Travis County Commissioners Court
October 27, 2009,
Item 10
>> number 10, since we have ms.
flemming here is to take briefing and 10.
receive briefing and take appropriate action on health and human services recommendation to implement a pharmaceutical savings program for county residents.
>> good morning, judge, Commissioners, the health and human services department at your request has been looking over the last year of fume savings programs that might benefit the residents of Travis County, so we have a brief presentation today and a recommendation.
i will add that staff is not asking for action today.
we have a request from the county attorney's office and audittor's office if they can have one week to complete their review but it is staff's interest to make the presentation and indicate our recommendation and hopefully your approval in one week.
>> okay.
>> are we ready?
>> okay.
so I think it would be somewhat redundant and a waste of time to indicate why there might be a need for any drug savings programs for county residents, but in 2008, hhs staff were asked to identify and evaluate prescription drug discount programs, including a program by the national association of counties or naco, familywize and the coast 2 coast program, more than 22% of individuals in Travis County based on the community survey were uninsured and even among those who have insurance, many have limited or nonexistent drug coverage.
we would expect int's economy that number would have increased.
so we looked at the three programs that I mentioned and compared them and what you are looking at is side by side comparison of those three programs, briefly, the naco program is contingent on your continued participation as a naco member which means you would have to pay membership fee annually to participate in that program.
the cost to residents is free, of course.
there is a card provided for the entire family, the discounts in that program average from 18 to 22%.
naco did not distribute the card so the administrative functions related to that would become the responsibility of the county.
it would -- so, therefore, would require staff time.
there was no monthly contact with the pharmacies to assess the amount of use.
the card did not come in english and spanish, there was no royalty to the county and there was an exclusivity agreement which mean that is naco would not do any other pharmacy card related programs during the period of time that you would be committed to that program.
at the time we looked at this project, naco was requiring a term of an agreement up to three years.
the familywize program is free, also, to the county, free to residents, it did require a card or it did have a card, the average savings per resident was up to 38% t familywize program did not distribute the card so therefore it requires staff time to -- to maintain a supply and distribute the cards.
the cards were available in english and spanish.
there was no royalty for the county or an exclusivity agreement and then there was no agreement at all and so that -- that's familywize and finally the coast 2 coast program which we will talk about more specifically, basically is free to both county and the residents.
it covers the entire family, the savings are up to 38%, the coast 2 coast vendor distributes the cards.
we may also provide to them a list of locations that we would like them to provide the cards to and they will make sure that the cards are delivered.
so it does not require staff time and the actual maintaining of inventory and delivering of cards.
they make monthly contact with the pharmacies, therefore, reporting to us on a monthly basis on the usage of the cards.
the cards are provided in both english and spanish and the coast 2 coast program proroyalty to the county which in this case would be 75% of each use of the card and there is not a new exclusivity agreement and there is a 30-day cancellation -- the county can cancel the program with 30 days' notice to the vendor.
how the program works basically is the coast 2 coast had relationships with pharmacies, large chains, as well as independent pharmacies to off savings to the card holders.
they print out and distribute the cards to locations specified by county staff.
these includes pharmacies, public locations, the county's family support services center could be included.
libraries.
we could also request our partners in a nonprofit arena to have the cards available so any location we would identify could have the cards, in addition the cards are available for our residents to download from the internet, so a person with computer access could print a card from the internet.
coast 2 coast designs and implements press evens surrounding launch of the program with assistance of county staff and then coast 2 coast reports to us the usage of the card to the county by zip code of the participating pharmacy and sends a monthly royalty check.
so staff looked at the potential revenue that might be generated from participation in the program and basically what we looked at was the dallas county began using this program in September and during their -- the second week of September had generated 3800 prescriptions, so that -- so at that point they -- we looked at the 3800 prescriptions generated.
we estimated our population was 40% of -- of the dallas population.
therefore, if we generated 40% of that number, it would be about 14 -- I lost my number -- 1520 prescriptions per month, which would yield about $4,500 per month in -- in revenue.
>> so if you took out revenue to the county, what firm would you recommend?
>> the coast 2 coast program.
>> I would like to ask that, the Travis County health and human services and the reason would be that it is a larger formulary which is a list of medicines that are covered by the pharmaceutical program.
the formulary for coast 2 coast has more than 60,000 drugs.
it is a very large formulary, which covers a large span of possible medicines needed by our -- our residents.
>> plus the fact it is in english -- the program is in english and spanish and it is' so available in its distribution mechanisms?
>> correct.
>> what, if anything, does coast 6 coast do to advertise the availability of a discount program?
>> go ahead.
>> they --
>> they --
>> are you the coast 2 coast representative?
>> sorry?
>> no.
>> are you with Travis County?
>> yes, sir.
>> welcome.
>> they assist us in promotion of the program in any mechanism that we choose, certainly through press releases they assist us in setting up a press event to announce the program.
i think the usage of the cards we found -- of what has been shared with half is the usage is in direct relationship of how much you promote the program, and so we would develop a promotion sort of schedule with the -- the provider so that we continue to promote the programs but of course it would be -- we would promote it on the county's website, on the county's tv station and anyplace that we might be able to post signage and that sort of thing.
