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					Blue Cross and Blue Shield of Florida

Change in Pharmacy Benefit Manager -- 2007
Click a page number below to jump to a category: General........................................................................................................................................1 Network .......................................................................................................................................3 Mail Order ...................................................................................................................................3 Benefits .......................................................................................................................................4 Notification Strategy ....................................................................................................................5 Forms ..........................................................................................................................................5 Other: ..........................................................................................................................................6

General
Q: A: What led to the strategic decision to transition our Pharmacy Benefit Manager (PBM)? Continual increases in our pharmacy costs, consolidation and advancement in the pharmacy benefit management industry, as well as our desire to execute a comprehensive Pharmacy Program approach, led to the strategic decision. Who is Prime Therapeutics? Prime Therapeutics (Prime) is a national pharmacy benefit manager (PBM) that helps manage the cost of pharmacy benefits and encourages appropriate and safe pharmacy care for approximately eight million lives nationwide. Prime’s mission is to empower its clients to make informed decisions in health care management and to pursue the highest quality of care for the consumer. What is Prime’s ownership structure? Prime is a privately held, Limited Liability Company (“LLC”) owned by the Blue Cross and Blue Shield plans it serves, including:        Q: A: Blue Cross and Blue Shield of Florida HCSC (Illinois, Texas, New Mexico and Oklahoma) Blue Cross and Blue Shield of Kansas Blue Cross and Blue Shield of Minnesota Blue Cross and Blue Shield of Nebraska Blue Cross and Blue Shield of North Dakota Blue Cross and Blue Shield of Wyoming

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Why was Prime Therapeutics selected? Prime was selected because its strategic direction is aligned with our commitment to providing our members with high-quality, affordable health care choices now and in the future. As noted in the previous question, Blue Cross and Blue Shield of Florida (BCBSF) and our HMO affiliate, Health Options, Inc. (HOI), have purchased an equity interest in Prime Therapeutics. Prime understands that each of its Blue Cross and Blue Shield client markets is unique. This allows us to apply a more customized, market-specific approach to pharmacy benefit management.

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Will the members’ pharmacy benefits be affected by the PBM transition? The affect to the members’ pharmacy benefits as a result of the PBM transition will be minimal. Members will continue to work with us directly for their pharmacy benefits; however, prescription mail order will transition from Walgreens Healthcare Plus to PrimeMail, Prime’s mail order pharmacy. How is Prime different from other Pharmacy Benefit Managers? Prime differentiates itself through four key areas: 1. A business model that delivers greater cost savings through low net costs and clientaligned incentives, rather than a focus on maximizing rebates; 2. Integrated pharmacy and medical data for total health care management; 3. Unique service model with medical and pharmacy account teams working together for increased client collaboration and expertise; and, 4. Competitive pricing and disclosure of costs and revenue streams to health plan clients. How is Prime’s business model unique? Prime has a unique business model that begins with its private ownership structure by Blue Cross and Blue Shield plans. Through this model, Prime strives to increase its value to its health plan owners, like BCBSF, by aligning health plan and pharmacy goals to deliver the best pharmacy benefits to our customers – not by increasing its own profits. Prime focuses on patient safety, low net cost and high quality care. In contrast to other PBM vendor relationships, Prime’s owners are also its clients, and they comprise its board of directors. This positions Prime to always operate in the best interest of the health plan, and ultimately employer groups and their employees. Prime’s business model adheres to these principles:  Full disclosure of revenue sources. Prime has been a leader in offering full disclosure.  Client-aligned financial interests. Prime’s model eliminates misaligned incentives because Prime does not receive a disproportionate amount of revenue from drug manufacturers, nor is Prime obligated to meet Wall Street expectations.  Clinical integrity of products. Prime is free to promote the most appropriate, costeffective therapies because Prime does not have hidden incentives from drug manufacturers, retail chains or wholesalers driving its decisions.  Patient-centered programs. Prime concentrates its efforts on a targeted set of highimpact clinical categories that hold down rising medication costs and provide access to appropriate medications. Its clinical tools are based on the rationale that promotes best practices and supports evidence-based medicine. The company focuses on reducing pharmacy benefit carve-outs from the health plan. Carving out such benefits often causes networks, systems, formulary design and other elements to be outsourced to vendors whose interests are not necessarily aligned with those of the client. Prime’s strategy returns control to clients, enabling them to integrate pharmacy management with their medical management.

