Drug plan changes set for July
Mail order program now optional in agreement
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
- 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
- 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
plans 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 plans 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 shouldnt
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
The plans 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
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 wont have to obtain new prescriptions.