More pharmacy benefit changes, some already effective

According to Medco Health, the company that manages UNT employees' pharmacy benefits for HealthSelect of Texas, a combination of higher costs and lower state funding has prompted some cost-cutting measures for the prescription drug plan. Four major changes are affecting the prescription drug plan — some are different from changes previously reported.

1. As of May 1, when HealthSelect subscribers purchase a brand-name drug when a generic alternative is available, they must pay their generic drug co-payment plus the cost difference between the brand-name and the generic drug.
2. Also as of May 1, subscribers' co-payments increased for all prescription drug categories.
3. As of July 1, subscribers who purchase a 30-day supply of maintenance medication at a retail pharmacy pay a higher retail maintenance co-payment. Subscribers may purchase up to a 90-day supply of their maintenance medication using the Medco Health Home Delivery Pharmacy Service to avoid paying more. The benefit program announced in May, which was linked to the number of refills a subscriber fills, no longer applies.
4. Beginning Sept. 1, a $50 pharmacy benefit deductible will go into effect.

Details about the four changes are outlined below.

Medco Health recommends using generic medications when they are available.
Otherwise:

• if subscribers purchase a brand-name drug when a generic alternative is available (regardless of the reason), they will pay the generic drug co-payment plus the cost difference between the brand-name and the generic drug.
• or if subscribers purchase a preferred or non-preferred brand-name drug and there is no generic alternative, they will pay the generic drug co-payment.

For example, if a subscriber goes to a participating retail pharmacy and a particular brand-name drug costs $60 and its generic alternative costs $25, the difference between the costs of the two drugs is $35. If the subscriber purchases the generic drug, he or she will pay the generic co-payment of $10. If the subscriber purchases the brand-name drug, he or she will pay the generic drug co-payment, plus the $35 cost difference, for a total of $45.

To start using generic drugs, Medco Health suggests that subscribers speak to their doctor or pharmacist about using generic medications and about whether a generic drug is available and appropriate for the subscriber. For more information about costs and coverage information for brand-name and generic drugs, visit www.medcohealth.com.

As of May 1, subscribers are paying a higher co-payment for all prescription drugs.

• When subscribers purchase medications at a participating retail pharmacy, they pay the following co-payments for up to a 30-day supply: $10 for generic drugs, $25 for preferred brand-name drugs and $40 for non-preferred brand-name drugs.
• If subscribers order their long-term prescription drugs through the Home Delivery Pharmacy Service, they pay the following co-payments for up to a 90-day supply: $30 for generic drugs, $75 for preferred brand-name drugs and $120 for non-preferred brand-name drugs.

If a generic drug is available but the subscriber chooses the brand-name drug, he or she may pay more than the brand-name co-payment. Also, if the co-payment for a medication is higher than the total cost of the medication, the subscriber will pay the lesser amount.

Subscribers can purchase their long-term medications either at retail pharmacies or through the Home Delivery Pharmacy Service.

This is a change to the information that was communicated in May.

• Effective July 1, 2003, all purchases of long-term drugs at participating retail pharmacies will be charged a retail maintenance co-payment for up to a 30-day supply, which is higher per days' supply than the home delivery co-payment. The retail maintenance will be $15 for generic drugs, $35 for preferred brand-name drugs, and $55 for non-preferred brand-name drugs. If a generic drug is available but the subscriber chooses the brand-name drug, her or she will pay more. Subscribers can choose whether to fill their maintenance prescription at a participating retail pharmacy and pay the higher cost or use the Home Delivery Pharmacy Service.
• The most cost-effective way for subscribers to purchase their long-term drugs (up to a 90-day supply) is through the Home Delivery Pharmacy Service.
• Medco Health strongly recommends that subscribers purchase all short-term drugs, such as antibiotics, at a participating retail pharmacy. Subscribers will pay their retail pharmacy co-payment for short-term drugs.

An annual deductible for prescription drugs is being added.

Effective Sept. 1, a pharmacy benefit deductible of $50 will go into effect. Each plan year, subscribers will pay the first $50 in prescription drug costs for each covered individual in their family. After the subscriber reaches that amount, he or she will pay the co-payments as described above. The deductible will apply at a participating retail pharmacy and through the Home Delivery Pharmacy Service. For example, if a brand-name preferred antibiotic costs $85 and no generic alternative is available, a subscriber will pay the deductible of $50 plus his or her co-payment for a brand-name preferred drug of $25, leaving a balance of $10, which will be paid by the prescription plan. After that, the subscriber will pay only the appropriate co-payments for his or her medications for that plan year, as described above.

Editor's note: All information for this article came from a letter from Medco Health sent in July to UNT employees enrolled in HealthSelect.

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• UNT names provost and vice president for academic affairs
• UNT names Davison interim vice president for development
• TAMS gets $87,000 grant from TI Foundation
• UNT's NAACP chapter earns national recognition
• UNT professor warns of potentially unhealthy eating environment in schools
• Professor talks about USA PATRIOT Act's effect on libraries
• Anti-smoking CD-ROM is cool to Texas middle schoolers

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