Washington State Rx Services: Prescription Benefit Update Elizabeth James, PharmD October 16, 2007

Outline  Identify Washington State Rx Services  UMP vs. Aetna Prescription Benefits  Major Changes for 2008  Q & A

What is Washington State Rx Services?  Prescription drug benefit of two Washington State self-insured products –Uniform Medical Plan (UMP) –Aetna Public Employees Plan of Washington (Aetna)  Administered by the HCA via the partnership of: –The ODS Companies –MedImpact Healthcare Systems, Inc. –Wellpartner, Inc. –BioScrip

Why?  Senate Bill 5471 directing the HCA to create the prescription drug consortium (WPDP)  In summer 2006, Oregon & Washington together released the RFP for the drug discount card program  In the state of Oregon, The ODS Companies & MedImpact do not compete for business  UMP joined when its contract with Express Scripts would expire at the end of calendar year 2007, as UMP does not meet exemption criteria

Who Does What for WSRXS?  The ODS Companies –Plan administration –Customer service  MedImpact Healthcare Systems, Inc. –Network pharmacy management –Prescription drug claims processing  Wellpartner, Inc. –Mail order pharmacy  BioScrip –Specialty drug pharmacy

UMP vs. Aetna Benefit

Retail Pharmacy Benefit UMP  Deductible: $100/person or $300/family  Up to a 90-day supply  Enrollee cost-share –Tier 1: Lesser of 10% coinsurance or enrollee cost-share limit –Tier 2: Lesser of 30% coinsurance or enrollee cost-share limit –Tier 3: 50% coinsurance (For drugs with a generic equivalent, the enrollee pays the tier 1 coinsurance plus the ancillary charge. Maximum cost-share limit does not apply. Aetna  NO DEDUCTIBLE  30-day supply for 1 copay  90-day supply for 3 copays  Enrollee cost-share –Tier 1: $10 –Tier 2: $25 –Tier 3: $40 (For drugs with a generic equivalent, the enrollee pays the tier 1 copay plus the ancillary charge)

Mail Order Benefit UMP  Enrollee cost-share for up to a 90-day supply –Tier 1: $10 –Tier 2: $50 –Tier 3: $100 (For drugs with a generic equivalent, the enrollee pays the tier 1 copay plus the ancillary charge) Aetna  NO DEDUCTIBLE  Enrollee cost-share for up to a 90-day supply –Tier 1: $20 –Tier 2: $50 –Tier 3: $80 (For drugs with a generic equivalent, the enrollee pays the tier 1 copay plus the ancillary charge)

Specialty Benefit  Must Purchase from BioScrip  Pre-authorization required  Limited to a 30-day supply  Copays same as mail order by tier; ancillary charges apply to some tier 3 specialty drugs  Preferred Specialty Drugs Copay (tier 1) –$10 for UMP –$20 for Aetna  Non-Preferred Specialty Drugs Copay (tier 3) –$100 for UMP –$80 for Aetna

UMP vs. Aetna  Otherwise, both plans… –Same cost-share tiers –Same preferred drug list –Same quantity level limits, step therapy programs, and prior authorizations –Same vacation/travel policy –Subject to Washington State Preferred Drug List and Therapeutic Interchange Program

Major Changes to Benefit

Cost Share Tiers  Tier 1: Generic drugs, injectable insulin, & preferred specialty drugs, preferred diabetes supplies  Tier 2: Preferred brand drugs, non- preferred diabetes supplies  Tier 3: Non-preferred brand drugs, non- preferred specialty drugs & compounded drugs

Diabetes Supplies  Injectable insulin is covered under Tier-1  Glucometers –Those in Tier-1 are at no cost to enrollees –All others are covered under Tier-2  Test strips & lancets covered according to the tier listed on the PDL

Tobacco Cessation Program  OTC nicotine products provided directly to enrollees by Free & Clear –Covered products at no cost to enrollees: lozenges, gum, and patches –Excluded products: nasal spray, oral inhalers  Prescription products will continue to be obtained through the prescription benefit at either the Wellpartner mail order pharmacy or network retail pharmacies at no cost to enrollees

Specialty Drug Program  BioScrip exclusive  Pre-authorization required for most drugs

UMP Vaccine Program  Vaccine services coverage –Beginning in 2008, Uniform Medical Plan will have contracts with retail pharmacies to allow pharmacists to administer vaccines to enrollees –This benefit will NOT be administered through the prescription benefit but through the medical benefit

Minor Changes  Some PDL changes  New generics available  New drugs added to QLL  More drugs with Step or PA  Some drugs removed from specialty pharmacy  Current UMP enrollees affected by these changes will receive notification or be grandfathered to changes

Washington State Rx Services Contacts UMP  Customer Service: (888)  Wellpartner Mail Order Pharmacy: (800)  BioScrip: (877) Aetna  Customer Service: (888)  Wellpartner Mail Order Pharmacy: (800)  BioScrip: (877)

Q & A