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Training Seminar

An Overview of Your Prescription Drug BenefitFebruary 8, 2008

William F. Laman Public Library

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Overview

Co-pay Structure Over the Counter Program Coordination of Benefits Diabetic Sense Program Specialty Program Website

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Co-Pay Structure

$10 for Generic Medications $30 for Brand Medications $50 for Brand Medications with Generics available $50 for Non-Preferred Medications

Days SupplyRetail: 30 days for non-maintenance medsRetail: up to 90 day supply for maintenance meds for 1 co-payMail: 90 day supply

Retail Pharmacy Network:Comprised of over 59,000 pharmacies in all 50 states, including all major chains

Mail Order: Walgreens Tempe, Arizona

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Formulary Communications

• Additions to the formulary occur quarterly

• Medications placed in the 3rd tier category generally have generic alternatives or brand alternatives that are equally effective

• Deletions occur annually• Proactively communicate deletions

for standard and client-specific formulary clients:– Formulary change letter– Web site tools– Pocket preferred drug list– Physician formulary

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Coverage of Over the Counter (OTC) Products

Municipal Health Benefit Fund offers coverage for OTC products at a $5.00 co-pay in two classes: – Anti-Ulcer Medications

• Prilosec OTC, Pepcid AC, Tagamet HB, Zantac-75, Zantac-150, and Axid AR

– Non-Sedating Antihistamines• Claritin, Claritin-D, Alavert, Alavert-D

Coverage requirements for the OTC medications: – Member must have a valid prescription from their primary physician– The co-payment of $5.00 for covered OTC medications will be

charged for each prescription for up to a 30 day supply

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Coordination of Benefits

As applies to Medicare – Part D– Present your Medicare Discount Card and your Catalyst RX card to

the pharmacy– The pharmacy will submit the full cost of the prescription to your

Medicare Discount Card. – The pharmacy will then submit the portion that Medicare did not

pay to Catalyst for payment. – You should never pay more than your co-pay ($10, $30, or $50)– If the pharmacy is unable to submit to Catalyst as secondary:

• Obtain DMR form off internet or from Benefits Office and submit to Catalyst RX for reimbursement

• If you have any questions, call Catalyst customer service at (888) 869-4600

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Catalyst Rx Diabetic Sense Program

Diabetic Sense is a compliance program offered at no cost to clients and provides testing supplies for zero co-pay to members– Easy enrollment:

• Call 877-852-3512• Log on to the Catalyst website and enroll on-line

– Includes a free glucose monitor– Items covered at zero co-pay include strips, lancets, needles,

alcohol swabs, etc. (medications not included)– 90 day supply mailed to member’s home– Access to certified diabetes educators and a variety of educational

materials– Refill reminders and compliance reporting

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Specialty Program

Offers access and management of injectable, infusible, and certain oral therapies used to treat complex, sometimes chronic & rare disease states

May use Walgreen’s Retail or Walgreens Specialty Pharmacy through mail. Specialty drugs are those that may have the following characteristics:

– High Cost of Treatment– Clinical Indications– Limited access– Complicated treatment regimens– Compliance issues– Special Storage Requirements– Manufacturer reporting requirements

Examples include:– Enbrel & Humira for Rheumatic Diseases– Lovenox & Procrit for Hematologic Diseases

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Catalyst Rx Specialty Pharmacy Offering

• 5,100 Walgreens stores; 1,540 are 24 hour stores

• Pharmacy locator capability to find local pharmacy with product in stock

• Specialized software to monitor history and track refill compliance to reduce waste

• Specialized pharmacist counseling, side-effect management, educational support, adherence monitoring

• Pharmacists available 24 hours a day, seven days a week

• Nurses on staff to answer questions about prescriptions and injection techniques and training

• Routine letters of encouragement and disease-specific educational materials that contain valuable information for patients

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Enrolling in the Specialty Program

Call Walgreen’s at 888-782-8443 Provide the Walgreen’s Representative with the following:

– Your personal information (i.e. name, address, etc)– Insurance I.D. number (off your card)– Name of medication– Prescribing Doctor’s Name and phone number

Once RX is verified with doctor, a Walgreen’s Representative will contact you to set up delivery time and date– These medications are not left at delivery address and must be

signed for

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The World Wide Web

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Web Site Solutions

Member Co-payments and Possible Brand and Generic Alternatives

Formulary Lookup Tool

Pharmacy Locator with Maps and Directions

Drug Dictionary

Mail Service Information

Member-specific Prescription History

Printable Claims Form

Printable Temporary ID Cards

Catalyst Rx provides plan specific web sites which offer members, clients, and physicians convenient access to:

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Providers Resource Center Physicians have access to:

– Formulary information • Download printable version of the

Catalyst Rx full formulary in PDF format

– Prior Authorization forms– Rx Updates

• What is going on in the recent news that may affect you?

– Rx Watch• Catalyst Rx newsletter with

industry news– Drug Pipeline Report

• Detailed information about new products

– New brands on the market – New generic availability

Physicians can utilize www.catalystrx.com to learn more about a member’s specific formulary or obtain prior authorization information

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Logging on to the Site

Follow 4 easy steps to log on:1. Go to www.catalystrx.com2. Locate the “Members

Login” box on the right side of the screen

3. Enter your Member ID number (printed on your ID card) including the person code (“01”, “02”, etc.), your date of birth, and your Rx Group #

4. Click “Login”

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Access Quick Links including:

• Pharmacy locator

•What’s covered

•Mail order refills

•Drug information and possible alternatives

•Co-pay information

•Healthy links:

•Asthma

•Diabetes

•View your on-line history

•Common questions

Quick Links

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Quick Link Features

Print a temporary ID Card Print a direct member

reimbursement form Access health related content Print your preferred drug list Access information related to

your mail order program

Useful tools which you can access via www.catalystrx.com include:

Common QuestionsCommon Questions

Healthy LinksDrug InformationMail Order Refills

Feature / Tool Quick Link

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Pharmacy Locator

By clicking on the “Pharmacies” Quick Link, you can search your participating pharmacy network by city and state or zip code.

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What’s Covered

“What’s Covered” provides an overview of your plan’s covered items and exclusions.

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Co-pay Information

“Co-Pay Information” provides an overview of your plan’s retail and mail order co-pays as well as deductibles.

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Drug Information

Query by drug name to identify the corresponding co-pays, view possible cost-saving alternatives, and review drug information

(including indications, directions for use, and possible side effects)

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View Your On-Line Drug History

Your prescription drug history (“Online Drug Profile”) can be viewed and printed by establishing an account in the See My Prescriptions section of the member portal.

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Questions