BULLETIN 2005 - 11
TO ALL BENEFIT CONTACTS
Via Fax

NOTE: The Prescription Drug page (http://das.ohio.gov/hrd/oem/p4_05.htm) of the on-line Comparison Chart and Guide has been updated with the following information.

Drug Formulary:

For some participants in the state health plans a key factor in making a health plan choice is the plan's drug formulary. Each health plan has its own formulary. The formulary indicates the brand name drugs that are considered “preferred” and have the retail copay of $20 (30 day supply) and mail order copay of $50 (90 day supply). Those brand name drugs not on the formulary are considered “non-preferred” and have a copay of $40 for retail and $100 for mail order. If employees and/or their family members use several brand name drugs, the formulary can be an important financial factor. Please note that generic drugs are the same for all of the plans: they have a copay of $10 for retail and $25 for mail order.

To assist in plan selection, the PlanFormularyComp.pdf attachment is a comparison of the top 50 drugs (by usage) indicating what the copay would be for each plan. For several of the plans the vast majority of these top 50 brand name drugs are considered preferred (see summary at bottom of attachment). In most if not all cases there is an alternative brand name drug that is considered preferred ($20 retail copay) that could be substituted. What drug you take would be a decision you and your doctor would make.

Realizing there are thousands of drugs and this list only highlights the top 50, we want to encourage employees to verify the copay level of their drugs by the plans being considered. At the bottom of this email are the steps to determine drug availability and cost-level for each plan. If you have any questions, please contact the particular health plan. If the plan does not meet your need, please contact our customer service unit at 1-800-409-1205.

Please note that several of the plans use the term “tiers”. The copays for the tiers are:
Tier 1: (Generic)$10 retail; $25 mail order
Tier 2: (Brand Preferred/formulary)$20 retail; $50 mail order
Tier 3: (Brand non-preferred/non-formulary) $40 retail; $100 mail order

Attached you will find 2 documents that are updates to Open Enrollment information:
-- Drug formulary comparison by plan (PlanFormularyComp.pdf)
-- Formulary differences between ESI and Medco (CurrentESIDrugsNotOnMedco.pdf)

Please review these documents and distribute them to your employees, as you deem appropriate. They both provide new information that, for some employees, could influence their health plan election.

The first document shows a side-by-side comparison of all available health plans and their retail copayments for the top 50 medications utilized by state employees.

The second document is for current Ohio Med members only. It is a list of the 79 drugs that are on the ESI formulary that are not on the Medco formulary. Employees currently taking one of these medications will continue to be able to purchase it at the formulary copay level until January 1, 2006. At that time, the drugs will be considered non-formulary.

This information has been added to the Open Enrollment information on the Benefits’ Web site.

If you have any questions, please contact Benefits Customer Service at (614) 466-8857 or send an E-mail to benefits@das.state.oh.us

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Instructions for finding drug copays at each of the health plans

Aetna:
Go to http://aetna.com
Select: Members and Consumers
Select: Medication Formulary Guide
Select: Formulary Search
For item #2, select: Three-Tier Copay/Open Formulary; Or call Aetna at 800-520-4785.

OhioMed: simply call Medco Health at 800-903-8030. Indicate your drugs and dosage amounts. Customer service rep will verify the copay amounts and alternatives. Please remember that Medco will be grandfathering 79 drugs that are on the current Express Script’s formulary that are not on the Medco formulary.

UnitedHealthCare:
Go to www.365wellst.com
Select Prescription Drug List
Select 2005 Drug List
or call UnitedHealthcare at 877-442-6003.

The Health Plan:
Call 888-847-7902 to verify your drug copays.

Paramount:
Go to www.paramounthealthcare.com
Select: Member Services
Select Prescription Drug Program
Select Preferred Drugs
Select 2005 Preferred Drug List
Or call Paramount at 800-462-3589.

QualChoice:
Go to www.qualchoice.com
Select: Searchable Drug Formulary. You can enter the specific drug name or click on the "Search by Therapeutic Class" or "Search by Alphabetic Index"
Click on the highlighted drug name to see the formulary status of the drug including whether the drug requires prior authorization.
Or call QualChoice at 800-260-2643.