URx: Rethinking our Rx program: A New Strategic Approach

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Clinical Monographs From

PTAC (Pharmacy & Therapeutics Advisory Committee)

Independent Committee consisting of the following:

3 Active Practice Physicians

3 Active Practice Pharmacists

3 Consumers - Plan Members / Retirees / Union Reps

Drug is tiered A,B,C,D, or F Efficacy evaluated first The Higher the Value,

Cost evaluated second The Higher the Drug is tiered.

Efficacy + Cost = Drug Value

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URx Benefit DesignURx Medication Classification(Based on medical evidence of impact to health and overall net cost)

MedicationClass Deductible Retail Rx

(30-day supply)Mail Rx

(90-day supply)

Excellent level of value based on best medical evidence, best opportunity for improved health outcomes via disease management, and best overall net cost. This tier includes both generic and brand name medications.

Tier A $0* $0 Copayment $0 Copayment

High level of value based on medical evidence of outcomes and lower overall net cost savings. Includes both generic and brand medications compared to higher cost brand name counterparts.

Tier B $0* $15 Copayment $30 Copayment

Good level of value based on fair medical evidence grading, but displaying higher overall net cost relative to generic counterparts and less expensive brand name drug or clinical alternatives.

Tier C $0* $40 Copayment $80 Copayment

Lower level of value based on evidence of outcomes relative to other clinical alternatives. Generally have much higher overall net costs. [Coinsurance is calculated on the discounted cost of the medication. Discounts have been negotiated for most medications purchased through URx.]

Tier D $0* 50%**Coinsurance

(You pay half ofthe discounted price)

50%**Coinsurance

(You pay half of the discounted

price)

These medications have the lowest level of value (based on clinical evidence) or the highest overall net cost in relation to generic or other brand alternatives. [Coinsurance is calculated on the discounted cost of the medication.. Discounts have been negotiated for most drugs purchased through URx.]

Tier F $0*100%**

Coinsurance (You pay 100% of the

discounted price)

100%**Coinsurance

(You pay 100% of the discounted

price)

Specialty Pharmacy Program. Specialty drugs are defined as high cost prescription medications that may require special handling and/or administration to treat chronic, complex conditions. These medications may be taken orally but often are injectables with a complex manufacturing process or may have a limited distribution status. This specialty program includes medications to treat Hemophilia, Arthritis,etc.

Tier S $0* $50 copay / $200 copay Not Covered

*Members on a High Deductible Health Plan (HDHP) will pay 100% of the cost of their medications until their medical plan deductible is met. See reverse for more information.**Co-insurance payments for D & F medications do not accumulate to the out-of-pocket maximum.

—For members on RM or CM plans, URx plan has an out-of-pocket prescription maximum of $1,650 ($3,300 family).—For members on HDHPs, URx uses the plan’s medical out-of-pocket maximum.

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

STEP 1Review Your Medications – Know what they are………..

Complete Name

Dosage – i.e. 10mg, 20mg. etc

Frequency – i.e. Once daily, Twice daily, etc.

STEP 2Find out what tier your drugs received under the URx

drug list.

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

STEP 3If 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 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, URx Ask A Pharmacist 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, or call 1-888-527-5879).

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: 1-888-648-6764

• On the internet go to www.urxpharmacy.org

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For all MUST members your member ID # is a 9 digit number starting with 87 and EXCLUDES the -01 behind your ID number. For example, use 871234567 to register. DO NOT include 871234567-01.

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Where do I go to fill my prescriptions ?You can still use all of the same retail pharmacies.

In addition to Ridgeway Mail Order, URx also utilizes Costco Pharmacy for mail-order prescriptions.

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, 2013.

S-$50 & S-$200 Specialty Medications

Questions?

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General information on URx available at:

1- 888-648-6764n the internet go twww.urxpharmacy.org