Travis County Commissioners Court
Tuesday, May 31, 2011 (Agenda)
Item 16
16, d, e and f?
>> yeah.
and miss peargton sheer along with miss blank enship.
what name are you going by today, miss department head?
on item 16, consider and take appropriate action on the following employee health care benefit items: we did not take action on d, e and f.
we thought we ought to lay that out so employees who are watching today's meeting would hear.
d is customized quantity limitation on the formulary effective January 1, 2012.
e, customized prior authorization for certain prescription drugs, effective January 1, 2012.
and f is standard pay the difference protocol for using a brand prescription drug when a true generic is available on the formulary and deemed acceptable by the prescribing physician, effective January 1, 2012.
I thought it would be good for employees and retirees just to hear our layman's explanation of those three.
>> absolutely.
diane blank enship and this is cindy paring ton, our benefits administrator.
we're going to go over quickly 16 d, e and f.
and again I would like to encourage any of our employees to go online and view the entire work session if at all possible so that they have a good center nding of what we're asking-- a good understanding of what we're requesting with regard to the pharmacy.
>> I would like to say too that work session is awesome.
its the employees should look at that.
it is very clear, very straightforward and very useful.
>> thank you.
we've gotten a lot of positive feedback from the evacuees imeez with the benefits things we're doing.
I think they're finding it helpful and that's good.
that's exactly what we're hoping for.
d, we're asking a customized limits on the formulary limits effective January 1st, 2012.
the quantity limits for the co-pays would be a one month limit for the walk in the door of a pharmacy or if you're ordering by mail a three month limit.
we're asking for that is two fold.
our co-pay is designed to give a one month or three month supply of medication.
but a one month or three month supply isn't always 31 drugs or 90 pills or 31 pills.
so we're trying to make sure that we get a standard one month or three month supply.
that will help to ensure that the co-pays are being used for a one month or three month supply and it will help with the most effective dispensation of medication.
we want to make sure if somebody is getting -- needs 150 milligrams of drugs that they're getting 150 milligrams and not 275 because that's twice as expensive basically to get twice as many pills.
so that's why we're asking for the quantity limits.
if of course somebody needed to take 75-milligram in the morning and with unin the evening that's something completely different.
they have to have two pills at a time.
that would not effect them.
any questions on the quantity limits, the formula?
>> the 90 day supply, that basically under the mail order scenario?
>> that's mail order and it would still be a 90 day supply, not a one month supply.
>> and to encourage that is it still a situation where you actually end up paying for two months and you get the other one actually free?
>> yes.
absolutely.
>> [overlapping speakers]
>> the employees understand the benefit of the mail order versus the walk-in pharmacist where each time you go you have to pay whatever that is.
under the monthly supply.
>> I do believe that they do.
I will let cindy answer that.
she interacts with them.
>> I think they're using it more and more.
for those that may not know what we're talking about, we're talking about the 90 day supply that you can get through mail order.
currently it's with med coa.
you pay two co-pays, which is one month worth of co-pays, but you get three months worth of medication.
so you get one month of medication free and it's delivered directly to your home.
there are certain drugs that cannot be mailed through the mail because of laws and temperatures and things like that, but most drugs, if it's a drug for a chronic condition, you can use the mail order and save yourself a whole month's co-pay.
>> okay.
I'm glad you laid that out because maybe everyone maybe did not understand that.
thank you.
>> and some of those things once you try it you love it, but for some reason people love going into the pharmacy and you have to make 'em try t but once they try it, they love it.
>> I take it that there are a few drugs that where the quantity cannot be limited, right?
I'm thinking of insulin.
the fast act insulin, you really take as needed based on your test results.
>> correct.
and there's still going to be a limit they give you every month, but if you need more than that then we'll go to an override situation.
we just need to know that.
we want you to get a one month supply f your one month supply is more than a normal one month supply, then we need to make sure that we know that and we can get you the correct medication.
but you shouldn't -- I don't believe you will have a problem with the insulin.
>> okay.
>> any more questions on the quantity limits before we move on?
>> no.
>> the second thing we want to talk about was prior authorization for certain prescription drugs.
and we do have a few drugs that are currently prior authorization.
what do we have on that, cindy?
>> like a growth hormone.
you have to have a prior authorization.
or if you're getting the drug wellbutrin, an antidepressant, but it is shown to be effective in smoking cessation.
it's not designed for soaking cessation, so if -- wellbutrin is on a prior authorization, they have to check and see if the use of the drug is what it's designed for and not smoking cessation.
that's an example they're trying to make sure you're using the drug the way it was designed to be used.
