Memo:

TO:        Kenneth Brynien, President

FROM:  Deborah Stayman, Health Program Analyst

               Lorraine Simpkins, Health Benefits Specialist

DATE:   November 8, 2007

RE:        2008 Empire Plan Preferred Drug List (PDL)

Beginning January 1, 2008, UnitedHealthcare (UHC) will insure and administer the Empire Plan Prescription Drug Program.  UHC will partner with Medco, an organization that specializes in managing prescription drug benefits.  UHC also insures the medical portion of the Empire Plan.

Network Changes:

The majority of network pharmacies will participate in the Empire Plan/Medco network, including retail chain pharmacies Walgreens, CVS, and Rite Aid.  However, Medco has not yet contracted with Duane Reade, a pharmacy chain located in and around New York City.  If no agreement is reached prior to 1/1/08, members using Duane Reade will have to change pharmacies to receive in-network benefits.

Prescription Drug List (PDL) Changes

In consultation with UnitedHealthcare (UHC) the state has finalized the 2008 Empire Plan Preferred Drug List (PDL).  The Empire Plan PDL includes generic drugs, preferred brand name drugs, and non-preferred brand name drugs. The preferred brand name drugs are selected on the basis of therapeutic effectiveness, safety, market share, and cost relative to other brand name drugs used to treat the same conditions.

Civil Service has released a summary of the 2008 Empire Plan PDL.  This list 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.

Of the top 25 drugs used by PEF members (based on the number of scripts), 24 will remain in the same tier in 2008 (either preferred or non-preferred) as they were in 2007.  One drug, Avapro, a drug for high blood pressure, will move from Tier 2 to Tier 3 as a non-preferred medication.  Another medication used to treat high blood pressure, Diovan, is moving from Tier 3 to Tier 2.

For a drug not included on the list, the enrollee will need to contact UHC to determine its Tier placement for 2008.  UHC is prepared to handle these inquiries.  Enrollees can reach the staff assigned to this function by calling 1-877-7NYSHIP (1-877-769-7447) and choosing the Prescription Drug Program and then the prompt for 2008 benefit information. We also anticipate that it will soon be possible to search for this information on line through the Civil Service/NYSHIP website www.cs.state.ny.us/ebd.

With one exception, brand name drugs can only be moved from the preferred (Tier 2) to the non-preferred (Tier 3) category on January 1^st of each year.  The exception is, when a generic equivalent for a preferred brand name drug becomes available, UHC immediately moves the brand name drug to the non-preferred (Tier 3) category. However, when there is a change in program vendor, there is a greater potential for disruption as the different vendors have typically negotiated different discounts and rebates with drug manufacturers.  The State has told us that approximately five percent (5%) of Empire Plan enrollees will be affected by a drug moving from preferred to non-preferred status.

UHC is preparing letters to all enrollees potentially impacted by this disruption who: 1) filled a prescription for the drug at least twice within the last six months; or 2) received a 90-day supply for the drug within the last 90 days. The letter advises them that these drugs are being removed from the PDL and will become Tier 3 non-preferred brand name drugs effective 1/1/08 (sample attached). 

Neither the change in vendor nor the PDL will change the co-pay associated with each tier of the prescription plan. 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 1/1/08, 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 2008 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.

Since the changes to the Empire Plan PDL may affect enrollees’ out-of-pocket expenses for their prescription drugs, members who enrolled in the Health Care Spending Account (HCSAccount) may be concerned that their election amount will now be too low or too high.  Fortunately, the state allows employees who enrolled in the HCSAccount by the deadline to change their election amount in December.  In early December, the HCSAccount administrator, FBMC, will send participants a letter confirming the amount set aside for 2008.  Participants who wish to change their election amount, either increase or decrease it, must notify FBMC by 12/12/08.  Members who have questions regarding the procedure for changing their election amount should contact FBMC at 1-800-342-8017.

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.

Informational Materials

We cannot avoid the disruption that will be caused by changes to the Empire Plan PDL every January 1^st.  However, we can make sure our members have access to the information they need to make informed decisions about their choice of prescription drugs.  Civil Service and UHC are preparing informational materials, including an Empire Plan Special Report and direct mailings to members using a drug that will not be on the 2008 Empire Plan PDL, that will be distributed soon.  As new informational materials become available, we will distribute and post them on the PEF website as soon as we can.  Finally, we are available to assist any member with issues arising from the change in the PDL. 

If you have any questions regarding the changes to the 2008 Empire Plan PDL, please contact Deborah Stayman or Lorraine Simpkins.