Michigan Public School Employees Retirement System (MPSERS)
Michigan Public School Employees Retirement System (MPSERS)
Michigan Public School Employees Retirement System (MPSERS)
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2012 – 2013<br />
<strong>Michigan</strong> <strong>Public</strong> <strong>School</strong> <strong>Employees</strong><br />
<strong>Retirement</strong> <strong>System</strong> (<strong>MPSERS</strong>)<br />
Prescription Drug Coverage
2<br />
Topics<br />
● Pharmacy Benefits Management (PBM) Company<br />
Name News and Update<br />
● Coverage Highlights<br />
● Three Months Supply<br />
● Stages of Coverage<br />
● Looking Forward to the Future<br />
● Resources<br />
● Questions<br />
© Catamaran 2012. All Rights Reserved. May not be copied or distributed without authorization.
Pharmacy Benefits Management (PBM)<br />
Company Name News and Update<br />
Catamaran<br />
Express Scripts, Inc.<br />
© Catamaran 2012. All Rights Reserved. May not be copied or distributed without authorization.
4<br />
Pharmacy Benefits Management (PBM)<br />
Company Name News and Update<br />
● Catamaran<br />
» Formerly called Catalyst Rx.<br />
● Effective Fall 2012.<br />
» Only the name is changing. Your pharmacy<br />
services and contact information stays the same.<br />
● Express Scripts, Inc.<br />
» Formerly called Medco.<br />
● Effective plan year 2013.<br />
» The plan name is changing to Express Scripts<br />
Medicare (PDP). Look for the new logo when<br />
you receive your Annual Notice of Changes<br />
(ANOC) mailing and other Medicare related<br />
informational documents.<br />
© Catamaran 2012. All Rights Reserved. May not be copied or distributed without authorization.
Coverage Highlights<br />
Prescription Drug Coverage ID Card<br />
Drug List Formulary Updates<br />
Overview<br />
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6<br />
Coverage Highlights – ID Cards<br />
● Important information is not changing<br />
» Non-Medicare Members – New Enrollees and<br />
replacement ID cards.<br />
» You can continue to use your Catalyst Rx ID card to get<br />
your prescriptions filled.<br />
© Catamaran 2012. All Rights Reserved. May not be copied or distributed without authorization.
7<br />
Coverage Highlights – ID Cards<br />
● Prescription Drug Coverage ID Card<br />
» Medicare Part D Enrolled Member<br />
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8<br />
Coverage Highlights<br />
● Overview—Your current coverage<br />
» LivingWell Health Assessment will be mailed to members in the Fall<br />
and also advertised in the quarterly Best of Health publication.<br />
● Out of Pocket Maximums<br />
» $1,000 for Medicare Part D enrolled members.<br />
● $900 for Medicare members after completing the LivingWell Health<br />
Assessment.<br />
» $1,000 for Non-Medicare members.<br />
● $900 for Non-Medicare members after completing the LivingWell<br />
Health Assessment.<br />
» Co-Insurance<br />
● 20% member cost-share for all generics, formulary brands and<br />
preferred specialty medications (tiers 1,2,4).<br />
» $7.00 minimum and $36 maximum for < 31-day supply.<br />
» $17.50 minimum and $90 maximum for 90-day supply.<br />
● 40% member cost-share for all non-formulary brands and nonpreferred<br />
specialty brand medications (tier 3,4).<br />
» $7.00 minimum and no maximum for < 31-day supply.<br />
» $17.50 minimum and no maximum for 90-day supply.<br />
© Catamaran 2012. All Rights Reserved. May not be copied or distributed without authorization.
Three Months Supply<br />
Mail Service through Mail Order Pharmacy & the<br />
90-day at Retail Program<br />
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10<br />
Three Months Supply – Mail Service<br />
● Mail Service through Express Scripts Pharmacy<br />
» Available to all members.<br />
» Medications filled more than three times at a retail<br />
pharmacy will incur an additional sanction of 10<br />
percent.<br />
» Using mail for your maintenance prescriptions saves you<br />
trips to the pharmacy every month and saves you money<br />
with better drug pricing and avoidance of the 10 percent<br />
sanction.<br />
© Catamaran 2012. All Rights Reserved. May not be copied or distributed without authorization.
