a prescription for success …expanding your pbm know-how 2009 retiree symposium making the...
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A Prescription for Success …expanding your PBM know-how
2009 Retiree SymposiumMaking the Prescription Drug Benefit Work for You
Presented by:Ashley BlevinsPeter OrlaskeyJudi Middleton
A Prescription for Success …expanding your PBM know-how
World Bank Catalyst Rx Team
• Ashley Blevins, Director of Client Services, 7 years of healthcare experience
• Judi Middleton, Sr. Client Services Manager, over 25 years of healthcare experience
• Peter Orlaskey, Pharm D., Clinical Manager, 5 years of pharmacy experience
• Erin Picariello, Client Services Representative, 6 years of healthcare experience
2A Prescription for Success …expanding your PBM know-how
A Prescription for Success …expanding your PBM know-how
Catalyst Rx Corporate Overview
• Catalyst Rx is a full-service national pharmacy benefit management company providing benefits since 1994
• 4th largest publicly traded PBM (NASDAQ: CHSI)
• Manage pharmacy benefits for 6 million members
Our mission is to deliver unbiased pharmacy benefit management solutions that improve patient safety, achieve the highest standards
of care, and effectively manage our clients’ drug costs
Our mission is to deliver unbiased pharmacy benefit management solutions that improve patient safety, achieve the highest standards
of care, and effectively manage our clients’ drug costs
3A Prescription for Success …expanding your PBM know-how
A Prescription for Success …expanding your PBM know-how
Catalyst Rx Customer Service • Dedicated team of experienced Nationally Certified Pharmacy
Technicians via fully integrated 24/7/365 service centers located in Las Vegas, NV, Ft. Lauderdale, FL, San Juan, PR, Avon Lake, OH, and Des Moines, IA
• Immediate access to benefit parameters, eligibility, retail and specialty data
• Q1 2009 Service Level Validation
– Consistently exceeding industry standards in all key categories
• Average speed to answer : <22 seconds
• Call abandonment rate: < 2.8%
• First call resolution: 99.7%
• Comprehensive prior authorization processing: < 24 hours
4A Prescription for Success …expanding your PBM know-how
A Prescription for Success …expanding your PBM know-how
Mail Order Statistics
• January 1, 2009 – April 30, 2009– 5,706 Total Scripts Filled– 1.32 Average Days in House– 96.41% 2-day Turn Around
5A Prescription for Success …expanding your PBM know-how
A Prescription for Success …expanding your PBM know-how
Generic Medications
• Accounted for over 72% of all drugs filled in 2008 vs. 56% for World Bank
• Saved an estimated $121 billion for the healthcare system in 2008
• Regulated by the Food & Drug Administration (FDA)
• Contain the same active ingredient as the Brand drug
• Manufactured in FDA approved facilities
6A Prescription for Success …expanding your PBM know-how
A Prescription for Success …expanding your PBM know-how
Cholesterol Drugs• Generics
– Simvastatin, Pravastatin, Lovastatin– Average Yearly Cost: Member - $0, World Bank - $105
• Preferred Brand Names– Lipitor, Crestor, Advicor, Simcor– Average Yearly Cost: Member - $228, World Bank - $913
• Non-Preferred Brand Names– Lescol, Altocor, Vytorin, Altoprev– Average Yearly Cost: Member - $333, World Bank - $776
7A Prescription for Success …expanding your PBM know-how
A Prescription for Success …expanding your PBM know-how
GERD/Heartburn Drugs• Generics
– Omeprazole, Pantoprazole– Average Yearly Cost: Member - $0, World Bank - $882– Omeprazole: $407– Pantoprazole : $ 1200
• Preferred Brand Names– Nexium, Prevacid– Average Yearly Cost: Member - $413, World Bank - $1,700
• Non-Preferred Brand Names– Aciphex, Protonix– Average Yearly Cost: Member - $632, World Bank - $1,500
8A Prescription for Success …expanding your PBM know-how
A Prescription for Success …expanding your PBM know-how
Chronic Disease Non-Compliance
• What percentage of prescriptions written for chronic diseases are never picked up?
– A. 25%– B. 50%– C. 75%– D. 100%
9A Prescription for Success …expanding your PBM know-how
A Prescription for Success …expanding your PBM know-how
Non-Compliance leads to:
• Unnecessary disease progression• Disease complications• Reduced functional abilities• Lower quality of life• Increased medical costs• Premature death
10A Prescription for Success …expanding your PBM know-how
A Prescription for Success …expanding your PBM know-how
I forgot to take the drugs. 64%
I had no symptoms/symptoms went away. 36%
I wanted to save money. 35%
I didn’t believe the drugs were effective. 33%
I didn’t think I needed to take them. 31%
I had painful or frightening side effects. 28%
The drugs kept me from doing what I wanted to do. 25%
Nobody reminded me to keep taking them or to get refills. 20%
I had trouble getting the script filled. 20%
The drugs tasted or smelled unpleasant. 19%
I had trouble opening the bottle or swallowing the drug. 16%
I was confused by all the drugs I had to take. 15%
Reasons for Non-Compliance
11A Prescription for Success …expanding your PBM know-how
A Prescription for Success …expanding your PBM know-how
How Catalyst Improves Compliance
• Education• Generics• Simplify the medication regimen• Patient reminder aids
– Auto-refill– Refill reminders– Behavioral support– Devices/Programs
12A Prescription for Success …expanding your PBM know-how
A Prescription for Success …expanding your PBM know-how
Three Things to Remember!
• Share your Preferred Drug List with your Doctor
• Always ask for Generics when possible• If you are prescribed a non-preferred drug,
ask if a generic or preferred brand is available
13A Prescription for Success …expanding your PBM know-how
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