2017 N NMPSI SIA Regiona onal Traini ning ng M Meeting ng ERNESTINE C ERN CHA HAVEZ DEPUTY DE TY DI DIRECTOR
NMPSI SIA T A TODAY • Covered Lives on Medical • Staff • 22,730 Employees • 11 FTE • 50,517 Total Lives • Board of Directors • 11 Board Members • 88 School Districts (Mandatory) • 2 NEA-NM • 1AFT-NM Excludes APS • 3 Governor Appointees • 1 Superintendents’ Association • 100 Charter Schools (Mandatory) • 1 New Mexico Association of School Business Officials • 1 Educational Entities at Large • 26 Educational Entities • 1 School Boards Association • 1 Public Education Commission
Legis isla lativ ive Proces ess s – FY18 Appr 18 Approved ed Budget Fund FY17 Operating FY18 Appropriation FY18 Appropriation Budget Request Benefits $320,859,700 $351,995,200 $325,783,600
HISTORI RICAL L LOO OOK Rat ate Increase ses a s and Fun und Bal alan ance Plan Year Fund Balance at Rate Increase Fund Balance at End of Plan Start of Plan Year Year 2010-2011 $6.1 million Medical 6.4% $23.9 million Dental 6.4% 2011-2012 $23.9 million Medical 0.0% $28.5 million Dental 0.0% 2012-2013 $28.5 million Medical 6.1% $31.6 million Dental 0.0% 2013-2014 $31.6 million Medical 6.6% $42.3 million Dental 3.0% 2014-2015 $42.3 million Medical 1.5% $41.4 million Dental 0.0% 2015-2016 $41.4 million Medical 4.0% $20.4 million Dental 0.0% 2016-2017 $20.9 million Medical High 8.30% $15.6 million Medical Low 7.15% (projected) Dental 0.0% 2017-2018 $15.6 Million Medical High 3.98% $23.2 million (Projected) Medical Low 1.82% (projected) HMO 3.98% Dental 0.00%
Fy17 Pl Plan Design gn Changes Benefit P Plan Reduction ons Change FY17 Estimated Savings Medical Increased calendar year plan deductibles effective 1/1/17 $5.5 million High Option Plan - from $300 to $750 for in-network services Low Option Plan – from $1500 to $2000 for in-network services Increased calendar year out-of-pocket maximum effective 1/1/17 $5.0 million High Option Plan – from $2800 to $3750 for in-network services Low Option Plan – from $3500 to $3750 for in-network services Value of Medical Plan Design Changes (6 months) $10.5 million Change FY17 Estimated Savings Prescription Increased copayments on diabetic oral medications, retail generic, mail $4.5 million generic, retail preferred brand, mail preferred brand, and specialty medications effective 7/1/16 Eliminate coverage for over-the-counter (OTC) medications (Proton Pump $1.2 million Inhibitors, Antihistamines and Intranasal Steroids) effective 7/1/16 Value of Prescription Plan Design Changes (12 months) $15.7 million
Fy17/F /FY18 U Upcom oming Pl g Plan Design ch changes Ben enefi fit p plan reducti tions
SaveonSP Cop Copay Assistance O Offset Prog ogram am ( (July 1, 1, 2017) 2017) CLIENT IMPACT FOR PATIENTS EXAMPLE AND THE CLIENT • $ 2.4M savings for the • 52K lives plan • $70 copay for brand specialty • $ 3.84 PMPM client • 379 Members with 2,438 refills savings * • $ 0 member copay BY IMPLEMENTING SAVEON SP COPAY OFFSET PROGRAM *Savings based on most expansive drug list and actual savings will vary based on state certification and are not guaranteed. Official savings will be provided by SaveonSP. ESI does not endorse the services provided by SaveonSP or provide any guidance or endorsement to SaveonSP on the legal structure of the services offered by SaveonSP, including without limitation, any representation of compliance with any applicable laws.
Be Bene nefits f fund c und claims hi history
Medical Cost Dr Drivers • Affordable Care Act costs • $2.7 million in Reinsurance fees in FY15; $1.7 million FY16; $700K FY17 • Provider reimbursement fees • Increased Cost of Catastrophic Claims • FY14 - $23.4 million • FY15 - $44.7 million • FY16 - $51.4 million • Top Medical Conditions • Inflammatory Conditions • Diabetes • Cancer • Hodgkin’s Disease • Coronary artery disease • Cardiovascular disease • Stroke • Injury and poisoning • MS • Maternity • Vaccine Program • $1.4 million FY16 (FY15 cost - $740k; FY14 cost; FY14 $696k)
Prescription d drug c cos ost d driver ers • Increased prescription drug costs driven by increased utilization and inflation • Rx Plan drug cost increased 7.4% from $77.69 per member per month (PMPM) to $83.46 PMPM driven by Specialty Drugs • Non-specialty plan cost PMPM trend -0.6% - $51.80 PMPM • Specialty plan cost PMPM trend 23.8% - $31.66 PMPM • Largest trend driver – diabetes at 23.9% (prior was Hep C) • Top Drugs • Oral Diabetic Drugs/Insulin • Humira & Enbrel • Viekira Pak • Cancer Drugs • Top Conditions • Diabetes - $9.6 Million • Inflammatory Conditions $6.4 Million • Cancer - $3 Million • Hep C - $2.8 Million • MS - $2.5 Million • Asthma $2.3 Million • Hemophilia - $1.5 Million
Clinical al Savi vings and and Rx Progr ogram ams • Utilization Management (prior authorizations, drug quantity rules, step therapy) • For FY16, NMPSIA saved $4 million • SafeGuardRx • Hepatitis Cure Value Program Lowered the cost of a cure - 100k cap) • Cholesterol Care Value Program (Avoiding up to 90% of the plan cost increases in this therapy class) ; • Oncology Care Value Program (Aligning cost with efficacy for selected oncology drugs) • Inflation Protection Program for Brand Name Drugs (Inflation protection guarantee) • Fraud Waste and Abuse Program Identifies outliers, flags suspicious activity, gather evidence, investigate, intervention by restricting certain members to one pharmacy for substance abuse medications (opioids, ADHD, sleep, anxiety, muscle relaxers, anticonvulsants) • fraudulent claims - out-of-state pharmacy filling unauthorized diabetic supplies • Flagged member with 9 prescribers and 2 pharmacies • SaveonSP Copay Assistance Offset Program
Be Bene nefits U Upda pdate • Upcoming RFP for Pharmaceutical Benefits Management Services - New contract effective July 1, 2018 Interagency Benefits Advisory Committee Albuquerque Public Schools (APS) New Mexico Public Schools Insurance Authority (NMPSIA) New Mexico Retiree Health Care Authority (NMRHCA) State of New Mexico, Risk Management Division (RMD) • 2017 Program Guides at print – will be shipped early August • electronic copy available late-July at nmpsia.com • Individual benefit plan information under “Insurance Carriers” tab at nmpsia.com
NM NMPSIA W A Wellne ness Visit: https://nmpsia.com Click on “NMPSIA Wellness” • Select “Well onTarget” for Blue Cross Blue Shield Members • Select “Wellness at Work” for Presbyterian Members •
Questions??? 410 Old Taos Highway Santa Fe, New Mexico 87501 Phone: 505-988-2736 Fax: 505-983-8670 Website: https://nmpsia.com ernestine.chavez@state.nm.us
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