652-0505