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What is Prime’s account management philosophy? Prime’s account management philosophy is based on a consultative approach to managing its clients’ pharmacy programs. This means providing expertise and knowledge on the pharmacy industry, trends, benefit designs and cost-saving opportunities. Another unique account management aspect is its strategic approach. Prime works hand-inhand with its Blue Cross and Blue Shield clients to provide proactive service for employer groups. Prime’s pharmacy experts, in partnership with the health plan’s medical experts, consult with groups to optimize their pharmacy program. Whether implementing flexible benefit

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designs or analyzing data, Prime provides collaborative service and clear program communication. Q: A: What is the scope of service that Prime Therapeutics will provide to BCBSF? Prime will provide a full spectrum of pharmacy benefit services, including claims processing, customer/pharmacy services, pharmacy point-of-sale connectivity, manufacturer contracting/rebates, clinical pharmacy management, reporting as determined, pricing and financial administration.

Network
Q: A: Q: A: What pharmacy will fill members’ mail order prescriptions? Members will have their mail order prescriptions filled through PrimeMail, Prime Therapeutics’ mail order service. What level of pharmacy network disruption, if any, do you expect? We don’t anticipate any pharmacy network disruption. Prime has an extensive national pharmacy network throughout the U.S. Prime will administer our existing in-state pharmacy network and provide a national “wrap-around” network for outof-state prescriptions through its Prime Select national network. This will result in little or no network disruption. Prime will conduct an analysis of our national network coverage as part of the implementation process. If this analysis shows a coverage gap, Prime will actively recruit additional pharmacies to meet coverage requirements. If pharmacies meet the criteria for inclusion and accept the reimbursement structure, Prime will include them in the network. Q: A: Q: A: Will our members continue to call BCBSF’s toll-free number for assistance? Yes, commercial members will continue to contact BCBSF directly. Medicare members will be assigned a toll-free number that will route them to Prime’s dedicated Medicare area. Whom do I call to initiate contact to encourage a “mom & pop” pharmacy to participate in our pharmacy network? Requests for consideration of Florida-based network participation by independent pharmacies can be made through BCBSF Network Manager Scott McClelland, and for Prime’s national network, Implementation Director Brenda Nelson can be contacted. Requests will then be processed through the appropriate network management department. Brenda is available via e-mail at bnelson@primetherapeutics.com or directly at 651-286-4197 and Scott McClelland is available at Scott.McClelland@BCBSFL.com or directly at 904-9051133.

Mail Order
Q: A: How does this change impact the Rx mail order program? We will utilize PrimeMail, Prime’s mail order pharmacy, instead of Walgreens Healthcare Plus, our current mail service vendor. This transition presents a great opportunity to achieve a fully integrated retail and mail order pharmacy program. Prime’s mail rates and turnaround times are market competitive. The initial transition may result in some minor disruption because some members will need to request new prescriptions from their physicians for specific classes of drugs.

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How will a member’s transition from Walgreens to PrimeMail work? Prime will coordinate with Walgreens to transfer existing prescriptions. Members who receive a controlled substance will be required to obtain a new prescription from their physicians. Non-controlled prescriptions will not require a prescription unless there are no valid remaining refills. Members who use a controlled drug will require new prescriptions. What is the target date for informing these members? The targeted date for mailing letters to impacted members is the end of November 2006. What is the location/address for mail order through Prime? Do they have a location in Florida? The PrimeMail Pharmacy is located at 2901 Kinwest Parkway in Irving, Texas. Prime does not have a mail order facility in Florida. If a member has a refill in December for a 90 day mail order – will members send it to Walgreens? Will Walgreens fill the prescription for 90 days or will the refill need to go to Prime? Will this be outlined to members in the letter they receive? The letters that will be mailed at the end of November tell members to begin using the new mail order forms effective Jan. 1, 2007. The letters also inform members that prescriptions will be transferred to PrimeMail, unless they are controlled substances, in which case the member must obtain a new prescription and submit to Prime beginning Jan. 1, 2007. All refills and new prescriptions should be sent to Walgreens until December 31, 2006. Beginning January 1, 2007, all refills and new prescriptions should be sent to PrimeMail. Describe mail service ordering options for initial prescriptions and refills. To obtain a prescription through PrimeMail, members simply complete a PrimeMail Pharmacy Order form and send it, along with their new or refill prescription and copayment, to PrimeMail. In addition, members can use one of the following convenient refill methods:  PrimeMail Automated Refill Line – Members are able to enter a prescription refill and credit card payment information through the interactive, automated phone system 24 hours a day, seven days a week.  Internet – Members have access to PrimeMail’s secure website through the BCBSF corporate website MyBlueService portal with the MyRxHealth feature. The website prompts members for the prescription number and credit card payment information.  Mail Forms – Members complete an order form and send it, along with their new or refill prescription and copayment, to the PrimeMail address.  Member Contact Center – Mail Service Agents are available toll-free to provide additional assistance to members submitting refill requests. BCBSF and PrimeMail are committed to providing members with ordering options that are convenient, efficient and timely. With each prescription order, PrimeMail provides a reminder on the receipt to notify members of the number of remaining refills available, and the prescription label identifies the date on which the member should refill the prescription.

