Wink Loving ISD Employee Orientation- generics plus- wellness August 15, 2016 Seltz Insurance Consulting 1

Generics Plus  Important: NPLUS/en/find-medicine.html NPLUS/en/find-medicine.html  Generics Plus is a pharmacy program within the HCA plan. It is also in the Buy Up Plan.  The HCA plan has no drug co pay- it pays drugs under the HCA, then is subject to the deductible, then pays at 80% until the out of pocket limit. 2

Generics Plus  MyPrime.com will let you verify payment for a drug. It is highly recommended that you go over your drug list with your physician.  IMPORTANT: You may be responsible for the brand member payment amount plus the difference in cost between the brand and generic equivilent if you or your doctor requests the reference brand rather than the generic.  Page 3 Formulary 3

How Are Costs Managed  Drivers to drug costs:  Trial and Error  Advertising – consumer demand  Unused Drugs- multiple Rx’s  In 2014 Specialty drug trend went to 30.9%. These are drugs that run $ per prescription.  $1 in every $9 of drugs is wasted because people do not take their drugs as prescribed. 4

Exclusions  Over – The – Counter  Compounded  Repackaged 5

Limitations and Management  Prior Authorization- MD must submit a request and it must be approved.  Step Therapy- You need to buy and try the lower cost drug first.  Dispensing Limits- May include quantity in a given period, or in a given prescription  Specialty Drugs – new and very expensive. (See MyPrime). Order through Prime Theraputics Specialty Pharmacy. 6

Conclusion  Visit the website to be sure that your drug is covered and not subject to PA, ST, DL or Specialty Purchase.  Go over the list with your MD. It is likely that they are familiar with this process.  Some prescriptions may be grandfathered- consider this.  Use the decision tool under Blue Directions to determine the best plan for you.  Contact our offices by e mail for hardship case. We can assist with drug scholarships and other transitional 7

Wellness  Health Care plans today do more than pay claims and achieve discounts to billed costs. They incent people to be well and avoid claims.  Within the past several years, WLISD’s plan cost went from about $800,000 to over $1.2 million. 8

Wellness continued  Blue Cross wellness includes:  1.Telehealth- a lower cost method of electronic treatment for minor accidents and illnesses. $40/visit- easier than driving to the doctor and waiting in the office to be seen. Could avoid ER and UC charges.  2. Catapult- at no added cost to the plan, BC/Catapult will come on site and confidentially provide a wellness exam and consultation by appointment through a nurse practitioner.  3. Web based wellness program - BC will provide points for wellness habits and give you gifts- e.g., new car (JUST KIDDING!). These programs include discounts on fitness centers, diet programs, educational programs, smoking cessation and the like. Visit at bcbstx.com. 9