11<br />
Mail Service Contact Information<br />
● Mail Service through Express Scripts Pharmacy<br />
» Non-Medicare Members<br />
● For more information on using mail order, please call<br />
Express Scripts Mail Order Pharmacy at 1-800-711-<br />
3783 (TTY users should call 1-800-759-1089) or<br />
visit www.Express-Scripts.com.<br />
» Medicare Part D Enrolled Members<br />
● For more information on using mail order, please call<br />
Express Scripts Medicare PDP Customer Service at<br />
1-866-544-2916 (TTY users should call 1-800-716-<br />
3231) or visit www.Express-Scripts.com.<br />
© Catamaran 2012. All Rights Reserved. May not be copied or distributed without authorization.
12<br />
Three Months Supply – 90-day at Retail Program<br />
● 90-day at Retail Program<br />
» Available for Medicare Part D-enrolled members, at<br />
participating pharmacies.<br />
» Medicare provisions allow participating retail<br />
pharmacies the opportunity to participate in the 90-day<br />
network if they agree to the same pricing discounts<br />
available at mail order. This means you save money.<br />
» A complete list of pharmacies participating in the 90 day<br />
at Retail Program is available at www.Express-<br />
Scripts.com.<br />
© Catamaran 2012. All Rights Reserved. May not be copied or distributed without authorization.
13<br />
90-day at Retail Program Information<br />
● 90-day at Retail Program<br />
» If you have any questions regarding the 90-Day at Retail Program,<br />
please call Customer Service using the phone number provided on the<br />
back of your prescription drug coverage ID Card.<br />
» To access the 90-day at Retail Program participating pharmacies list:<br />
● Medicare Part D Enrolled Members<br />
» Express Scripts Medicare PDP Customer Service<br />
● Members call 1-866-544-2916 (TTY users should call 1-800-716-<br />
3231).<br />
● Or visit us on the web at www.Express-Scripts.com.<br />
90-Day at Retail Program participating pharmacies include (not limited to):<br />
Kmart Kroger Busch’s Meijer<br />
Savon Publix Costco Osco<br />
© Catamaran 2012. All Rights Reserved. May not be copied or distributed without authorization.
Stages of Coverage<br />
Medicare Part D Enrolled Members<br />
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15<br />
Stages of Coverage<br />
● Medicare Part D Enrolled Members<br />
» Initial Stage<br />
» Your plan has no Deductible<br />
» Coverage Gap<br />
● Commonly referred to as “The Donut Hole.”<br />
● $2,970 of Total Drug Spend (both plan and member costshare).<br />
● Your plan ‘fills in’ this gap for you by providing coverage so that<br />
your cost does not change.<br />
» Catastrophic Coverage<br />
● $4,730 member out of pocket expense.<br />
● Your out of pocket costs will be reduced in this stage.<br />
» Check your monthly Explanation of Benefits (EOB). This will let you<br />
know where you are at in the Stages of Coverage.<br />
© Catamaran 2012. All Rights Reserved. May not be copied or distributed without authorization.
Looking Forward to the Future<br />
The New Year<br />
2013<br />
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17<br />
Looking Forward to the Future<br />
● Members should be on the look-out for the Winter<br />
2012 Best of Health publication, where all plan<br />
updates are communicated.<br />
● Medicare Part D-enrolled members should also<br />
expect to receive upcoming annual materials such<br />
as the ANOC, EOC and Summary of Benefits<br />
around late Fall and early Winter.<br />
© Catamaran 2012. All Rights Reserved. May not be copied or distributed without authorization.
Resources<br />
Available Tools and Information<br />
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19<br />
Resources<br />
● Non-Medicare Members<br />
» Catamaran Customer Service<br />
● Members call 1-866-288-5209 (TTY users should call 1-888-206-<br />
8041).<br />
» Express Scripts mail order pharmacy service. For your maintenance<br />
medications (3-month supply / 90-day supply).<br />
● Members call 1-800-711-3783 (TTY users should call 1-800-759-<br />
1089).<br />
● Medicare Part D-Enrolled Members<br />
» Express Scripts Medicare PDP Customer Service<br />
● Members call 1-866-544-2916 (TTY users should call 1-800-716-<br />
3231).<br />
» Express Scripts Medicare PDP mail order pharmacy service. For your<br />
maintenance medications (3-month supply / 90-day supply).<br />
● Members call 1-866-544-2916 (TTY users should call 1-800-716-<br />
3231).<br />
© Catamaran 2012. All Rights Reserved. May not be copied or distributed without authorization.
Thank you for your time and the<br />
opportunity to serve you.<br />
Questions??<br />
© Catamaran 2012. All Rights Reserved. May not be copied or distributed without authorization.
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