Montana University System

URx: Rethinking our Rx program:  A New Strategic Approach

Hello, my name is Cindy Millard and I am the Montana University System Employee Wellness Director. This presentation today is on Urx the new Montana University System prescription drug program that takes effect July 1, 2010.

WHY URx

Why are we developing our own prescription drug program?

• Prescription drugs are the largest and fastest rising cost component of “our plan”.
  • Our Plan = our self insured offerings – Medical, Pharmacy, and Dental.
  • We pay 100% of our pharmacy costs through our premiums and out-of-pocket cost sharing.
    
    
• Prescription drugs account for roughly 31% of our health care expenditure.
  • We spend approximately $69,500 per day for prescription drugs.
  • We spend more for prescription drugs than doctors or hospitalizations.
    
  
  

• URx is a Pharmacy Benefit program “owned” by Montana University System
  • The “U” originally stood for University and Rx means prescription
    
    
• State Of Montana quickly partnered with MUS on the build of URx
  • URx went live 1/1/2010 for State Of Montana
  • URx goes live 7/1/2010 for MUS
    
    
• Some major players helped in the design/development of URx.
  • Pharmacy Benefit Administrator (MedImpact)
  • Skaggs School of Pharmacy (University of Montana)\
  • University of Massachusetts Medical School (MedMetrics)

We will explain how these players are involved as this presentation progresses.

Clinical Monographs From MedMetrics

PTAC, the (Pharmacy & Therapeutics Advisory Committee)

Independent Committee consisting of the following:

Chair - Mark Eichler, RP

• 3 Montana based Physicians
• 3 Montana based Pharmacists
• 3 Consumers - Plan Members / Union Reps
  
  
• One member of PTAC is an MUS Physician, one is a Pharmacist with the University of MT Skaggs School of Pharmacy and one consumer is an MUS retiree on the MUS Benefits committee.
  
  
• PTAC was assisted by the U of MT Skaggs School of Pharmacy, and MedMetrics, a group of nationally recognized medical and pharmacy researchers who provide the research and literature components, and whose focus is achieving clinical excellence.
  
  
• The PTAC committee is charged with assigning each drug to its appropriate tier.  The most effective prescription drugs are the least expensive to the member, regardless of the cost.  PTAC looks at the research and medical studies on prescription drugs, and tiers them from A to F.

Drug is tiered A,B,C,D, or F

• Efficacy evaluated first
• Cost evaluated second
• Efficacy + Cost = Drug Value
  

The higher the value, the higher the drug is tiered.

-Read slide first.

• URx groups drugs into tiers based on how well they treat disease first, then on the drugs overall value. (efficacy plus costs).
  
  
• More drugs will be covered under URx than in the past. 
  
  
• Drugs that were not previously covered, may be an F, but you can take advantage of the negotiated discount on pricing.
  
  
• Certain OTC (over the counter) drugs are now covered (baby aspirin 81mg, omeprazole, pre-natal vitamins) with a prescription from your doctor.
  
  
• No deductibles for prescriptions this year!

What you pay today would not be what you would pay July 1, 2010 without URx. URx will help with that out of pocket exposure.

     Example: A $10 drug today, in July 2010 would have cost you $17 without URx after a $150 deductable.

How Will URx Work For Me???? THE URx 4 STEP

-There are 4 steps, we will show you how to access the drug list in steps 3 and 4.

STEP 1

• Review Your Medications – Know what they are………..
  • Complete Name
  • Dosage – i.e. 10mg, 20mg. etc
  • Frequency – i.e. Once daily, Twice daily, etc.
    

STEP 2

• Find out what tier your drugs received under the URx drug list.

STEP 3

• If they are D or F, you can find out about potential alternatives in classes A through C to discuss with your doctor. Call Ask-a-Pharmacist at 1-888-5-ASK-URX (527-5879) for assistance if needed.
  
  
  • We will be mailing letters to members who have D and F drugs beginning in April and again throughout the year to assist you with learning about your drugs and potential alternative drugs.

STEP 4

• If there are documented medical reasons why you cannot take one of the alternative drugs with a higher grade, MUS Benefits staff can work with you to see if you are eligible to receive a better benefit for a lower grade drug. Have your PROVIDER complete and submit a Plan Exception Request form (available on-line, campus HR, or call MUS Benefits).
  
  
  • -the Plan Exception form is on the Choices website.

How do I find out my drug tier?

There are several ways to look up the tier of your drugs and potential alternatives:

Call general information at URx 1-877-501-1064

On the internet go to www.mus.edu/choices. Note NEW! URx

• MedImpact serves as the Pharmacy Benefit Administrator and claims processor.
  
  
• They have a dedicated customer service line for MUS to answer your questions.
  
  
• Note the Forms section – this is where the Plan Exception form is.
  
  
• If your drug is grandfathered, you do not need to do a Plan Exception form.
  
  
• If you wish to review the medical research and studies used to create the tier system, they are available for members and providers to review on the Choices website by clicking on Clinical Monographs. You are required to log in.
  
  
• If you have questions, note the Contacts link that contains phone numbers and emails for MUS Benefits staff.

This is the screen when you click into NEW URx:

Note how the grandfathering of current drugs is in the "Edits" column.

Effective July 1, Caremark is no longer available as a mail order option.

Where do I go to fill my prescriptions ???

• You can still use all of the same retail pharmacies and Ridgeway mail-order pharmacy. A new mail-order pharmacy called URx MedVantx will also be available for you to use. (MedVantx is located in South Dakota.)
  
  
• Diplomat Specialty Pharmacy is the URx provider for Specialty Drug Services. If you are currently in the specialty drug program, Diplomat will be in contact with you prior to July 1, 2010. We will maintain our current $0 Protocall program through Diplomat.

-Remind eligible members of medical flex accounts for out of pocket expenses. (Active members only)

-This is a really good time to have the conversation with your Physician about your medications.

With URx we can:

• Reduce pharmaceutical costs to both members and the plan. We expect costs to be reduced by 20% for the plan and save members on average 20% of their overall out-of-pocket costs.
• If you do your part (Steps 1 – 4)…..

Questions?

Please contact us at one of the following options:

Benefits & Claims Questions:
URx (powered by MedImpact) 1-877-501-1064

ASK-A-PHARMACIST:
1-888-5-ASK-URX (527-5879)