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Appendix A – Current Plan Design Information
UK Actives & Early Minimum out of pocket Maximum out of pocket
Retirees with ESI
1-34 days per Rx
Generic 20% or minimum of $8 Maximum of $50 per Rx
Formulary 40% or minimum of $20 Maximum of $60 per Rx
Non-formulary 50% or minimum of $40 Maximum of $100 per Rx
OTC Not covered Not covered
35-83 days per Rx (at mail Same as mail service Same as mail service
service or KCP)
90 days per Rx (only at
mail service or KCP)
Generic 10% or minimum of $24 Maximum of $100 per Rx
Formulary 30% or minimum of $60 Maximum of $120 per Rx
Non-formulary 40% or minimum of 120 Maximum of $200 per Rx
OTC Not covered Not covered
Days Supply Limit 34 days retail
90 days mail order or KY Clinic Pharmacy only
Mandatory Generic Member pays cost difference of brand dispensed when generic is
available plus brand coinsurance
Utilization Control Programs Step Therapy, Prior Authorization, quantity limits
Plan Exclusions Cosmetic, weight loss, sexual dysfunction, infertility, and smoking
cessation (NOTE EXCEPTION: Chantix is covered with maximum
benefit of $500 UK plan cost per person per year)
Drug List Customized (based on ESI PRIME)
Plan Year Fiscal year calendar (July 1 through June 30)
Medicare PDP (EGWP with ESI) Retail (1-90 days supply) Mail Order
Tier 1 (generic) 20% 10%
Tier 2 40% 30%
Tier 3 50% 40%
Tier 4 (Specialty Meds) $100 per 30 days $100 per 30 days
Days Supply Limit 1-90 days retail; mail order up to 90
Mandatory Generic Member pays cost difference of brand dispensed when
generic is available plus brand coinsurance
Utilization Control Programs Step Therapy, Prior Authorization, quantity limits
Plan description No deductible; plan coinsurance is applied until
catastrophic coverage level reached (then change to
Medicare standard greater of 5% or $2.40/$6.00)
Drug List ESI Medicare Prime
Plan year Calendar year (January 1 to December 31)
Key Statistics
Division Actives Plan Year 08‐09 Medicare EGWP 2008
Avg Members/Month 26,399 2,453
Unique Patients 22,010 2,454
Unique Specialty Patients 368 84
Rxs PMPM 0.99 3.03
# Rxs 313,061 89,255
# Specialty Rx 1,819 414
# Mail Order Rx 7,513* 10,889
# Retail Rx 305,548 78,366
# Single Source Brand Rx 81,709 24,456
# Multi Source Brand Rx 2191 624
# Generic Rx 229,161 64,085
*excludes 90‐day Rxs filled at Kentucky Clinic Pharmacy
(90 day‐Rxs at Kentucky Clinic Pharmacy = 14,754)
Usage by Therapeutic Class, Top 50– Active Employees
Plan Rx
Therapeutic Class Description Cost Therapeutic Class Description Count
