Presentation is loading. Please wait.

Presentation is loading. Please wait.

Medication Therapy Management Program TML Intergovernmental Employee Benefits Pool.

Similar presentations


Presentation on theme: "Medication Therapy Management Program TML Intergovernmental Employee Benefits Pool."— Presentation transcript:

1 Medication Therapy Management Program TML Intergovernmental Employee Benefits Pool

2 NEW Prescription Benefits! RESTAT is the new vendor that will manage the network of pharmacies RX Results-University of Arkansas College of Medical Services– peforms clinical evaluation, call center and physician outreach Medication Therapy Management Program expands the value tier to enhance access to the $0.00 and $9.00 generic program.  Wal-Mart  Sam’s  Dominick’s  Target  HEB  Fred Meyer  Kroger  Safeway  HealthMart Pharmacy  Randall’s  K-Mart  King Soopers  Tom Thumb  City Market Pharmacy  Ralph’s  Cub Pharmacy  Dillon Stores  Smiths  Farm Fresh  Fry’s Food & Drug  Vons Companies Inc.  Access Health  Quality Food Centers Inc  Shopko  Start Market Restat’s Align Network New Pharmacies are being added each month

3 Medication Therapy Management Program (MTMP) $ $$ $$$ Lowest Cost Highest Cost Mac A or C Employer Option Retail Copay Mail Order Copay Over the Counter Equivalence: Non-Sedating Antihistamines (Claritin, Alavert) Stomach and Ulcer (Prilosec) Allergy Medication (Zyrtec) Smoking Cessation (Nicorette Gum) Limit - 3 boxes $0.00N/A Value Tiered 34 day generic dispensement$0.00N/A Value Tiered 84-90 day generic dispensement$9.00N/A Generic$10.00$25.00 Best Brand Price List$38.00$95.00 Non-Best Brand Price List$60.00$150.00 Cost Share$120.00$300.00 Specialty/Biotech Prescriptions$100.00 for 34 day dispensement 8 ways to Purchase Prescription Drugs CVS Caremark will continue to administer mail order / Biotech.

4 Cost Share Drugs Evidence Based Drug Formulary Cost Share DrugsTherapeutic Equivalent / Clinical Drug Alternative Antibiotics: Anti-Infections Impacts utilization on: Doryx, Solodyn, Oracea Generic Minocycline (for Solodyn) Generic Doxycycline (for Doryx, Oracea) Cardiovascular: Antihyperlipidemic Lovastatin, Mevacor, Pravastatin Impacts utilization on: Altoprev, Advicor, Crestor 5 mg & 10mg, Lescol, Lescol XL, Lipitor 10mg, Lipitor 20mg, Lipitor 40 mg, Lovastatin, Mevacor, Pravachol, Pravastatin, Simcor, Zocor, Caduet and Vytorin Generic Simvastatin NOTE: Lipitor 80mg, Crestor 20mg, and Crestor 40mg require prior authorization – Physician may call Rx Results at 1-888-871-4002 for coverage criteria. Central Nervous System: Sedative Hypnotics Zaleplon Impacts utilization on: Ambien, Ambien CR, Lunesta, Rozerem, Sonata and Zaleplon Generic Zolpidem Gastrointestinal/Stomach: Proton Pump Inhibitors Lansoprazole, Pantoprazole, Impacts utilization on: Aciphex, Dexilant (formerly Kapidex), Nexium, Lansoprazole, Pantoprazole, Prevacid, Prilosec, Protonix and Zegerid OTC Prilosec (Prescription Required) Generic Omeprazole Respiratory/Allergy/Asthma: Antihistamines Fexofenadine, Impacts utilization on: Allegra, Fexofenadine, Clarinex and Xyzal OTC Claritin (Prescription Required) Generic Loratidine (Prescription Required) OTC Zyrtec (Prescription Required) OTC Cetirizine (Prescription Required) Anithistamines-Decongestant Fexofenadine-D Impacts utilizaqtion on: Allegra-D, Fexofenadine-D and Clarinex-D OTC Claritin (Prescription Required) Generic Loratidine (Prescription Required) OTC Zyrtec (Prescription Required) Generic Cetirizine (Prescription Required) Cost Share Generic Drugs

5 Relative Potency for Statins Atorvastatin (Lipitor) Fluvastatin (Lescol / XL) Lovastatin (Mevacor) Pravastatin (Pravachol) Rosuvastatin (Crestor) Simvastatin (Zocor) --40 mg20 mg --10 mg 80 mg40 or 80 mg40 mg--20 mg --80 mg 5 or 10 mg40 mg -- 80 mg -- 20 mg-- 40 mg--

6 Medication Therapy Management Program (MTMP) Clinically Appropriate & Cost Effective Prescriptions Prior Authorization: Growth Hormones- Botox, Myobloc Attention Deficit Disorder/Narcolepsy- medications for individual 17 years of age or older Oral Chemotherapy Antibiotic- Zyvox High Cholesterol- Crestor 20/40 mg, Lipitor 80 mg Osteoporosis- Forteo Testosterone Products- Androgel-Hormone Replacement/Erectile Dysfunction Asthma- Xolair, Advair and Symbicort (inhalers), Foradil, Perforomist, Brovana, Serevent, - individuals <40 years of age that have not utilized an inhaled steroid for at least 120 days Step Therapy: Asthma- Advair and Symbicort (inhalers), Foradil, Perforomist, Brovana, Serevent, - individuals <40 years of age that have not utilized an inhaled steroid for at least 120 days ***High Blood Pressure: Cozaar, Hyzaar, Diovan, Diovan HCT, Atacand, Atacand-HCT, Avapro, Avalide, Micardis, Micardis HCT, Teveten, Teveten HCT, Benicar, Benicar HCT, Exforge, Tekturna, Tekturna HCT and Valturna (***only applies to newly diagnosed individuals***) Concurrent Review: Hepatitus C prescriptions Current Prior Authorizations will need to be re-established

7 www.restat.com Member Login Restat Website

8 RESTAT Website Drug Pricing Lookup Drug Name Medical Condition Dosage

9 Drug Form/ Quantity Zipcode

10 Shop & Compare

11 RESTAT Website Drug Pricing Lookup

12

13 Is Evidence Based Medicine. Converts Patients from costly drugs to therapeutically equivalent, cost effective alternatives. Ask your Dr. to contact Rx Results, ( the number is on your ID Card) Look up drug prices at www.restat.com www.restat.com Medication Therapy Mangement Program:

14 Thank You. Thank You.


Download ppt "Medication Therapy Management Program TML Intergovernmental Employee Benefits Pool."

Similar presentations


Ads by Google