Part D Plan Perspective on Serving Dual Eligibles

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Presentation transcript:

Part D Plan Perspective on Serving Dual Eligibles Bob Donnelly June 6, 2006

Agenda Introduce MemberHealth Discuss importance of duals and low-income beneficiaries to plans Identify MemberHealth initiatives to serve duals and low-income beneficiaries

Who is MemberHealth? Founded in 1998, located in Solon, Ohio PBM and provider of specialty insurance products administering benefits for almost 5 million lives in the public and private sector Processed 12.2 million scripts in 2005 – project over 40 million in 2006 60,000+ pharmacy network Top company in Weatherhead 100 for 2005 Experience with Medicare Drug Discount Card One of 10 national PDP sponsors – 4th in enrollment as of 4/18 Sponsor of Community Care Rx plan

Community Care Rx Strong partners – CSC and NCPA Auto enrollment in 23 regions Broad network Broad formulary Aligned incentives Focus on strong relationships between pharmacist and enrollee

Importance of Duals/LIS to Plans 14 million duals and LIS eligibles – one third of all Medicare beneficiaries Auto-enrollment mitigates selection concerns Risk adjustment should limit risk associated with higher costs for duals Majority of CCRx enrollees are duals/LIS Need to keep costs in line and provide good service to keep dual/LIS enrollees

MemberHealth Initiatives 340B facilities Drug review as part of transition Medication Therapy Management Outreach to States Exploring ways to help with LIS applications

MemberHealth and 340B Facilities 340B facilities are an important resource for duals – 340B facilities serve significant numbers of dual-eligibles MemberHealth did extensive outreach to 340Bs to explain Part D and include them in our network Created specific contract terms to account for 340B program Over 250 340B facilities are now part of our Part D network

Welcome to CCRx Medication Review Part of transition plan Face-to-face review of new enrollees’ medications with community pharmacist Address both clinical and cost issues Initiate exceptions processes if needed No cost to enrollee For any new enrollee after June 1

CCRx Medication Therapy Management (MTM) Focused on Pharmacist-Patient Relationship Delivered through new industry communications system – Community MTM Services, Inc. Larger opportunity for Medicaid programs to connect with pharmacists to improve patient care management

CCRX MTM Program Qualified Patients Receive: Complete medication review with their pharmacist Resolution of identified clinical issues Review of appropriate cost-saving opportunities Hardcopy personalized “Patient Medication Record”

Financial Information

Clinical Alerts

Allergies/Conditions

Medications

Patient Education

Protocol Library

Outreach to States Getting to know insurance regulators Separate focus on Medicaid agencies: Make sure Medicaid authorities know who we are and how to work with us to resolve issues Get Medicaid agency input on how to serve duals most effectively