State of New Hampshire

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State of New Hampshire

• Pharmacy Benefit Changes Effective 10/1/2010
• Presented By
• Melisa Briggs

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Pharmacy Benefit Overview

• There are two ways you can obtain your
  prescription medications through CVS Caremark
• Mail Order Program To order prescriptions used
  on a regular basis (such as blood pressure,
  allergy)
• Retail Pharmacy Program To purchase medications
  needed for a short-term basis or if medications
  are needed quickly (such as antibiotics)

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Pharmacy Benefit Overview and Changes Effective
10/1/2010

• 500 Individual/1,000 Family calendar year
  out-of pocket maximum once this is met you will
  have a zero copay and 100 coverage for the
  remainder of the calendar year. Retail and mail
  order copays apply towards this maximum.

Active Employees and Retirees Generic Preferred Brand-Name Non-Preferred Brand-Name
Retail Pharmacy (co-payment per prescription or refill for up to a 31-day supply) refill limit of up to three fills (one initial plus two refills) for maintenance or long-term medications 5 10 15
Mail Order (co-payment per prescription or refill for up to a 90-day supply) 1 20 30
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Mail Order Prescriptions What You Should Know

• You and the States Prescription Benefit Program
  save money when you order maintenance or
  long-term prescriptions through mail order
• This is due to the cost savings received when
  prescriptions are filled through CVS Caremarks
  Mail Service Pharmacy
• Beginning 10/1/2010, all maintenance or long-term
  prescriptions will be filled through CVS
  Caremarks Mail Service Pharmacy

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Mail Order Prescriptions What You Should Know

• To allow you time to transition to mail order for
  your current maintenance or long-term
  prescriptions
• You may fill these for up to three fills (one
  initial plus two refills) on or after 10/1/2010
• If after three fills at the retail pharmacy you
  choose to fill your maintenance or long-term
  prescriptions at the retail pharmacy
• You will pay 100 of the cost
• You should still present your CVS Caremark
  identification card in order to receive CVS
  Caremarks discounted price
• This cost will not be applied to your calendar
  year out-of-pocket maximum

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Mail Order Prescriptions What You Should Know

• For any newly prescribed maintenance or long-term
  prescriptions that you fill on or after 10/1/2010
  
• You may fill up to a 31-day supply for up to
  three fills (one initial plus two refills) at a
  retail pharmacy location

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Mail Order Prescriptions What You Should Do

• Look for a letter from CVS Caremark explaining
  how to use the mail order pharmacy
• You will receive this letter if you are currently
  filling your maintenance or long-term
  prescriptions at the local retail pharmacy
• Ongoing notification will be sent if you have not
  transferred to mail order, or when you fill a new
  maintenance or long-term prescription

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Mail Order Prescriptions What You Should Do

• Take advantage of the cost savings and
  convenience right away!
• You do not have to wait until on or after
  10/1/2010 to begin using the mail order program
  to fill your maintenance or long-term
  prescriptions

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Mail Order Prescriptions Did You Know?

• Using the mail order vs. retail pharmacy will
  save you time and money
• Its convenient and an easy way to obtain your
  prescriptions
• New Prescriptions 7 to 10 days after CVS
  Caremark receives your order
• Refills 5 to 7 days after CVS Caremark receives
  your request
• You will save money
• For example, if you are taking a preferred
  brand-name medicine you will pay 20 for a 90-day
  supply through the mail order the cost would be
  30 at the retail pharmacy for the same supply

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Mail Order Prescriptions Did you know?

• Doctors can fax prescriptions directly to CVS
  Caremark by calling 800.378.5697
• FastStart Program
• To get started call 800.875.0867, or log on to
  www.caremark.com and click on Start a New
  Prescription, then click FastStart
• Provide the name of your medication, doctors
  name and phone
• CVS Caremark will contact the doctor for you to
  obtain a new prescription

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Mail Order Prescriptions Did you know?