Rank Rank
HMG COA REDUCTASE INHIBITORS 1 SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) 1
PROTON PUMP INHIBITORS 2 HMG COA REDUCTASE INHIBITORS 2
ANTICONVULSANTS - MISC. 3 COMBINATION CONTRACEPTIVES - ORAL 3
MULTIPLE SCLEROSIS AGENTS 4 ACE INHIBITORS 4
SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS 5 OPIOID COMBINATIONS 5
ANTI-TNF-ALPHA - MONOCLONOAL ANTIBODIES 6 PROTON PUMP INHIBITORS 6
SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) 7 THYROID HORMONES 7
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) 8 BETA BLOCKERS CARDIO-SELECTIVE 8
COMBINATION CONTRACEPTIVES - ORAL 9 NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS) 9
SYMPATHOMIMETICS 10 ANTIHYPERTENSIVE COMBINATIONS 10
INSULIN 11 CALCIUM CHANNEL BLOCKERS 11
ANTIRETROVIRALS 12 NASAL STEROIDS 12
ANTIDEPRESSANTS - MISC. 13 AZITHROMYCIN 13
NASAL STEROIDS 14 ANTICONVULSANTS - MISC. 14
METABOLIC MODIFIERS 15 SYMPATHOMIMETICS 15
LEUKOTRIENE MODULATORS 16 AMINOPENICILLINS 16
ANTIHYPERTENSIVE COMBINATIONS 17 THIAZIDES AND THIAZIDE-LIKE DIURETICS 17
SEROTONIN AGONISTS 18 BIGUANIDES 18
CALCIUM CHANNEL BLOCKERS 19 BENZODIAZEPINES 19
OPIOID AGONISTS 20 ANTIHISTAMINES - NON-SEDATING 20
STIMULANTS - MISC. 21 GLUCOCORTICOSTEROIDS 21
CALCIUM REGULATORS - MISC. 22 NON-BARBITURATE HYPNOTICS 22
IMMUNOSUPPRESSIVE AGENTS 23 CENTRAL MUSCLE RELAXANTS 23
HEPARINS AND HEPARINOID-LIKE AGENTS 24 SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) 24
ACNE PRODUCTS 25 COUGH/COLD/ALLERGY COMBINATIONS 25
DIAGNOSTIC TESTS 26 ANTIDEPRESSANTS - MISC. 26
ANTINEOPLASTIC ENZYME INHIBITORS 27 ESTROGENS 27
ANTIHISTAMINES - NON-SEDATING 28 OPIOID AGONISTS 28
ANGIOTENSIN II RECEPTOR ANTAGONISTS 29 FLUOROQUINOLONES 29
IMMUNOMODULATORS 30 ANGIOTENSIN II RECEPTOR ANTAGONISTS 30
NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS) 31 LEUKOTRIENE MODULATORS 31
AMPHETAMINES 32 PENICILLIN COMBINATIONS 32
HERPES AGENTS 33 DIURETIC COMBINATIONS 33
FLUOROQUINOLONES 34 CALCIUM REGULATORS - MISC. 34
AZITHROMYCIN 35 CORTICOSTEROIDS - TOPICAL 35
ANTINEOPLASTIC - HORMONAL AGENTS 36 TETRACYCLINES 36
IMMUNE SERUMS 37 IMIDAZOLE-RELATED ANTIFUNGALS 37
ACE INHIBITORS 38 POTASSIUM 38
PENICILLIN COMBINATIONS 39 ANTI-INFECTIVE MISC. - COMBINATIONS 39
OPIOID COMBINATIONS 40 HERPES AGENTS 40
BETA BLOCKERS CARDIO-SELECTIVE 41 INSULIN 41
INSULIN SENSITIZING AGENTS 42 ANTIHISTAMINES - PHENOTHIAZINES 42
PROSTATIC HYPERTROPHY AGENTS 43 DIAGNOSTIC TESTS 43
PLATELET AGGREGATION INHIBITORS 44 SULFONYLUREAS 44
TETRACYCLINES 45 FIBRIC ACID DERIVATIVES 45
