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Community CCRxSM PDP2010 Plan Year – Stakeholder Call

Speakers:

Marc Bralts, Vice President, Network OperationsMichael Bukach, RPh, Senior V.P. Pharmacy Network and Clinical OperationsAmber Jones, RPh, Sr. Manager, Pharmacy Relations

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Topics for Today’s Program

• Overall 2010 Medicare Part D Changes

• 2010 Bid Results

• 2010 PDP Plan Design

• MA-PD Overview

• 2010 Formulary Update

• 2010 MTM Program

• Agent-Pharmacy Partnership Program

• CMS Compliance & Community CCRxSM Tools

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Medicare Part D Updates

• Annual bidding continues to drive change each plan year.

• Nationally, there are approximately 800k auto-assigned duals being moved due to plans missing the benchmark.

– “choosers” will not be automatically reassigned• They can choose to switch plans or pay the difference (between plan

premium and benchmark)

• Part D members being moved will be notified via: – ANOC – late October– Letter notifying them of reassignment for upcoming year

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Community CCRx Bid Results

• Remained under LIS benchmark for 2010 in every current region with the exception of New Mexico

• States back under LIS benchmark for 2010:– MA, RI, VT, CT, UT, ID

• States new under benchmark for 2010: – AZ, NV

• Merging of PDPs to conclude in 2012– PrescribaRxSM Platinum (PDP) Community CCRxSM Gold (PDP) in 2010

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Gold• $0 deductible• Copays (30-day supply)

– Generics: $6– Preferred Brand:

$35– Non-Preferred

Brand: $65– Specialty: 33%

• Gap Coverage: Generic Tier Drugs Only

Choice• $150 deductible• Copays (30-day supply)

– Generics: $5– Preferred Brand:

$35– Non-Preferred

Brand: $65– Specialty: 29%

• No Gap Coverage

Basic• $310 deductible• Copays (30-day supply)

– Generics: $0– Preferred Brand :

25-30%– Non-Preferred

Brand: 50-75%– No specialty

• No Gap Coverage

2010 Plan Design Changes

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Agent Program

• Agent Partnership for 2010 selling season– Additional training to improve field results

– In-store agent opportunities (pending agent availability in certain regions)

– Strong support from 800# call-center• Highly trained, fully-licensed agents• Available for all stores

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Pharmacy Education Kits

• Education kits should arrive by 10/1

• Kits include: – Pre-enrollment packets - Formulary flyer– Cover letter with CMS guidelines - Tear sheets– Town Hall flyer - Plan Comparison Guide– Calendar with Marketing dates

• Request a Pharmacy Education kit or additional pre-enrollment packets:

– Email: experts@mhrx.com– Call: 866-684-3057– Online at: (www.mhrx.com)

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2010 Formulary Update: Tier Changes

Actos, ActoPlus Met, Duetact Aromasin Asacol Hectorol Invega Pentasa Sanctura, Sanctura XR VESIcare

Tier Changes

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2010 Formulary Update: Deletions

Deletion Alternative

Prevacid Solutab omeprazole (G), Nexium Oral Packets (PB), Zegerid Oral Packets (PB)

Aciphex omeprazole (G), Nexium (PB)

Amitiza lactulose (G)

Ranitidine Caps ranitidine tabs (G)

Catapres-TTS Patches any oral antihypertensive

Atacand, Atacand HCT Cozaar, Hyzaar, Diovan, Diovan HCT (PB)

Asmanex Flovent, Pulmicort Flexhaler, QVAR (PB)

Rhinocort Aqua Fluticasoen (G), Nasonex (PB), Vermayst (PB)

Oxytrol Detrol, Detrol LA, Toviaz, Enablex (PB)

Nitrolingual Nitrostat (NPB)

Antara fenofibrate (G), Tricor (PB), Trilipix (PB)

Deletion Alternative

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2010 Formulary Update: Deletions (Beers List)

Deletion Alternative

Diphenhydramine caps/tabs fexofenadine (G), Xyzal (NPB)

Meperidine tablets acetaminophen with codeine (G), acetaminophen with hydrocodone (G), morphine (G)