• Future refills can be ordered
• Online at www.caremark.com there is a one-time
  online registration that only takes a minute or
  two
• Call toll-free 888.726.1630 and use the automated
  refill service
• Complete the Mail Service Order Form and send
  directly to CVS Caremark
• New Mail Order Features
• Automatic Refills and Renewals

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Mail Order Prescriptions Did you know?

• Brand name prescriptions will automatically be
  substituted with a generic equivalent if
  available, unless your doctor indicates dispense
  as written or similar instructions
• Registered pharmacist are available for
  consultation 24 hours a day, seven days a week,
  by calling CVS Caremark
• Delivery will always be free even if there is
  special shipping requirements

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Mail Order Prescriptions Did you know?

• You can request an additional supply of
  medication by calling CVS Caremark if you will be
  traveling for a long period of time
• Specific procedures are followed in the rare
  event your medication is lost, stolen or damaged
• CVS Caremarks mail order pharmacies have the
  appropriate quality and safety procedures in
  place when shipping medications

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Retail Pharmacy Prescriptions What You Should
Know

• You can continue to use retail pharmacy locations
  for
• Your short-term prescription needs
• Other types of non-maintenance medications, such
  as sleep agents and pain relief prescriptions
• Compound medications
• You can go to any participating pharmacy and do
  not need to use a CVS pharmacy
• Just show your CVS Caremark ID card and pay the
  applicable copay

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Specialty Drug Program - What You Should Know

• Specialty medications are used to treat chronic
  and/or genetic conditions, such as multiple
  sclerosis and rheumatoid arthritis
• Often infused or injected medications
• Beginning 10/1/2010, all specialty medication
  will be provided by CVS Caremarks Specialty
  Pharmacy
• CVS Caremarks Specialty Pharmacy is a mail order
  facility dedicated to dispensing specialty
  medications

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Specialty Drug Program - What You Should Know

• This program is designed to provide you with
  personalized care, education and support
• Access to a pharmacist 24 hours a day, seven days
  a week
• Coordination of care with you and your doctor
• Convenient delivery directly to you or your
  doctors office
• Medicine- and disease-specific education and
  counseling
• Online support through www.caremark.com/specialty,
  including interactive areas to submit questions
  to pharmacists and nurses

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Exclusive Specialty Drug Program - What You
Should Do

• Look for a letter from CVS Caremark explaining
  how to enroll in the Specialty Drug Program
• You will receive this letter if you are currently
  taking specialty medication(s) and purchasing
  them through a retail pharmacy
• You should contact CVS Caremark Specialty
  Pharmacy at 800.237.2767 if you are newly
  prescribed a specialty medication

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Generic Equivalent Program What You Should Know

• You and the States Prescription Benefit Program
  save money when you use generic equivalents
• Generic medications often cost much less
• Beginning 10/1/2010, if you request a brand-name
  medication when the generic equivalent is
  available
• You will pay the generic copay plus the
  difference in cost between the generic and
  brand-name medication
• This additional cost will not be applied to your
  calendar year out-of-pocket maximum

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Generic Equivalent Program What You Should Know

• When your doctor recommends the brand-name
  medication for your treatment
• Your doctor will indicate Dispense as written
  or similar instructions
• You will pay the brand-name copay

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Generic Equivalent Program What You Should Do

• Look for a letter from CVS Caremark explaining
  which medications have generic equivalents
• You will receive this letter if you are currently
  filling your prescription(s) with a brand-name
  medication when a generic equivalent is available
• It will include the steps to take to avoid paying
  the added cost of the brand-name medication

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Generic Equivalent Program What You Should Do

• Talk with your doctor to determine if the generic
  equivalent is appropriate for you
• Ask for a new prescription from your doctor if
  you would like to change to the generic
  medication

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Generic Prescriptions Did You Know?