>> and there are typically on this list, there's 148 drugs that would be on the preauthorization list.
and they happen to be drugs that are commonly misprescribed.
they're for a very narrow use.
so we want to make sure that our employee or the participant actually has the correct diagnosis for those drugs being prescribed.
and I gave an example in the work session of the drug xyram, which is for a very narrow use.
it's for narcolepsy and yet we seem to have more widespread use than that wha the pharmacist we consulted with would call normal.
we want to make sure those drugs are being used for that very, very narrow diagnosis.
the diagnosis approve by the f.d.a.
>> okay.
>> okay?
the last one, f, is a pay the difference protocol for using a brand prescription drug when a true necessity jair rick is -- gentlemen geners available.
there seems to be confusion on this, so I want to be sure I'm very clear.
this would be in a case where you go to the doctor and the doctor prescribes a drug and the doctor knows there's a generic out of that drug and the doctor says generic substitution is okay.
in that case if our member decided to choose the more expensive brand drug, then the member would pay the difference.
the reason is because the member has chosen to go with the more expensive drug.
their doctor, their own health care provider that knows their conditions and all their allergies and everything else, said that the generic substitution was absolutely okay.
and the member elected for the more expensive brand name drug.
in cases where the doctor says no, generic substitution is not acceptable, you must take the brand name drug, then the member will may pai the co-pay as usual.
no difference at that point.
it's only when the doctor says it's absolutely okay for you to take the generic and the member decides to have the more expensive drug, then the pay the difference protocol would come in.
>> plus the co-pay.
>> how would we actually know that, though?
>> it's on the prescription.
when the doc fills out a prescription on the prescription pad, there's two check boxes.
one says dispense as written and the other says generic substitution is okay.
and pharmacies have been set up to take this and to do this pay the difference for a long time.
they implement it regularly.
>> so the doctor would know -- in other words, the doctor would prescribe a generic if the name brand is even available, they would usually just prescribe the generic in substitute of the name brand, even if the patient says, listen, I would like to have name brand.
>> if the patient says I would like to have name brand, I have -- don't mean to be cynical, but I have no doubt the physician will click name brand.
we hope to make sure that the employees know that's a waste of money if your doc says that the generic is okay for you and it's in all of our best interests to save money so our co-pays don't go up, the taxes don't go up.
we want to make sure that our employees are educated about this.
>> but I'm saying as a physician -- are the physicians dedicate odd that end?
>> typically the physician will have a talk with you and say, you know, how do you feel about this?
I want to try you a generic.
I got an anecdotal story from somebody I won't name because it's hippa, but he said my doc started me on this generic and that wasn't working so well.
and we talked about that the doctor was actually doing a good job on trying you of lower classes of drugs to find the one that was right.
so it really depends on how your doctor -- what your doctor feels about the drugs.
a lot of times the doc will provide something, the name brand.
they'll put vicodin, but then they'll put on the bottom, generic substitution it okay.
and that means the substitution for vicodin is perfectly fine with him or her.
>> so if in doubt ask your physician basically.
>> absolutely.
we hope to have people really start a lot of conversations with their physicians so they understand their condition, their drugs, why they're prescribed certain drugs and they can go in armed with information.
>> this is a two-parts.
one is that a true generic is available.
>> correct.
>> and two is your physician is saying the generic is fine.
>> correct.
>> which means it ought to have the same active ingredient as the name brand.
>> it will have the same active ingredients and dispensation as the name brand.
>> do we believe the cost savings in all these comparisons that we're doing -- I understand that there will not be any increase I guess in the premiums according to what we're saying here.
is the offset really re-- does the offset really reflect the amount of cost savings?
>> the pharmacy right now is where most of you read the journals, that's where your health care costs are really going up is the pharmacy costs.
for us in the last two years it has gone up 39 percent.
so that is a significant cost for us.
so we want to do is really take the time to educate our employees about why do you see so many drug commercials on the television.
that it is big business and some of the things that we have actually discovered in going through our pharmacy reports.
we need to save where we can.
some people need obviously their expensive drugs.
if you're having a transplant or a cancer, there may be only one drug that neets treets you.
but for people who can take generic, the savings can be significant.
one of the things I pointed out in the work session was just the people on the brands that have generic can save the plan over $200,000 and save our employees about $100,000, which isn't nothing.
a successful conversion to the formulary if we had some good behavior modification with our employees where they were starting to ask about drugs, we think it can be at least another million perhaps.
I ran the numbers and just going to the formulary, our people went to the average cost of a substitute, it could save us about 1.5 million.
so those are significant savings.
again, it's not going to happen overnight, but the more we educate our employees and change the benefit designs where it incentivizes that, I think we'll see more savings.
>> okay.
>> any other questions?
move approval of 16 d, e and f.
seconded by Commissioner Davis.
discussion?
all in favor?
that passes by unanimous vote.
thank y'all very much.
appreciate your patience.
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