Law Enforcement Health Benefits Prescription Benefits Changes 20060401

Law Enforcement Health Benefits
1237 Spring Garden Street, Philadelphia, PA 19123, 215-763-8290
http://www.lehb.org

L.E.H.B. PRESCRIPTION FUND

IMPORTANT PRESCRIPTION BENEFIT CHANGES - APRIL 1, 2006

All L.E.H.B. proposed changes have been overwhelmingly approved by the membership completing surveys at the 22 city-wide L.E.H.B. meetings. Members approved all L.E.H.B. proposals addressing the arbitration panel $700,000 “cost-shifting” to members via plan benefit design change.

L.E.H.B. Prescription Fund will remain mandatory generic (if you select a name brand when generic is available you will be financially responsible for difference in cost.)

CHANGES EFFECTIVE APRIL 1, 2006 COPAYS:

Retail pharmacy - Prescriptions at a network pharmacy up to a 30 day supply:

Generic Drug (Chemical copies of their brand name)

$2.00 copay

Brand Name Drug (Trade name under which the product is advertised and sold) Patent protected for 17 years

5% copay cost of your prescription ($2.00 Minimum copay and $20.00 Maximum copay)

Mail Order – Pre-$2.00 copayscriptions filled through ESI Mail Order up to a 90 day Supply

Generic Drug (Chemical copies of their brand name)

$2.00 copay for 90 day supply

Brand Name Drug (Trade name under which the product is advertised and sold) Patent protected for 17 years

Computer will bill you one copay for 90 day supply. ($2.00 Minimum copay and $20.00 Maximum copay)

You should receive medication within 14 days

Complete list of maintenance medications available at listed website http://www.express-scripts.com

CURASCRIPT (Specialty Injectables)

CuraScript has been chosen as your preferred specialty pharmacy.

CuraScript specializes in oral and injectable specialty medications. Specialty Products are those biotech or injectable prescription drug products requiring special handling.

CuraScript offers many products and services.

Assigns you a Patient Care Coordinator who serves as your personal advocate and your point of contact. This highly trained individual works closely with your physician and your insurer to obtain prior authorizations, coordinate billing with your insurer and will even contact you when it’s time to refill your prescription.
Has a complete specialty pharmacy inventory with many specialty medications that aren’t readily available at a local pharmacy
Delivers your specialty medications directly to you or your doctor to insure receipt of prescription.
Provides you with the necessary supplies (such as syringes, swabs, etc.) you need to administer your medications—at no additional cost.
Offers clinically based care management programs—which include consultation with your doctor—to help you get the most benefit from the specialty medications that your doctor has prescribed for you.

Medications that are processed through CuraScript are limited to a 30 day supply and have the following copayments:

Generic Drug $2.00 copay
Brand-Name Drug $7.00 copay
First prescription should be filled at retail pharmacy.

STEP THERAPY PROGRAM

Since many different drugs are available for treating a medical condition, step therapy follows a step wise process to find the best-most efficient treatment for you at your lowest copay.
You will be recommended to use a first line medication (defined by clinical experts as the simplest treatment and the preferred therapy for most people—at your lowest copay)
April 1, 2006 you will be required to use step therapy for the following classes of drugs (new patients only)

ADHD	High Blood Pressure	Ulcer/Acid Reflux
Asthma/Allergies	Depression	Arthritis/Pain
Dermatitis/Eczema	Diabetes

Note: Current users of above classes will continue their second line therapies.

Complete list of second line medications available at http://www.express-scripts.com or http://www.lehb.org/second_line_medications.html
You may ask your doctor to approve changing your current second line treatment to effect a lower copay—this is only a suggestion and the decision is entirely between you and your doctor.

FAMILY ANNUAL PRESCRIPTION CAP JANUARY 1^ST—DECEMBER 31^ST

July 1, 2006 through December 31, 2006
- $8,000 cap will be in effect
January 1, 2007 through December 31, 2007
- $16,000 Annual Family Cap will be in effect

EXCLUSIVE HOME DELIVERY (Mandatory Mail Order)

Maintenance medication (same prescription/same strength for six months) mainly effects ongoing conditions such as diabetes, high blood pressure, etc.
First 90 day prescription you will fill at retail pharmacy; you will receive notice during your second 90 day refill that your next refill must be mail order—information will be provided.
Mandatory mail order will provide:
- 3 month (90 day) supply
- One (1) month copay
- 24 hour access to pharmacist
- Free home delivery
Two easy ways to start “exclusive home delivery” mandatory mail order.
1. Online at http://www.express-scripts.com/getstarted
2. By mail
- Ask doctor to write prescription for 90 days supply (if appropriate) plus refills for up to one year (if appropriate)
- Complete home delivery order form available online http://www.express-scripts.com or call 1-800 number on your member ID card.
- Mail your order form and your prescription to the address on the form.

OVER THE COUNTER (OTC) CLARITIN AND PRILOSEC
Over the counter (OTC) means medications that are available to you without a prescription. In the past couple of years two medications went to OTC status and no longer require a prescription. These medications are Prilosec (20 mg strength only) and Claritin (all strengths). L.E.H.B. OTC limited to these two prescriptions.

Effective April 1, 2006:

Claritin OTC and Prilosec OTC will be covered through L.E.H.B. Prescription Fund with a $0 copay to you.
You must have your doctor write a prescription for Claritin OTC or Prilosec OTC
You will have two (2) options:
- Doctor write prescription for Claritin OTC or Prilosec OTC and your copayment is zero ($0).
- Present your prescription to the pharmacist.
- Continue taking one of the following brand name medications your copay will be 5% of cost of prescription with a $2.00 minimum copay and $20.00 maximum copay

Alternatives to Claritin OTC		Alternatives to Prilosec OTC
Allegra		Nexium
Allegra-D		Prilosec
Clartinex		Axid
Zyrtec		Prevacid
Zyurtec-D		Omeprazole

QUESTIONS

Please call L.E.H.B. Prescription Fund (215) 763-8290 and speak with Helen or Sheena.