Butalbital-ASA-Caffeine-Codeine acetaminophen with codeine (G), acetaminophen with hydrocodone (G)

Meprobamate buspirone, sertraline

Pentazocine-Naloxone acetaminophenwith codeine (G), acetaminophen with hydrocodone (G)

Deletion Alternative

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2010 Formulary Update: Step Therapy

– VESIcare – Actos, Actos PlusMet, Duetact – Abilify, Invega – AVINza – BuPROPion HCl & – Budeprion XL 24-hr ER tablets

– Aromasin, Femara

Step Therapy

View formulary alternatives and step therapy criteria at:

www.mhrx.com/providers

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Formulary Updates

• Group Plans move from Alliance and Alliance Plus formularies to Optimal Med formulary – starting 1/1/2010.

• Communication– Member

• Formulary change letters• ANOC• EOB

– Pharmacist • Fax

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2010 Updates

• Payer Sheet – no significant changes– “Prescription Origin” code

• Mail Order – no mail order for Community CCRx in 2010

• 2010 Incentive Program– MTM – new eligibility criteria

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Medicare Advantage Prescription Drug Plans (MA-PD)

• Private Fee-For-Service (PFFS)• Preferred Provider Organizations (PPO)• Health Maintenance Organizations (HMO)• Most Universal American MA-PD plans are “powered by

CCRx” drug benefit

• Extended enrollment period through March 31st.• Online: www.UniversalAmerican.com

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Fraud, Waste and Abuse

• CMS Regulation• Attestation is not required• Conducted in 2009 calendar year

– Universal American Part D Fraud, Waste and Abuse training module

– Alternative Training Programs must address specific topics at a minimum

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Alternative Training Requirements

• Compliance with Federal statutes (i.e., False Claims Act, Anti-Kickback Statute, HIPAA, etc.)

• Requirement to have appropriate policies and procedures to address fraud, waste and abuse

• Types of fraud, waste and abuse that can occur, including but not limited to:• Inappropriate billing practices• Bait and switch pricing• Prescription altering• Dispensing expired or altered prescription drugs• Illegal remuneration• True Out of Pocket (TrOOP) manipulation

• Incorrect or misleading notices to employees• U.S. Office of Inspector General (OIG) exclusion list• Process for reporting fraud, waste and abuse• Protections in non retaliation for employees who report suspected fraud,

waste and abuse

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Providers Can:

Distribute CMS- approved Plan Finder information. Display promotional materials that announce your relationship with a plan. Make available printed information provided by a plan sponsor to your

patients, as long as there is no “ranking,” “highlighting” or comparison of specific plans.

Provide contact information for any plan which a beneficiary expresses an interest and requests such contact information from you.

Make available PDP marketing materials and enrollment applications. Use direct mail and/or e-mail to announce a new plan affiliation Provide information and assistance to your patients in applying for the low

income subsidy.

For additional information, see the Medicare Marketing Guidelines, available at: http://www.cms.hhs.gov/ManagedCareMarketing/Downloads/R91MCM.pdf

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Providers Cannot

Direct, urge, persuade, steer or offer inducements to join a particular plan. Compare plan benefits against other health plans, unless the materials were written or

approved by CMS Make available PDP enrollment forms at the counter. Collect or accept Medicare enrollment applications of any kind. Offer sales or appointment forms. Mail marketing materials on behalf of a plan. Make available third party sales or plan promotional materials that are not CMS -

approved. Expect or accept compensation for conducting enrollment or marketing activities. Suggest that a particular plan is approved, endorsed or authorized by Medicare. Make or distribute plan information, including PDP enrollment forms, during health

screenings.

For additional information, see the Medicare Marketing Guidelines, available at: http://www.cms.hhs.gov/ManagedCareMarketing/Downloads/R91MCM.pdf

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Tools and Resources

• Website: www.mhrx.com 2010 Formularies

60 Day Formulary Notices

Drug Search Tool Fraud Waste and Abuse Module PA Forms PA Criteria PA Status Search Pharmacy Scorecard

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2010 Part D: Community CCRx

Thank You for your continued Support.

Questions & Answers