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| Karen Burton, Aviation, uses a mail-order
pharmacy to get three months' worth of prescription for the price
of two months. Photo by Dave Schafer |
Dave Schafer
Even with benefits from the city, the six medications Karen Burton
takes daily would cost nearly $2,500 per year at her local Walgreens.
But the widow has found a way to ease those costs.
She uses a mail-order pharmacy.
Through the home-delivery service, Burton gets three months worth
of drugs for the price of two months.
“It’s a lot cheaper,” said Burton, senior account
clerk with the Aviation Department. “I don’t think anybody
wants to throw their money away.”
Since July 2000, AdvancePCS has been the mail-order pharmacy for
Blue Cross Blue Shield of Texas, the city’s health-care provider.
That will soon change. On Jan. 1, Prime Therapeutics will become
the pharmacy benefits manager for employees and retirees covered
under the city’s plan.
Few changes
Except for the reclassification of some drugs from preferred to
nonpreferred status, members shouldn’t notice any changes,
said Stacy Sloan, strategic account executive with BCBSTX.
“We expect to have greater control over pharmacy costs and
how we manage the pharmacy benefits for our customers,” Sloan
said. “The processing and how it will appear to the member
will be seamless. The only changes that the member will feel will
be the formulary list.”
A formulary is the list of drugs BCBSTX prefers doctors prescribe.
The city’s formulary breaks down into three categories: generic,
preferred and nonpreferred. The categories have an ascending copay
of $10, $30 and $45.
The city’s formulary list will change May 1, 2005. The 2005
preferred drug list will be available Jan. 1 on BCBSTX’s Web
site, www.bcbstx.com, Sloan said.
Just three of the 25 prescription drugs most used by city employees
and retirees are moving from preferred to nonpreferred: Pravachol,
Wellbutrin and Oxycontin CR. All have generic versions available.
Actos, which improves blood-sugar control for people with type
2 diabetes, is also one of those 25 most-used drugs. It will move
from nonpreferred to preferred, meaning it will have a lower copayment.
Sloan said safety, effectiveness, uniqueness of drug and overall
cost are factors that determine which drugs are in the preferred
list
HMO Blue Texas plan members will have access to the same pharmacies
they have now. About 97 percent of PPO plan pharmacies will be covered,
Sloan said.
Except for narcotics and compound drugs, which have to be mixed
at the pharmacy, prescriptions with refills left won’t have
to be rewritten by your doctor, Sloan said.
Members who expect to run out of medication before Jan.10, 2005,
should mail their prescriptions to AdvancePCS before Dec. 24, Sloan
said. Those who don’t need new medications until after Jan.
10 should mail their prescription to Prime around Dec. 24.
For new prescriptions written in mid- to late December, ask your
doctor to give you a 30-day script to fill at the local pharmacy
and an additional 90-day prescription to send to Prime.
Prime manages pharmacy benefits for Blue Cross Blue Shield chapters
in six other states and will add two more, including Texas, in January.
Because the medications are bought in bulk, the cost per pill will
decrease, saving BCBSTX money.
Savings could be passed to the city and help offset the escalating
cost of prescription drug benefits, which for the city increased
7.25 percent in FY 2003-2004.
Mail-order
benefits
Because personal data cannot be carried over from one pharmacy manager
to another, members need to fill out new member profiles. Members
can do this by visiting the pharmacy section of www.bcbstx.com and
clicking on Prime Therapeutics; calling Prime’s customer service,
(877) 357-7463; or mailing a completed member and dependent history
section of the mail-order form to Blue Cross and Blue Shield of
Texas, c/o PrimeMail Pharmacy, P.O. Box 650041, Dallas, TX 75265-0041.
For Burton, the process should be seamless because all her drugs
remain in the same formulary categories.
Refills are just a phone call away and the packages are delivered
to the members’ door, said Judy Kelley, vice president for
mail services for Prime. Doctors or members should send in new prescriptions
via postal mail.
About 75 percent of faxes don’t contain enough information
on drug specifications or the patient, so the pharmacy has to contact
the doctor or customer to get the rest of the information, Kelley
said. On average, it takes 2.75 days to reach physicians or customers,
delaying the time it takes for the prescription to be filled.
New medications will arrive in 10 to 14 days after Prime receives
the order. Refills, which can be ordered by phone or the Internet,
often leave the pharmacy the same day they are ordered.
Prime’s automated pill dispensary system ensures the correct
pills and quantity are dispensed for the correct prescription and
that the new drug won’t interact with other drugs the member
is already taking, Kelley said.
Kelley said 9/11 changed the way Prime sends packages through
the mail. Prime is the first mail-order pharmacy to cap pill vials
with an airtight, tamper-proof foil seal.
“With the Anthrax scare after 9/11, we started thinking
we need to ensure that nobody has opened that bottle or done anything
with it,” Kelley said. “And the way to do that is with
that seal.”
The seal also protects the pills from spilling during the delivery
process.
If a member has the time to wait for the drugs to arrive at the
front door, it’s certainly more convenient to use mail order,
Burton said. And it’s much cheaper.
“Unless you’ve used it, you really don’t know
how much you’ll save,” she said.
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