>> what I would ask that, is that they also contacted pharmacies independently so without us having to farm the pharmacies, they even talked to people, nonpharmacy, terrytown and they have gotten --
>>
>> [indiscernible]
>> exactly and they have said this is coming up, Travis County will be doing this.
they have done a lot of the groundwork for us.
>> okay.
>> okay.
just a bit about participating counties, several counties across the nation are already using the coast 2 coast program.
there is not a reliable average for revenue simply because it is a new program and that counties are vastly different in populations, so the estimate was all we were able to provide to you today in terms of the amount of revenue generated.
but we did interview 7 counties who reported satisfaction with the program, baker county, florida, collier county, florida, har differ county, florida, highlands county, florida, santa barbara county, california, saratsota, florida, and dallas county signed into the program in September of 2009.
>> terms of related Travis County investments as it relates to prescription drug assistance, the family support services division currently offers prescription drug assistance to individuals whose income falls between 50 and 125% of the federal poverty income guidelines.
the recipients of these funds can receive no more than $157 per year in assistance to purchase pharmaceuticals so we are certainly talking about assistance that would be recurring in that folks could experience the discount each time that they have their prescriptions filled.
the program is also able to be used by person who is have prescription coverage on their policies but may encounter, either prescription drugs who are not on their insurance carriers formulary, or they may receive a better discount by using the card versus their insurance carrier's program.
the program also covers veterinary medicines, so persons filling prescriptions for their pets will also be able to experience a discount for those drugs that are on the coast 2 coast formulary.
>> that concludes our presentation.
questions?
>> and this covers any county resident, no matter where they live, inside or outside the city?
>> correct.
>> that is correct.
in addition if our residents are outside of Travis County but use their card in another community at a provider who is on the program, we will still experience credit for that usage, so if a county resident fills a prescription at a pharmacy that's on the program in bexar county, Travis County would still get -- we would still get to count that use.
>> have we looked at all of the impacts to senior citizens in regards to -- I know that many seniors in our community are contemplating purchasing additional pharmaceutical coverage above their medicare, an I was just wondering if we had looked at all of the impact of the additional discount card on --
>> we did not look at that particular comparison, but it is our understanding that the pharmacies have the ability to do a little bit of comparison -- of price comparison for residents, so as they have a particular drug identified, the pharmacies can look at the various programs that they participate in and give the resident information about which program provides the best discount.
>> that is great.
because there is a tremendous amount of confusion out there in trying to compare those prices.
it is really wonderful that the pharmacists are stepping up and helping out.
>> so residents, regardless of income or assets --
>> that's right.
>> that's correct.
>> -- can participate?
>> that's correct.
>> some of their pay may will higher than the price offered by the card, at which time we could then purchase the medicine through that card.
>> thank you, judge, my question was just about -- I am curious, how does one get involved?
does it cost anything to get a card as a Travis County resident?
what is their procedure for acquiring a card?
>> there is to cost to receiving a card.
the cards will be readily available at Travis County facilities should this be approved by the court.
you could print it yourself or you could receive it at any locations such as a library, at another nonprofit entity, at any location that would be willing to -- to have the cards available, you could receive it and you would just pick it up.
there is no cost.
>> and libraries would be a good possibility.
>> yes, we hope the libraries will allow us to put them in.
>> great.
thank you so much.
>> can you bring one of those cards to court next Tuesday?
we want those back on Tuesday for action?
>> yes.
>> one from dallas county if we don't have one forrous, that would be fine.
>> we have a mock up of ours, too.
>> and if vendor will provide -- the vendor will provide a website that describes Travis County programs in addition to having the information available on our website, there will be a link that takes our residents just to specific Travis County information, which will include the pharmacies in our area who recognize the card and it's a long list.
>> we can hardly wait until next week.
-- yes.
>>
>> [laughter]
>>
>> [indiscernible] there is an agreement that we are working on, but unlike previous offers that have come to us but they are willing and are working with us to include the provisions -- standard provisions and stuff that Travis County needs so there will be a contract that will be brought back to you but they are working on that to get it to us in a way that we think will best help the county program and I think -- won't the pharmacies have the cards as well?
>> the pharmacies will also have the cards.
and like I said, also the ability to -- to compare across -- across programs, because there are -- programs within the community.
vendors have programs, the city participates in the familywize program, so there will be opportunities for residents to determine which deal is the best deal for them for each pharmacy purchase.
>> and the exclusivity, there is not exclusivity, but my understanding is starting from this point, if the court approves this, if we enter into additional ones, our royalty will be decreased?
>> twenty-five-cents per prescription.
>> seventy-five to 25 but we can enter into other programs an any programs we are into right now, anything, the health care district, anything that is in displace as of now, won't be impacting future --
>> so as soon as we approve this, it is effective right away?
>> as soon as we can get the cards printed and -- and get the information up and then, of course, the vendor will want to know from us what type -- if we want to have a press event or we want to issue a press release, those sorts of things, so we can also give you a recommendation on that next week.
>> it sounds like a pretty good deal.
>> one thing we forgot to mention is that lab services and some diagnostic services, residents will receive a discount for those services from certain vendors, although there is not a royalty for that component affidavit program but there are discounts available.
>> and your name is.
>> I am melissa fella, Travis County health and human services (n
>> you think we will have a contract by next week?
>> yes.
>> okay.
thank you very much.
>> thank you so much for your work on this.
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Last Modified:
Tuesday, October 27, 2009 1:40 PM
