Montana University System

URx: Rethinking our Rx program: A New Strategic Approach

2

WHY URxPrescription 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.

3

URxURx is a Pharmacy Benefit program “owned” by Montana University

System

The “U” originally stood for University Rx

State Of Montana quickly partnered with MUS on the build of URxURx

URxURx went live 1/1/2010 for State Of Montana

URxURx goes live 7/1/2010 for MUS

Some major players helped in the design/development of URxURx.

Pharmacy Benefit Administrator (MedImpact)

Skaggs School of Pharmacy (University of Montana)

University of Massachusetts Medical School (MedMetrics)

4

Clinical Monographs From MedMetrics

PTAC (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

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

5

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

DrugClass

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, and best overall net cost.

Tier A $0 $0 Copayment $0 Copayment

High level of value based on medical evidence of outcomes and lower overall net cost. Includes generic and brand drugs 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 or brand name drug counterparts.

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. Tier D

$0 50% Coinsurance (You will pay half

ofthe discounted

price)

50% Coinsurance

(You will pay half of the discounted

price)

These drugs have the lowest level of value (based on clinical evidence) or the highest overall net cost in relation to generic or other brand alternatives. Class F includes drugs that were not previously covered, allowing members to purchase them at a substantial discount, if they choose.

Tier F $0

100% Coinsurance (You will pay 100% of the

discounted price)

100% Coinsurance (You will pay 100% of the

discounted price)

A copayment is a flat dollar amount you pay for Rx services. Coinsurance is a percentage of the total discounted cost you pay for Rx services.

6

2009 - 2010 2010 - 2011 2010 - 2011Present Plan Without URx With URx

Retail Retail Retail$100 Deductible $150 Deductible No Deductible

$10 or 20% $17 or 20% A = $0 D=50%Greater of $20 or 30% Greater of $35 or 30% B = $15 F=100%

$30 or 40% $45 or 50% C = $40

Mail Mail MailNo Deductible $100 Deductible No Deductible

$20 $33 A = $0 D=50%

$40 $66 B = $30 F=100%

$60 $100 C = $80

7

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

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

Complete Name

Dosage – i.e. 10mg, 20mg. etc

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

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

drug list.

8

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

STEP 3STEP 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 beginning in April and again throughout the year to assist you with learning about your drugs and potential alternative drugs.

STEP 4STEP 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).

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 URx 1-877-501-1064

• On the internet go to www.mus.edu/choices

9

10

11

If you are established on certain types of drugs, you can remain on those drugs with an enhanced benefit. Examples include specialty drugs, transplant drugs, and certain neurological drugs such as anti-depressants (Grandfathering).

12

Where do I go to fill my prescriptions ???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.

13

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?

9