• Taking generics will save you money
• The copay for generic medicine will always be
  less than the brand name copay
• Generics are FDA-approved equivalents of their
  brand counterparts and cost less
• Generics typically cost 30-80 less than the
  brand name
• The FDA reviews generics to make sure they are
  safe, the same ingredients, strength, dosage form
  and performance (how it works in the body)

U.S. Food Drug Administration
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Other Pharmacy Benefit Program Enhancements
Effective 10/1/2010

• New Generic Mail Order Copay
• Your copay for all generics will be reduced to 1
  when you use the mail order pharmacy
• Discuss generic alternatives with your doctor
• Obtain a new prescription if the generic
  medication is appropriate for you

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Other Pharmacy Benefit Program Enhancements
Effective 10/1/2010

• New Coverage for Physician-Prescribed Tobacco
  Treatment Medications and Over-the-Counter (OTC)
  Medications
• You may purchase tobacco treatment prescriptions
  and over-the counter medications to help you quit
  using tobacco products
• Nicotine Replacement Therapy Patches, Gum, and
  Lozenge
• Bupropion
• Zyban
• Nicotrol Nasal Spray
• Nicotrol Inhaler
• Varenicline
• Chantix

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Other Pharmacy Benefit Program Enhancements
Effective 10/1/2010

• Discuss your desire to stop using tobacco
  products and treatment options with your doctor
• Ask if a prescription or OTC medications would
  help you with your quit attempt
• A prescription is also required for all OTC
  medications
• Present your CVS Caremark prescription ID card
  with your prescription at the local retail
  pharmacy, or use the mail order program

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Other Pharmacy Benefit Program Enhancements
Effective 10/1/2010

• The same copays apply to tobacco treatment
  medications and OTC medications as all other
  prescription copays
• Covered dependents age 17 and younger are not
  eligible for these medications
• Ask your doctor if participation in a group or
  individual tobacco dependence counseling program
  would also be of help with your quit attempt

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Other Pharmacy Benefit Program Enhancements
Effective 10/1/2010

• Dependence counseling programs available
• Your Employee Assistance Program Call
  800.852.3345, ext. 4336
• NH Smokers Helpline 800-Try-To-STOP
  (800.879.8678)
• Other group counseling programs are also offered
  in your local community, hospital and workplace
  setting

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Other Communications What You Should Know

• Look for a personalized prescription drug benefit
  booklet in the mail that will provide
• Information about your prescription drug benefits
  and how to make the best use of them
• A convenient pull-out guide outlining plan
  specifics
• You will not receive new prescription ID cards
• Continue using your current ID cards when
  purchasing prescriptions at the retail pharmacy

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What is covered under your pharmacy benefits?

• State-restricted drugs (i.e. cough syrups with
  codeine)
• Diabetic supplies, including insulin syringes
• Insulin by prescription only
• Federal legend Drugs, including
• -Cardiovascular Drugs
• -Anti-infectives
• -Dermatological Therapies
• -Ear, nose and throat medications
• -Ophthalmology drugs
• -Respiratory, allergy, cough, and cold
  medications
• -Oral diabetic drugs
• -Growth hormones and injectables

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What is covered under your pharmacy benefits?

• Compound medications
• Birth control devices and oral contraceptives
• Immunizing agents
• Tobacco treatment medications and
  over-the-counter medications (effective
  10/1/2010)

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What is not covered under your pharmacy benefits?

• Therapeutic devices or appliances (i.e. bandages,
  humidifiers)
• Non-federal legend drugs, except insulin (i.e.
  over-the-counter medications)
• Anti-Obesity Medications
• Drugs labeled Caution-Limited by Federal Law to
  Investigational Use, or experimental drugs
• Medication for which the cost is recoverable
  under any workers comp or occupational disease
  law, any state or government agency, or
  medication furnished by any other pharmaceutical
  or medical service for which no charge is made to
  the individual
• Medication taken or administered to the member
  while he or she is inpatient
• Any prescription that has reached the maximum
  number of refills specified by the physician or
  any prescription that is more than 1-year old

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• Questions?