INFLAMMATORY BOWEL AGENTS 46 ACNE PRODUCTS 46
QUINOLINONE DERIVATIVES 47 TRICYCLIC AGENTS 47
FIBRIC ACID DERIVATIVES 48 AMPHETAMINES 48
CENTRAL MUSCLE RELAXANTS 49 SEROTONIN AGONISTS 49
CEPHALOSPORINS - 3RD GENERATION 50 ANTICONVULSANTS - BENZODIAZEPINES 50
Usage by Therapeutic Class, Top 50– Medicare PDP
Plan Rx
Therapeutic Class Description Cost Therapeutic Class Description Count
Rank Rank
HMG COA REDUCTASE INHIBITORS 1 HMG COA REDUCTASE INHIBITORS 1
PROTON PUMP INHIBITORS 2 ACE INHIBITORS 2
CALCIUM REGULATORS - MISC. 3 BETA BLOCKERS CARDIO-SELECTIVE 3
MULTIPLE SCLEROSIS AGENTS 4 CALCIUM CHANNEL BLOCKERS 4
ANTIDEMENTIA AGENTS 5 PROTON PUMP INHIBITORS 5
PLATELET AGGREGATION INHIBITORS 6 THYROID HORMONES 6
CALCIUM CHANNEL BLOCKERS 7 OPIOID COMBINATIONS 7
SELECTIVE SEROTONIN REUPTAKE INHIBITORS
ANTICONVULSANTS - MISC. 8 8
(SSRIS)
SYMPATHOMIMETICS 9 CALCIUM REGULATORS - MISC. 9
ACE INHIBITORS 10 ANTIHYPERTENSIVE COMBINATIONS 10
PROSTATIC HYPERTROPHY AGENTS 11 THIAZIDES AND THIAZIDE-LIKE DIURETICS 11
ANTIHYPERTENSIVE COMBINATIONS 12 LOOP DIURETICS 12
BETA BLOCKERS CARDIO-SELECTIVE 13 POTASSIUM 13
NONSTEROIDAL ANTI-INFLAMMATORY AGENTS
ANGIOTENSIN II RECEPTOR ANTAGONISTS 14 14
(NSAIDS)
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) 15 BENZODIAZEPINES 15
ANTINEOPLASTIC ENZYME INHIBITORS 16 ANGIOTENSIN II RECEPTOR ANTAGONISTS 16
SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS 17 ANTICONVULSANTS - MISC. 17
INSULIN 18 PROSTATIC HYPERTROPHY AGENTS 18
NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS) 19 PLATELET AGGREGATION INHIBITORS 19
ANTI-TNF-ALPHA - MONOCLONOAL ANTIBODIES 20 BIGUANIDES 20
ANTIPARKINSON DOPAMINERGICS 21 ANTIDEMENTIA AGENTS 21
OPIOID AGONISTS 22 SULFONYLUREAS 22
ANTIRETROVIRALS 23 COUMARIN ANTICOAGULANTS 23
OPIOID COMBINATIONS 24 NON-BARBITURATE HYPNOTICS 24
INSULIN SENSITIZING AGENTS 25 SYMPATHOMIMETICS 25
PULMONARY HYPERTENSION - ENDOTHELIN RECEPTOR
26 ANTIADRENERGIC ANTIHYPERTENSIVES 26
ANTAGONISTS
SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS
27 OPIOID AGONISTS 27
(SNRIS)
URINARY ANTISPASMODICS 28 INSULIN 28
NASAL STEROIDS 29 FLUOROQUINOLONES 29
ANTINEOPLASTIC - HORMONAL AGENTS 30 NASAL STEROIDS 30
INTESTINAL CHOLESTEROL ABSORPTION INHIBITORS 31 DIURETIC COMBINATIONS 31
DIBENZAPINES 32 GLUCOCORTICOSTEROIDS 32
ANTIHYPERLIPIDEMICS - COMBINATIONS 33 ANTIHISTAMINES - NON-SEDATING 33
LEUKOTRIENE MODULATORS 34 NITRATES 34
FLUOROQUINOLONES 35 URINARY ANTISPASMODICS 35
ANTIHISTAMINES - NON-SEDATING 36 CARDIAC GLYCOSIDES 36
BIGUANIDES 37 ANTIPARKINSON DOPAMINERGICS 37
