Appendix A – Current Plan Design Information by Jeronohnson

VIEWS: 33 PAGES: 5

									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

								
To top