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Benefits
Q: A: Will there be a change in formulary? As part of the transition process, there will be changes to the formulary. However, if any formulary changes occur, they will be communicated to groups, providers and members through the normal channels before Jan. 1, 2007.

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How and when will new formulary brochures be sent to members/groups/agents? The Medication Guide, effective January 2007, will be included in new enrollees’ packets beginning late November. The Medication Guide will also be available on the BCBSF website January 1, 2007. If a medication is less than the standard copayment amount, can the medication be purchased for the lesser amount? BCBSF’s participating retail pharmacy contract allows a pharmacy to charge up to a member’s copayment amount. Our participating pharmacies will charge a member their usual and customary cash price for a prescription, even if that price is less than the member’s copayment amount. The cash price MAY be the pharmacy’s MINIMUM cash charge they will accept for filling a prescription. However, they are NOT to charge in excess of the member’s copayment amount.

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Notification Strategy
Q. A. What is the timeline for member notification activities? There will be a mass mailing to members on Nov. 29, 2006. Notification will be mailed in advance to group Benefit Administrators on Nov. 11, 2006. In October, members will also receive notification in our Florida Blue newsletter. Coordination for Major Accounts with “Do Not Mail” to employees requirements: How will the information be communicated to these members? A memo will be sent to internal Sales Reps well in advance of the mass mailings to inquire about “Special Handling” groups. This list will be included in an internal notice to the BCBSF sales representatives that will be released prior to the mailing.

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Forms
Q. A. Will members be sent new mail order forms? Yes, members will be sent new forms. Members will also receive a Mail Order Service Introductory Packet. Mail Order Service Introductory Packet Prior to the pharmacy program effective date, a PrimeMail introductory packet will be provided to members with the following components, all of which are available in English and Spanish:    All About PrimeMail Guide with frequently asked questions Pharmacy order form and return envelope Retail and mail order prescription checklists

We will also develop a customized welcome letter that will indicate the specific date for the mail service transition and explain the need for certain members to obtain and submit a new, original prescription to the PrimeMail pharmacy. The materials will also include a toll-free number for the Contact Centers, where Member Service Representatives (MSRs) are available to respond to any transition or service inquiries. Q. A. Mail order form - will it be placed on www.bcbsfl.com? Yes. It will replace the form that is currently on our website.

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Other:
Q. A. Q. A. Will step therapy be implemented? Step therapy is not being implemented as part of the PBM transition. Will there be changes in the rebate program for ASO groups? There will not be any changes in the rebate program for ASO groups at this time. BCBSF returns 100 percent of earned rebates to ASO groups and retains rebates for fully insured groups in order to reduce overall medical costs resulting in a more cost effective plan long term. When will the Pharmacy section of the BCBSF website – www.bcbsfl.com – be updated? Our website will be updated by Jan. 1, 2007 for commercial members. Are there any new tools available for BCBSF members with this PBM change? Yes! We now have MyRxHealth, which is a comprehensive member-directed website. It enables participants to easily access helpful information on prescription drugs and their cost, pharmacy benefit information and general health topics. This secure tool encourages costconscious purchasing behavior by promoting generic utilization, formulary compliance and healthy lifestyles. MyRxHealth includes a drug cost calculator, formulary search capability and generic alternative information, all in an easy-to-use format designed to highlight the advantages of formulary and generic drug use by participants. Members can access this site directly through the BCBSF website, in the MyBlueService portal, beginning Jan. 1, 2007.

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