Introducing exciting new Rx benefits 2019

Transcription

1 Introducing exciting new x benefits 2019 In 2019, the Middlesex prescription plan is aligning with best-in-class evidence-based practices. Two new tiers will be added that evaluate drugs on the basis of clinical data, not simply cost alone, for 10 medical conditions. powered by: Empowering management and employees to take charge of their pharmacy costs and clinical effectiveness with evidence-based data analytics

2 2019 new MHS x benefits Green Level ewards $0 Co-pay MHS will provide all drugs in this category at NO COST TO MEMBE! New The Green tier includes drugs that Middlesex will cover at full cost, and the member will pay $0. Yellow Level Co-pay (30 days) (Same Structure as 2018) Generic: $12 Brand Name (Formulary): $40 Brand Name (Non-Formulary): $75 90 Day Mail Order Features 3 months for 2 co-pays No change All other drugs not listed on the Green or ed list will be available at the current co-pays. ed Level Cost Member pays 100% of partially discounted cost New The ed tier includes drugs that members will pay the partially discounted price. All ed drugs have multiple Green and Yellow alternatives.

3 Medical condition: ADHD methylphenidate $0 methylphenidate E (italin E) $0 combination ed combination atomoxetine $12 amphet/dextroamp salts (Adderall) $12 amphet/dextroamp salts E (Adderall X) $12 dexmethylphenidate $12 dextroamphetamine $12 dextroamphetamine E $12 methylphenidate E (Concerta) $12 methylphenidate E (italin LA) $12 Adderall X* ~$200 Mydayis* ~$266 Quillichew* ~$300 Quillivant* ~$300 italin LA* ~$300 Vyvanse* ~$300 Zenzedi* ~$200 *Generic or alternative available

4 Medical condition: Allergy combination ed combination OTC-Self Pay cetirizine ~$17 fexofenadine ~$16 loratadine ~$16 loratadine ODT ~$21 cetirizine/pseudoephedrine E ~$14 fexofenadine/pseudoephedrine E ~$13 loratadine/pseudoephedrine E ~$11 fluticasone nasal spray ~$13 flunisolide nasal spray ~$27 triamcinolone acetonide nasal spray ~$17 azelastine spray* ~$30 Clarinex tabs* ~$200 Nasonex* ~$250 olopatadine spray* ~$60 *Generic or alternative available

5 Medical condition: Depression amitriptyline $0 citalopram Tabs $0 escitalopram Tabs $0 fluoxetine $0 imipramine $0 sertraline Tab $0 venlafaxine E Tab $0 combination bupropion $12 bupropion S $12 bupropion XL $12 desipramine $12 desvenlafaxine $12 doxepin $12 duloxetine $12 mirtazapine $12 mirtazapine ODT $12 nortriptyline $12 paroxetine $12 paroxetine $12 phenylzine $12 tranylcypromine $12 trazodone $12 venlafaxine $12 ed combination paroxetine capsule 7.5MG* ~$130 paroxetine E* ~$90 venlafaxine E Tab (ed )* ~$350 *Generic or alternative available

6 Medical condition: Dermatological conditions combination ed combination OTC Self-Pay Sarna lotion $14 hydrocortisone cream $5 diphenhydramine cream $8 diphenhydramine gel $8 doxepin cream* ~$2,000 doxycycline 40MG* ~$500 fluocinonide cream 0.1%* ~$1,700 *OTC or alternative available

7 Medical condition: Heartburn combination ed combination omeprazole D $12 omeprazole granules $12 omeprazole mag D (OTC) $12 omeprazole/sodium bicarb (OTC) $12 pantroprazole $12 cimetidine* ~$30 famotidine* ~$5 lansoprazole* ~$20 Prevacid Solutab* ~$400 rabeprazole* ~$60 ranitidine* ~$5 *Generic or alternative available

8 Medical condition: High Blood Pressure benazepril $0 chlorthalidone $0 hydrochlorothiazide Tabs $0 irbesartan $0 labetalol $0 lisinopril $0 lisinopril/hctz $0 losartan $0 losartan/hctz $0 propranolol $0 ramipril $0 valsartan/hctz $0 Benicar* ~$290 Corgard* ~$100 Qbrelis solution* ~$480 acebutolol $12 amiloride $12 amiloride/hctz $12 amlodipine $12 amlodipine/benazepril $12 amlodipine/olmesartan $12 atenolol $12 atenolol/chlorthalidone $12 bisoprolol $12 bisoprolol/hctz $12 bumetanide $12 captopril $12 captopril/hctz $12 carvedilol $12 clonidine $12 clonidine transdermal $12 diltiazem $12 diltazem CD $12 diltiazen E $12 enalapril $12 enalapril/hctz $12 felodipine E $12 eplereone $12 furosemide $12 hydralazine $12 indapamide $12 irbesartan/hctz $12 isradipine $12 methyldopa $12 metolazone $12 metoprolol tartrate $12 metoprolol succinate $12 metoprolol/hctz $12 nadolol $12 nadolol/bendroflumethiazide $12 nicardipine $12 nifedipine $12 nifedipine E $12 olmesartan $12 olmesartan/hctz $12 perindopril $12 pindolol $12 propranolol er $12 propranolol/hctz $12 sotalol $12 sotalol AF $12 spironolactone $12 spironolactone/hctz $12 torsemide $12 trandolapril $12 triamterene/hctz $12 valsartan $12 verapamil $12 verapamil S $12 verapamil E $12 verapamil E PM $12 *Generic or alternative available

