HomeMy WebLinkAboutEBAC Proposed Health Benefits ChangesDeschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 -Fax (541) 385-3202 -www.deschutes.org
AGENDA REQUEST & STAFF REPORT
Board Meeting of June 5, 2013
DATE: 05/30/13
FROM: Ronda Connor Personnel 385-3215
TITLE OF AGENDA ITEM:
Consideration Board Approval of EBAC recommended changes to the health benefits.
PUBLIC HEARING ON THIS DATE? No
BACKGROUND AND POLICY IMPLICATIONS:
Each year, in advance ofthe plan renewal the health benefits Renewal Committee and EBAC meet to
analyze our current benefit structure, state and federal requirements, benefits trends, and requests from
employees.
Our health plan insures approximately 3,000 people. We provide a comprehensive benefit package of
Medical, Dental, Vision, Prescription and Alternative Care coverage.
Below is a listing of the items that are recommended by EBAC.
• Increase employee premium! co-pay from $65 per month to $90 per month. This is expected to
generate approximately $300,000 in revenue to the plan.
• Changes to the prescription portion of our benefit as follows
1. Remove the preferential co-pay pricing at the Redmond, Oregon Walgreens location
2. Change co-pays for retail and DOC Pharmacy as described below
3.
Deschutes County 2013/2014 Prescription Plan Changes
1. Remove preferential co-pays at the Redmond, Oregon Walgreens retail location
2. Change co-pays for retail and DOC Pharmacy as described below
DOCPharm CUrrent CoPay 30 CUrrent CoPay 90 Proposed CoPay 30 Proposed CoPay 90
Generic 0.00 0.00 2.00 4.00
Formulary 10.00 20.00 20.00 40.00 •
Non-Formulary 20.00 40.00 40.00 80.00
Retail CUrrent caPay 30 CUrrent CoPay 90 ProposedCoPay 30 Proposed CoPay 90 !
Generic 10.00 0.00 20.00 0.00 i
Formulary Greater of 20% or
$35-$70
0.00 Greater of 20% or
$50-$100
0.00
Non-Formulary Greater of 20% or
$50-$100
0.00 Greater of 20% or
$75-$125
0.00
i
" Mall Order Current CoPay 30 Current CoPay 90 Proposed ~Pay 30 Proposed CoPay 90,
Generic 0.00 20.00 0.00 40.00
Formulary 0.00 Greater of 20% or
$55-$110
0.00 Greater of 20% or
$100-$200
Non-Formulary 0.00 Greater of 20% or
$140-$280
0.00 Greater of 20% or
$150-$300
3. Implement Step Therapy Program as described in attachment "Making Prescription Drugs More
Affordable"
a. Must try a least costly alternative before a more expensive brand-name drug in certain
categories of drugs. Plan payment in each category is limited to $50 per 30-day supply.
The categories are listed below:
i. Proton Pump Inhibitors-gastric acid
ii. Antidepressants (SNRI)-mood
iii. Antihyperlipidemic-cholesterol
iv. Sedative-Hypnotic-sleep
v. Adrenergics, Aromatic, Non-Cathecholamine-ADHD
vi. Lipotropics-cholesterol
b. Limit the first fill of a brand name drug to a 30 day supply
c. Limit dispense of narcotic and chemotherapy classes of drugs to 15-day supply unless
involved in a pain management, ADD/ ADHD, or oncology program.
d. Limit fills of medications costing the plan greater than $1,000 to a 30-day supply with the
exception of diabetic medications and supplies.
Estimated savings: $500,000
FISCAL IMPLICATIONS:
Net savings of $800,000
RECOMMENDATION & ACTION REQUESTED:
Consideration of approval of EBAC recommendations.
ATTENDANCE: Ronda Connor
DISTRIBUTION OF DOCUMENTS:
MAKING PRESCRIPTION DRUGS MORE
AFFORDABLE. For you and your employer.
Step Therapy is a program designed
especially for people who take
prescription drugs regularly to treat
ongoing medical conditions, such
as arthritis and asthma.
Overview
Step Therapy is a program designed especially for people who take
prescription drugs regularly to treat ongoing medical conditions, such as
arthritis and high blood pressure. The program is a new approach to getting
you the prescription drugs you need, with safety, cost and — most importantly —
your health in mind.
The program makes prescription drugs more affordable for most members and helps
control the rising cost of medications. It allows you and your family to receive the
affordable treatment you need.
In Step Therapy, drugs are grouped in categories, based on cost:
• STEP 1 DRUGS — are generic drugs proven safe, effective and affordable. These
drugs should be tried first because they can provide the same health benefit as more
expensive drugs, at a much lower cost.
• STEP 2 OR 3 DRUGS — Step 2 and Step 3 drugs — are brand-name drugs such as
those you see advertised on TV. There are lower-cost brand drugs (Step 2) and
higher-cost brand drugs (Step 3). Brand name drugs always cost more.
What Happens at the Pharmacy
The first time you submit a prescription that isn’t for a Step 1 drug, your pharmacy
should inform you that your plan uses Step Therapy. This simply means that, if
you’d rather not pay more for your prescription drug, you need to first try a Step 1
drug.
To receive a Step 1 drug:
• Ask your pharmacist to call your doctor to request a new prescription.
OR
• Contact your doctor to get a new prescription.
Only your doctor can change your current prescription to a Step 1 drug covered by
your program.
To Receive a Step 2 Drug
With the Step Therapy Program, more expensive brand-name drugs are usually
covered as a back-up if:
1) You’ve already tried the generic drugs covered under Step 1
2) You can’t take a generic drug (for example, because of an allergy)
3) Your doctor decides, for medical reasons, that you need a brand-name drug
If one of these situations applies to you, your doctor can request an override for you,
allowing you to take a back-up prescription drug. Once the override is approved, you’ll
pay the appropriate copayment for this drug. If the override isn’t approved, you may
have to pay full price for the drug.
More About Generic Drugs
Generic alternatives have the same chemical makeup and same effect in the body as
their original brand-name counterparts. Generics, which have been manufactured for
many years, have undergone rigorous clinical testing and been approved by the U.S.
Food & Drug Administration (FDA) as safe and effective. Unlike manufacturers of
brand-name drugs, the companies that make generic drugs don’t spend a lot of
money on research and advertising. As a result, their generic drugs cost considerably
less than the original brand-name counterparts, and the savings are passed on to you
and your employer.
Asked Questions
