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News
Your source on union-negotiated health care
benefits
Changes to the mail-in pharmacy benefit for Ohio
Med enrollees
Effective July 1, 2004
March 10, 2004 -
OCSEA
members have a number of questions about the change from Medco to Express
Scripts as the pharmacy benefits manager (PBM) of the mail-in pharmacy
benefit for Ohio Med enrollees. Here are answers to some key questions.
Q. What is a pharmacy benefits manager
(PBM)?
Q. Why has the Joint Health Care
Committee (JHCC) recommended a change in the Ohio Med PBM from Medco to
Express Scripts effective July 1st 2004?
Q. How do multi-state drug purchasing
coalitions save money?
Q. I hear PBMs often mark up drugs
and don’t reveal that mark up to its clients. Will this new arrangement
allow the state to better monitor the true cost of drugs that OCSEA members
are buying?
Q. Will my retail pharmacy (places
like CVS, Kroger etc.) still be in network?
Q. What will happen to my prescription
I have at Medco after July 1, 2004?
Q. Will the cost of my mail-in drugs
cost more now that there is a new PBM effective July 1st?
Q. What is a pharmacy benefits
manager (PBM)?
A. Large employers hire PBMs to negotiate the best drug
price from pharmaceutical manufacturers and to pay the drug claims for
their employees. They also provide mail order drug programs and a number
of other services.
Q. Why has the Joint Health
Care Committee (JHCC) recommended a change in the Ohio Med PBM from Medco
to Express Scripts effective July 1st 2004?
A. As part of a strategy to keep health care costs down,
the union has been pressing the state to join a multi-state drug purchasing
coalition. By joining the RxIS drug purchasing coalition the state will
save about $15 million on what it normally spends on drugs over the next
three years.
Q. How do multi-state drug purchasing
coalitions save money?
A. Currently the state of Ohio buys drugs for 109,000
covered lives (employees and their dependents). The RxIS coalition buys
drugs for 570,000 lives. When Ohio joins it will have the buying power
of 679,000 lives. The larger the group the deeper the drug discounts and
the more money you save.
Q. I hear PBMs often mark up
drugs and don’t reveal that mark up to its clients. Will this new
arrangement allow the state to better monitor the true cost of drugs that
OCSEA members are buying?
A. Yes. The new PBM (Express Scripts) has agreed to
be more forthcoming with information on what they pay for drugs and what
savings are passed on to the state as a result. And they have agreed to
an outside audit to verify the pricing.
Q. Will my retail pharmacy (places
like CVS, Kroger etc.) still be in network?
A. The Express Scripts retail network matches the current
Medco network at better than 99%. So nearly every retail pharmacy state
of Ohio employees use will be in the network.
Q. What will happen to my prescription
I have at Medco after July 1, 2004?
A. All records will transfer by July 1st from Medco
to Express Scripts. If you have a refill due after July 1st, you will
contact Express Scripts for the refill.
Q. Will the cost of my mail-in drugs cost more
now that there is a new PBM effective July 1st?
A. Actually, the cost of drugs WILL increase on
July 1st, but that increase was bargained as part of the current union
contract and has nothing to do with the change from Medco to Express Scripts.
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