Public Employee Press

Drug plan changes set for July
Mail order program now optional in agreement with Innoviant,
new drug benefit administrator

Beginning in July, as its three-year contract with a new prescription drug administrator takes effect, the DC 37 Health and Security Plan will institute several changes to give participants more choices, make the benefit more convenient and in some cases reduce out-of-pocket expenses.

• In response to complaints from members and retirees, the union is making the mail order program for maintenance medication optional instead of mandatory.
  
  
• The plan will also offer the choice of getting a 90-day supply of medication at certain pharmacies by making three co-payments at once.
  
  
• Another option will let participants save up to 50 percent on certain medicines by using a free pill-splitting device.
  
  
• Because Express Scripts Inc. administers the city PICA program (Psychotropic, Injectable, Chemotherapy and Asthma), members and non-Medicare-eligible retirees covered by the program will get a new NYC ESI PICA card that will cover injectables and chemotherapy drugs at the applicable co-payment. For psychotropic and asthma medications, members will continue to use their DC 37 drug card and pay the union plan’s co-payments. (Under a 2005 agreement, the union plan covers psychotropic and asthma medications; the PICA program kept its name even though it covers only injectables and chemotherapy for DC 37 members.)

Under the contract the DC 37 plan’s trustees approved in April, the Wisconsin-based firm, Innoviant Inc., will replace ESI in handling day-to-day operations of the prescription benefit.

“As we were evaluating bids for a new administrator, we took a close look at the structure of the drug benefit itself,” said Mark Rosenthal, chair of the board of trustees and president of Motor Vehicle Operators Local 983. “We listened to members and retirees and decided we shouldn’t require people to get their maintenance drugs through the mail anymore. The trustees spent two years studying the benefit; we believe the contract will improve services and achieve savings.”

The new contract will help the DC 37 plan contain costs by requiring Innoviant to pass along all rebates and other financial benefits from pharmaceutical companies on brand-name drugs bought by participants. In addition, Innoviant must negotiate the best available discounts on all of its purchases for members and retirees.

Participants who prefer to get their medication through the mail will continue to have that option, which provides a 90-day supply of medication for two co-pays instead of the three co-pays required for retail purchases.

“Many of our participants are very comfortable with the mail-order program and enjoy the discount,” said Rosa Esperon, administrator of the DC 37 Health and Security Plan. “So we kept that as an
option.”

The plan’s current co-payment structure will remain in effect when Innoviant starts to administer the drug benefit in July. The benefit will also continue to require step therapy and the use of generic drugs; participants who use a brand-name drug when a cheaper generic equivalent is available will continue to pay the difference between the two in addition to the appropriate co-pay.

The DC 37 plan is working with Innov-iant on a member welcome package that will go out around Memorial Day describing the changes and including a new drug card to replace the Express Scripts card.

The plan is working with Innoviant and Express Scripts to ensure a smooth transition and the transfer of prescriptions with refills after July 1 so members and retirees won’t have to obtain new prescriptions.