NON-BARBITURATE HYPNOTICS 38 CENTRAL MUSCLE RELAXANTS 38
HORMONE RECEPTOR MODULATORS 39 TRICYCLIC AGENTS 39
FIBRIC ACID DERIVATIVES 40 ALPHA-BETA BLOCKERS 40
POTASSIUM 41 ESTROGENS 41
BRONCHODILATORS - ANTICHOLINERGICS 42 AZITHROMYCIN 42
BENZODIAZEPINES 43 H-2 ANTAGONISTS 42
PROSTAGLANDINS - OPHTHALMIC 44 PROSTAGLANDINS - OPHTHALMIC 44
ANTINEOPLASTICS MISC. 45 CORTICOSTEROIDS - TOPICAL 45
SEROTONIN-NOREPINEPHRINE REUPTAKE
ANTIDEPRESSANTS - MISC. 46 46
INHIBITORS (SNRIS)
INTESTINAL CHOLESTEROL ABSORPTION
INFLAMMATORY BOWEL AGENTS 47 47
INHIBITORS
THYROID HORMONES 48 ANTIHYPERLIPIDEMICS - COMBINATIONS 48
HEMATOPOIETIC GROWTH FACTORS 49 FIBRIC ACID DERIVATIVES 49
SULFONYLUREAS 50 BETA BLOCKERS NON-SELECTIVE 50
Top 25 Pharmacies
UK ACTIVES Plan Year 08‐09 MEDICARE PDP 2008
Rx Rx
Provider Name (NCPDP) Count Provider Name (NCPDP) Count
Rank Rank
KENTUCKY CLINIC PHCY (1809613) 1 KENTUCKY CLINIC PHCY (1809613) 1
KROGER PHARMACY #L-352 (1816670) 2 EXPRESS SCRIPTS MAIL ORDER (3944483) 2
KROGER PHARMACY #24706 (1825415) 3 KROGER PHARMACY #L-352 (1816670) 3
KROGER PHARMACY #24347 (1817432) 4 WALGREENS #04892 (1800196) 4
EXPRESS SCRIPTS MAIL ORDER (3944483) 5 KROGER PHARMACY #24361 (1817090) 5
WALGREENS #04892 (1800196) 6 KROGER PHARMACY #24359 (1822798) 6
KROGER PHARMACY #24315 (1816202) 7 WALGREENS #10206 (1816783) 7
KROGER PHARMACY #24371 (1819739) 8 DRUG MART, INC. (1807493) 8
KROGER PHARMACY #24407 (1823435) 9 CVS #06940 (1816911) 9
KROGER PHARMACY #24721 (1824324) 10 PHARMERICA #4117 (1823207) 10
WALGREENS #10776 (1811935) 11 MED CARE PHARMACY (1826924) 11
KROGER PHARMACY #24361 (1817090) 12 KROGER PHARMACY #00737 (1827407) 12
KROGER PHARMACY #24359 (1822798) 13 KROGER PHARMACY #L-768 (1830000) 13
WALGREENS #09857 (1829449) 14 KROGER PHARMACY #24347 (1817432) 14
KROGER PHARMACY #00737 (1827407) 15 WHEELER PHARMACY (1806085) 14
WALGREENS #07093 (1827887) 16 KROGER PHARMACY #24371 (1819739) 16
KROGER PHARMACY #L-768 (1830000) 17 WAL-MART #2783 (1826152) 17
KROGER PHARMACY #24364 (1822863) 18 WALGREENS #05574 (1826289) 18
KROGER PHARMACY #24713 (1824526) 19 KROGER PHARMACY #24407 (1823435) 19
KROGER PHARMACY #L-708 (1825605) 20 WAL-MART #1210 (1822952) 20
WAL-MART #1210 (1822952) 21 KROGER PHARMACY #24722 (1823601) 21
KROGER PHARMACY #24709 (1823687) 22 WALGREENS #10776 (1811935) 22
WAL-MART #2628 (1825439) 23 RITE AID #3921 (1818686) 23
RITE AID #7782 (1829285) 24 KROGER PHARMACY #24363 (1818232) 24
WAL-MART #2783 (1826152) 25 RITE AID #2573 (1820617) 25
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