Public Employee Press

Part 3 of a series on Prescription Drug Costs
Mail-order drug plan mandatory in January

HIP/VIP changes slated for 2004

Beginning Jan. 1, members and retirees must fill prescriptions for maintenance drugs through the union’s mail-order program. In another change to cut costs, the HIP VIP Premier Medicare Plan has agreed to cover the first $500 to $1,000 of annual drug expenditures of retirees in that plan, depending on where they live. Once they reach the cap, DC 37’s drug benefit will kick in.

The DC 37 Health and Security Plan is making the mail-order program mandatory to control prescription costs, which have been consuming a growing share of plan funds compared with the vision, audiology, dental and legal benefits.
The change will save participants $1.2 million and save the plan $1.8 million.

“We realize that a lot of people prefer to fill their prescriptions at local pharmacies,” said Rosaria R. Esperon, administrator of the plan. “But we believe almost everyone will find the mail program very convenient.”

How mail program works
In the mail-order program, members get drugs by sending in a postage-free envelope with their prescription and a check, money order or credit card number.

To get the envelopes, call the plan’s Inquiry Unit at 212-815-1531. The plan’s trustees voted in September to make mail-order mandatory. The mail program covers “maintenance” drugs — medications approved by the U.S. Food and Drug Administration for long-term illnesses, such as heart disease, hypertension, high cholesterol and arthritis.

The plan’s research found that a significant number of members and retirees who need maintenance drugs do not get them by mail in spite of the financial incentive.

The mail-order program saves purchasers one-third of the cost of maintenance drugs at a local pharmacy. By mail-order, a 90-day supply of medication costs $6 for generic drugs, $15 for medications on the plan’s preferred list and $30 for brand-name drugs that are not on the list.

At a pharmacy, generics cost $3 for a 30-day supply (or $9 for 90 days), preferred list drugs cost $8 for 30 days ($24 for 90 days), and non-preferred drugs are $15 for 30 days ($45 for 90 days).

During a transition period, maintenance drug users will be allowed to fill three successive prescriptions at pharmacies.
But if users submit a fourth prescription to a pharmacy, National Prescription Administrators, which handles the DC 37 drug benefit, will flag the order and instruct them to process it with Central Fill Inc., which runs the union’s mail-order program.

HIP/VIP
In November, the DC 37 plan notified the 2,500 affected retirees about the modifications in the HIP VIP plan, which are effective Jan. 1 and include changes in co-payments.

For a 30-day supply of drugs purchased at a pharmacy, the co-pay is $10 for generics, $15 for drugs on a preferred list and $45 for drugs not on the preferred list.

For a 90-day supply purchased through the mail-order program, the co-pay is $15 for generics, $22.50 for preferred list drugs and $135 for drugs not on the preferred list.

The $1,000 cap will apply in the five boroughs; Nassau, Westchester and Suffolk County enrollees will have a $500 cap.
For questions about the HIP/VIP changes or the mandatory maintenance drug plan, call the DC 37 Plan’s Inquiry Unit at (212) 815-1234.

The changes in the HIP/VIP plan will affect about 2,500 retirees. In October, the DC 37 plan notified them about the modified drug coverage. The modification, which is effective Jan. 1, will include changes in co-payments for some medications.

For questions about the HIP/VIP changes or the mandatory maintenance drug plan, call the DC 37 Plan’s Inquiry Unit at (212) 815-1234.