From The University Record, June 4, 2001

Editorâs note: Late in 2000, Provost Nancy Cantor and Robert Kasdin, executive vice president and chief financial officer, charged the Prescription Drug Work Group 2002 with examining prescription drug coverage in University health plans. To better understand the needs of the University community, the Work Group gathered input from focus groups composed of faculty, staff and retirees. A summary of what transpired in those focus groups follows.

By Kate Kellogg
Human Resources and Affirmative Action

Although faculty and staff value their prescription drug benefit, they would like to see changes that would protect employees from high costs, provide coverage for all employees through a single plan, and guarantee a continuous and flexible benefit for retirees.

These are a few of the findings that emerged from a series of 24 focus groups held on all U-M campuses during fall 2000 and January 2001. About 400 randomly selected faculty and staff, and 42 retirees participated in these forums.

In reporting findings from the focus groups, outside consultants Ovo Partners identified themes that arose repeatedly and that appeared to have high importance in the context of particular discussions. The dominant themes are summarized below.

For more details on the Focus Group 2002 report, visit the Benefits Web site, www.umich.edu/~benefits. The site includes that report in full, as well as the Report of the Prescription Drug Work Group 2002 to the University of Michigan Executive Officers and the series of articles on prescription drugs that ran in the Record last fall.

Cost control
Many participants were concerned about the impact of increasing prescription drug costs on household finances. Higher co-pays disproportionately affect employees at lower salary levels, they noted.

The majority favored a plan that would cap individual annual costs while maintaining the fixed co-pay method of cost sharing. The fixed co-pay, most agreed, best enables employees to budget for medicine needs and to most effectively use their pretax medical reimbursement account.

In addition, people said they would like a reference point for the total cost of their medications.

Single plan
Groups showed support for a single prescription drug plan, independent from the health plans, that would apply to union and retiree populations as well as nonunion active employees. Participants reasoned that a single plan would result in cost savings because it would cover a larger population and improve the Universityâs price-negotiating position.

Many believe a single prescription drug plan would be easier for the University to administer and for members to understand than the current system of multiple plans with varying coverage.

More consistent coverage
Participants indicated that some medically necessary drugs are not covered under all of the current plans. Several noted that their plans do not cover categories such as contraceptives and psychiatric drugs.

Most agreed they are willing to accept more tiers, or graduated levels of co-pay, for certain brand-name drugs in order to keep the formulary as broad as possible. The formulary is the list of prescription drugs covered under a health plan.

More flexibility in delivery
Participants favored high flexibility in prescription drug delivery. They advocated for all options, including a nonrestricted pharmacy network, mail order, Internet and the ability to obtain medications outside of the local area. Restricting the network potentially would minimize membersâability to select their pharmacy.

More extensive education
Focus groups felt that the University has the responsibility to see that all parties in the medical community÷from physicians to pharmacists÷educate patients. Physicians should educate patients on all aspects of the medications they prescribe and treatment plans. Pharmacists, as well as physicians, should educate patients on drug utilization, side effects and substitutions of generic drugs for brand-name drugs.

More communication
Participants want more communication from the University about changes in prescription drug plans and the rationale behind changes. Communication about the total plan structure should occur prior to open enrollment and include information on formulary structure and maintenance drugs.

Retireesâ concerns
The University remains committed to the prescription drug needs of its retirees. Some members of the retiree focus groups, who ranged in age from the late 50s to early 80s, want assurance that the University will continue to provide the prescription drug benefit throughout their retirement years. Retired faculty and staff worked with the understanding that coverage would be there in time of need, they noted. This benefit was part of the employment package and implicitly promised during their active years of service.

Active faculty and staff as well as retirees expressed concern about the impact that changes in retiree benefits would have on those living on a fixed income. Both groups also noted that aging brings health changes that likely will result in increased prescription drug use.

Retirees had the most concerns about flexibility and delivery. They would like to see the number of maintenance drugs÷those that come in 90-day supplies÷expanded. Quantity limits on maintenance drugs often require multiple trips to the pharmacy.

Most retirees said they prefer using the same pharmacy for all prescriptions, for both convenience and safety reasons. They believe pharmacists are more likely to catch drug interactions when all prescriptions are filled at the same pharmacy.

Like active employees, the retirees want to be included in the decision-making process. Some felt the University should better inform those about to retire about benefit options and health plan choices.

The focus group feedback included these themes, as well as comments from public hearings and messages sent via e-mail. The Work Group gave careful consideration to this input.

The Prescription Drug Work Group 2002 welcomes comments and opinions on the focus group findings. Readers can send e-mail comments to prescription.drugs@umich.edu.