TO: Roger E. Benson

FROM: Robert Carrothers, Director, Contract Administration

DATE: November 8, 2005

RE: 2006 Empire Plan Preferred Drug List


New Preferred Drug List for Empire Plan for 2006

Beginning January 1, 2006, Empire Blue Cross Blue Shield (BCBS) will insure and jointly administer the Empire Plan Prescription Drug Program with Caremark, its pharmacy benefit manager. State management has been working closely with Empire BCBS and Caremark to review and finalize the 2006 Empire Plan Preferred Drug List (PDL). We received an advanced copy of the 2006 Empire Plan PDL on Friday, 11/4. Civil Service began sending the 2006 Empire Plan PDL to current enrollees on Monday, 11/7.

The attached 2006 Empire Plan PDL identifies the most commonly prescribed generic and brand name drugs included on the list. This is not a complete list of prescription drugs on the PDL or covered under the Empire Plan. The drugs listed on the first three pages are either generic (Tier 1) or preferred brand name (Tier 2) drugs. Generic drugs are listed in lower case letters. Brand name drugs are listed with the first letter of the name capitalized. The drugs listed in the column on the left side of page four are non-preferred brand name (Tier 3). Tier 1 and Tier 2 alternatives for each of these drugs are listed on the right side.

For a drug not included on the list, the enrollee will need to contact Empire BCBS/Caremark to determine if it is on the 2006 Empire Plan PDL. Empire BCBS/Caremark is prepared to handle these types of inquiries. Enrollees can reach the staff assigned to this function by calling 1-877-7NYSHIP and selecting the prompt for the Prescription Drug Program. Callers will then have the choice of selecting one of two prompts. It’s important that they listen to the message carefully before making their choice. The first prompt will direct them to Express Scripts for information regarding their 2005 prescription drug coverage, the current PDL, and any prescriptions they have already had filled or will fill prior to January 2006. The second prompt will direct them to Empire BCBS/Caremark for information regarding their 2006 prescription drug coverage and the 2006 Empire Plan PDL. We are also working with management to provide on-line access to the 2006 Empire Plan PDL as quickly as possible.

Copays for all covered prescriptions for generic, preferred brand name and non-preferred brand name drugs will stay the same. However, members may see a change in their out-of-pocket expense because of changes in the PDL. If the member is currently using a Tier 2 preferred brand name drug that will no longer be on the PDL beginning 1/1/06, the member will have to pay the higher Tier 3 copay amount instead of the Tier 2 copay amount. On the flip side, if the member is currently using a Tier 3 non-preferred brand name drug that will be on the 2006 Empire Plan PDL, the member will benefit because s/he will only have to pay the Tier 2 copay amount instead of the Tier 3 copay amount.

Changes to the Empire Plan PDL would have occurred on January 1st even if Express Scripts had remained the vendor. Express Scripts has publicly announced that it is removing many drugs manufactured by Pfizer from its 2006 National PDL. One of the drugs being removed is Lipitor, a popular drug used to treat high cholesterol. Lipitor is the number one drug used by PEF members. The removal of this drug from the 2006 Empire Plan PDL would have caused enormous disruption for our members. The fact of the matter is that our members should be prepared for changes to the Empire Plan PDL every January 1st regardless of the vendor administering the Prescription Drug Program.

What’s Changed: Some Initial Analysis

An in-depth analysis of the 2006 Empire plan PDL is not possible with the limited information we have available to us. However, we have reviewed the 2006 Empire Plan PDL and compared it to the 2005 Express Scripts National PDL being used now. Based on this review, it appears that changes in tier status will be minimal, although our members’ view of the level of disruption likely will be influenced by the precise medication(s) they might use.

Of the top 25 drugs used by PEF members (based on the number of scripts), 23 will remain in the same tier in 2006 (either preferred or non-preferred) as they were in 2004. One drug, Ambien, a well known and highly marketed sleep aid, will move from Tier 2 to Tier 3 as a non-preferred medication. Another medication makes the opposite move; Zyrtec, a drug used to treat allergy symptoms, is moving from Tier 3 to Tier 2.

Although we do not yet have the complete list of drugs on the 2006 Preferred Drug List, we made what comparisons we could to assess the level of possible disruption caused by changes in tier status of different medications. For example, we reviewed the Non-Preferred Drugs (Tier 3) identified on page four of the 2006 Empire Plan PDL. Of these 32 drugs, 12 of them, including Ambien, are currently Tier 2 drugs on the 2005 Express Scripts National PDL. Empire BCBS/Caremark will be mailing a letter to enrollees currently using a Tier 2 brand name drug on the 2005 Express Scripts National PDL that will be changing to a Tier 3 non-preferred brand name drug on the 2006 Empire Plan PDL. The letter will notify them of the change in their drug’s placement on the PDL, and provide them with the names of both generic and preferred brand name drug alternatives. This is the same exercise that occurred when the Three Tier benefit was first implemented in January 2005.

We also reviewed the list of drugs currently identified as Non-Preferred (Tier 3) under the current plan. Of these 159 drugs, 25 of them, including Zyrtec, will be Tier 2 drugs on the 2006 Empire Plan PDL. Members currently using one of these brand name drugs will see a reduction in copay from $30/$55/$60 to $15/$20/$30.

We recognize that the choice of which prescription drug to use is a very personal one, and should be made by the patient in consultation with his or her doctor. We have encouraged our members to engage their doctors in a discussion of which prescription drug, if any, they should use. Many have switched to generic or preferred brand name medications as a result. We cannot avoid the disruption that will be caused by changes to the Empire Plan PDL every January 1st. However, we can make sure our members have access to the information they need to make informed decisions about their choice of prescription drugs. Communication materials, including an Empire Plan Special Report and direct mailings to members using a drug that will not be on the 2006 Empire Plan PDL, are being prepared and are either being or will be distributed soon. Any updates will also be distributed and posted as soon as we can make them available. Finally, my staff is available to assist any member with issues arising from the change in the PDL.

If you have any questions, or would like additional information, please contact Lorraine Simpkins or me.