1. SPRING 2003 - PRESCRIPTION DRUG
PLAN NEWSLETTER
Welcome to the first UM Prescription Drug
Plan Newsletter. This newsletter is being sent to all participants
in the University prescription drug plan. It updates the
2003 Prescription Drug Plan booklet you received in December
2002. We will provide updates to you several times each
year to keep you informed of changes to your prescription
drug plan, including benefit updates, new drug releases,
tips to help you obtain medications, and how to lower your
co-pays. To see the most current updates, visit either the
UM Benefits Office or Caremark Web sites.
Each section below is linked to the UM Benefits
Office Web site to provide you additional details for each
topic. In this issue, we are pleased to provide you information
that includes approval of 20 new drugs to our plan, how
to find your co-pay for any drug, increases to the quantity
limits on some drugs, and helpful tips for vacation or other
travel medication needs.
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2. NEW DRUG RELEASES
Since January 1, 2003, UM has approved 20
new drugs for the plan. A complete list of new drug releases
and their co-pay tier levels can be found at
http://www.umich.edu/~benefits/plans/drugs/updates/newdrugs03.htm
Claritin and Claritin-D were approved by
the Food and Drug Administration (FDA) for Over-the-Counter
(OTC) purchase and are no longer covered by the drug plan.
The announcement and recommendations on other antihistamines
can be found at
http://www.umich.edu/~benefits/plans/drugs/updates/claritin.htm
To learn more about allergies and the types
of medications used to treat them, see
http://www.umich.edu/~benefits/plans/drugs/updates/allergy.htm
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3. NEW FORMULARY
AND PREFERRED DRUG LIST (PDL)
A formulary is a broad listing of drugs
by category, including generic and brand name medications.
The UM formulary provides specific co-pay tier levels. The
UM Preferred Drug List (PDL) is a useful guide of select
therapeutic categories that provide the “best value”
drugs for members and physicians to choose. The PDL list
has been updated and can be found at
http://www.umich.edu/~benefits/plans/drugs/pdl.htm
A new searchable UM formulary that allows
you to find medications and their tier level has been posted
on both the UM Benefits Office and AdvancePCS Web sites.
The formulary can be found at
http://www.umich.edu/~benefits/plans/drugs/formulary.htm
or
https://umich.advancerx.com
AdvancePCS has implemented a new feature
on the AdvancePCS-UM Web site that allows you to search
for any drug and find out your specific co-payment or co-insurance
amount. You will need to log in at the Web site registration
area, go to Look Up Drug Coverage and Pricing, then click
on Search Your Formulary to get to the drug pricing feature.
Please visit the AdvancePCS Web site at https://umich.advancerx.com
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4. PLAN UPDATES
Participants in the BCBSM/United of Omaha
medical insurance plan have the advantage of Coordination
of Benefits (COB) for co-pays paid under other prescription
drug plans. The complete announcement can be found at
http://www.umich.edu/~benefits/plans/drugs/updates/cob.htm
Diabetic insulin, needles and syringes are
available at a zero ($0) co-pay under the AdvancePCS drug
card for all members. To obtain other diabetic supplies
that are available from your medical insurance plan, see
the complete announcement at
http://www.umich.edu/~benefits/plans/drugs/updates/diabetic.htm
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5. MAIL ORDER PHARMACY
AdvanceRx.com and the Benefits Office apologize
for the inconvenience to the members who experienced mail
order delays and other problems in January or February.
All mail orders are now processed and returned to you within
10-14 days. For a complete understanding of when and how
to use the AdvancePCS mail order pharmacy, see
http://www.umich.edu/~benefits/plans/drugs/mailorder.htm
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6. NEW QUANTITY
LIMITS
The quantity limit list has been updated
and some drug quantity allowances have been increased (e.g.,
migraine drugs). If your medication need exceeds the quantity
limits on the list, your physician may contact AdvancePCS
to discuss additional supplies. For all Proton Pump Inhibitors
(gastric acid blocking drugs) such as Prilosec or Protonix,
the quantity limit is 120 per year based on manufacturer
labeling and clinical criteria that ensure treatment guidelines
are followed. Additional supplies are available if your
physician calls 1-800-294-5979 at AdvancePCS to request
the additional supply, and your condition meets the treatment
guidelines. The complete list of quantity limits can be
found at
http://www.umich.edu/~benefits/plans/drugs/limits.htm
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7. SELF-ADMINISTERED
INJECTABLES LIST
New drugs were added to the list of prescribed
medications that individuals can safely self-administer.
The complete list can be found at
http://www.umich.edu/~benefits/plans/drugs/sinject.htm
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8. PRIOR AUTHORIZATION
(PA) AND APPEALS
There are several drug classifications that
require Prior Authorization (PA). These drugs are on the
PA list due to added safety and cost concerns, and the plan
requires that the use of the drug meets clinical criteria
and follows acceptable treatment guidelines. If your drug
requires a PA, your physician must call AdvancePCS at 1-800-294-5979
before the medication can be approved. The PA list can be
found at
http://www.umich.edu/~benefits/plans/drugs/priorauth.htm
If you did not receive a medication or a
supply you requested, you have the right to appeal the decision.
See “Understanding the AdvancePCS Prior Authorization
and Appeal Process” at
http://www.umich.edu/~benefits/plans/drugs/claimsappeal.htm
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9. DOSE OPTIMIZATION
Ten (10) drugs now have supply limits in
instances where the medication is taken twice or several
times per day, but can be safely taken with a single daily
dose. The Dose Optimization program results in significant
cost savings to the UM drug plan, helps to limit future
increases in premium costs for the University and members,
and helps to avoid future co-pay increases for all members.
Details on the dose optimization program can be found at
http://www.umich.edu/~benefits/plans/drugs/doseopt.htm
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10. HOW TO LOWER
YOUR CO-PAYS
(1) Ask your physician or pharmacist if
a generic alternative is available. Using a generic lowers
your co-pay and saves you money.
(2) Ask your physician if a “preferred” drug
is available.
(3) Order your larger supplies from mail order…you
can receive up to a 90-day (3 month) supply for only two
(2) times the co-pay.
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11. GENERAL REMINDERS
Travel Supplies
If you plan on traveling and need an additional one-month
supply of medication, call AdvancePCS at 1-866-485-0268
and ask for a “vacation override.” If you are
leaving the U.S. for more than 90 days and need additional
supplies, contact the Benefits Office at 734-763-1217.
Dates of Birth
Some members have experienced claim rejections for dependent
prescriptions because the dependent date of birth at UM
was not recorded or accurate. Please keep the UM Benefits
Office current with your address and any dependent information.
Call the HR/Payroll Service Center at 734-615-2000 or 1-866-647-7657
(toll free) with any questions regarding your prescription
drug enrollment.
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12. KEEP YOUR ADDRESS
CURRENT
It is especially important that the University
always have your current home and office addresses so you
can receive benefits mailings and other important information.
If your home or office address changes, make sure you update
your address with the University. You can:
(1) Email your change of address to address.change@umich.edu
(2) Call the HR/Payroll Service Center at 734-615-2000 or
1-866-647-7657 (toll free).
(3) View and update your Current Address (home address)
on Wolverine Access. Go to the Wolverine Access home page
at http://wolverineaccess.umich.edu.
Click on Human Resources and log in using your uniquename
and Kerberos (UMICH) password. Then click on Personal Information,
Address and Phone Number.
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13. QUESTIONS
If
you have questions regarding the Prescription Drug Plan,
you can email them to benefits.office@umich.edu.
Benefits Office staff will respond to your message.
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