Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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