9 Medical condition: High Cholesterol combination ed combination atorvastatin $0 gemfibrozil $0 lovastatin $0 pravastatin $0 simvastatin $0 amlodipine/atorvastatin $12 cholestyramine $12 cholestyramine light $12 colestipol $12 ezetimibe $12 ezetimibe/simvastatin $12 fenofibrate $12 fenofibric acid $12 niacin 500mg E $12 Praluent $40 prevalite $12 epatha $75 rosuvastatin $12 fluvastatin* ~$117 Livalo* ~$260 omega-3 acid ethyl esters* ~$108 *Generic, OTC, or alternative available

10 Medical condition: Low Testosterone combination ed combination testosterone cypionate inj $0 testosterone enanthate $12 testosterone gel $12 testosterone gel 25mg/2.5gm $12 Androderm* ~$350 *Generic or alternative available

11 Medical condition: Migraines rizatriptan $0 sumatriptan Tablet $0 combination ed combination dihydroergotamine nasal spray $12 naratriptan $12 rizatriptan oral dis tab $12 sumatriptan nasal spray $12 zolmitriptan $12 zolmitriptan oral dis tab $12 Onzetra* ~$670 elpax* ~$550 sumatriptan Injection* ~$3,330 Zomig Spray* ~$1,100 *Generic or alternative available

12 Medical condition: Type 2 Diabetes acarbose $0 alogliptin $0 glimepiride $0 glipizide $0 glipizide E $0 glipizide/metformin $0 glyburide $0 metformin $0 metformin tab 500 mg E $0 metformin tab 750 mg E $0 nateglinide $0 pioglitazone $0 pioglitazone/metformin $0 repaglinide $0 combination ed combination metformin E (Glumetza)* ~$2,200 metformin E (Fortamet)* ~$1,300 alogliptin/metformin $12 Invokamet $40 Jentadueto X $40 Novolog Mix 70/30 $40 alogliptin/pioglitazone $12 Invokamet X $40 Levemir $40 pioglitazone/glimepiride $12 Basaglar $40 Invokana $40 miglitol $12 tolbutamide $12 Farxiga $40 Janumet X $40 Novolin 70/30 $40 Tradjenta $40 glipizide XL $12 Janumet $40 Novolin N $40 Trulicity $40 glyburide micronized $12 Januvia $40 Novolin $40 Victoza $40 glyburide/metformin $12 Jentadueto $40 Novolog $40 Xigduo $40 *Generic or alternative available

13 FAQs Q: What is new for 2019? A: In 2019, the Middlesex prescription plan is aligning with best-in-class evidence-based practices. This means we are using two new tiers will be added that evaluate drugs on the basis of clinical data, not simply cost alone. The current co-pay model will apply to all drugs not listed on either the two new tiers - the Green tier and the ed tier. Q: Who is TruDatax and what is their role? A: TruDatax has spent years researching and developing a unique comparative effectiveness drug therapy model. The result is a system that evaluates and reveals the best method for successfully managing drug therapy for your medical condition in relation to medication costs. They performed an analysis of the prescription drugs available for 10 conditions. The drugs were evaluated on clinical effectiveness compared with their actual drug cost. Green drugs were significantly less expensive and very effective. ed drugs were far more expensive and similarly effective to Green drugs. Yellow drugs were in the middle -- they work about the same compared to Green and ed drugs but because of higher cost they are not as high value compared to Green drugs. Q: What is a Green drug? A: The Green tier includes drugs that Middlesex will cover at full cost, and the member will pay $0. This could result in significant yearly prescription savings for you and your family as you move away from higher copays. Q: What is a ed drug? A: The ed tier includes drugs that members will need to pay the full discounted cost. All ed drugs have multiple Green and Yellow alternatives and have been shown in a detailed analysis to be more expensive compared to their similar alternatives. Q: What is a Yellow drug? A: The Yellow tier includes drugs that are not affected by this new benefit and subject to your current copay. We provide this information so you can compare all of your options. There are many drugs that are not included here, but we ve tried to include all the drugs for a give condition to make this a helpful tool for you.

14 FAQs Q: Can I still choose to receive ed Drugs? A: Yes you can still get prescriptions for drugs on the ed list. You will be responsible for the full discounted cost. Middlesex Hospital gets a discounted price that will be lower than the pharmacy s usual and customary price, but not may be lower than the price of a discount card like Goodx. Q: How did you calculate the price for the ed drugs? A: These are roughly the current contract prices being paid by Middlesex Hospital in These prices can change over the course of a year and this information should be used as a guide, not as the actual drug cost for ed drugs. TruDatax will provided updated pricing as it becomes available. Q: If I want to stay with my current drug regimen can I? A: You will not be forced to make any changes. In many cases it will make sense for you and your provider to use an alternative therapy that will be more cost effective for you. You can always choose to maintain your current therapy at the new price levels. Q: Is there an appeals process for drugs on the ed list? A: Yes all drugs on the ed list may be appealed. They may require Step Therapy or meet other Prior Approval requirements. Q: What if my drug is not listed? A: The list is fluid and will be changed as information and prices change over time. If you drug is not currently listed it is best to check with CVS Caremark. They will have the most up to date listing. If a drug is not listed on the Green or ed tier but it on formulary, the cost will be the current copay model (see page 2 of this document.

15 FAQs Q: Will I have still have a deductible? A: Yes, deductibles for 2019 remain the same. $100 individual $250 families