2018 RETIREE PLAN DESIGN ANNUAL ENROLLMENT CHANGES FOR FY19 PLAN YEAR - PowerPoint PPT Presentation

RETIREE WELL ‐ BEING FAIR PRESENTATION November 15, 2017 2018 RETIREE PLAN DESIGN ANNUAL ENROLLMENT CHANGES FOR FY19 PLAN YEAR PERIOD (Effective 03/01/18) 11/15/17 – 11/29/17

TOTAL MEDICAL PLAN COST What was the total dollar amount that Harris Health spent last plan year to pay our Medical Claims, Pharmacy Claims and Administrative Fees? A. $67,480,000 B. $87,360,000 C. $120,000,000 harrishealth.org 1

TOTAL MEDICAL PLAN COST ANSWER: C. WHICH EQUALED $120,000,000 harrishealth.org 2

MEDICAL COST INCREASE What % did our Medical Plan cost increase from FY16 to FY17? A. 8.2% B. 11.1% C. 5.4% harrishealth.org 3

FY17 MEDICAL PLAN COST ANSWER: C. 5.4% Remember – Our Harris Health group Medical Plan is funded from our own Harris Health bank account. As plan administrator Cigna does not fund the Plan, we do! harrishealth.org 4

HISTORICAL COST & TREND PER EMPLOYEE/RETIREE PER YEAR Latest 12 month spend $120M: 72.8% Medical, 20.8% Rx, 6.4% Admin/Stop Loss 5.4% 4% $12,500 $12,433 4.5% 15% $11,798 $12,259 ‐ 8% $11,791 $11,000 $11,294 7% 7% ‐ 4% 6% Harris Health has remained $10,064 $10,246 $9,500 $9,616 $9,398 below U.S. medical trend for $8,906 4 years based on the Aon $8,000 Hewitt Global Medical Trend Rates Survey Report, with $6,500 trend at 6% in 2016. $5,000 * FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 ** Cost PEPY *FY13 changed TPA to Cigna. **FY17 extended Deductible and Out ‐ of ‐ Pocket maximum by 2 months. Data Source: March 2017 FMR. harrishealth.org 5

FY19 MEDICAL PLAN DESIGN CHANGES Low Deductible Medical Plan Option ‐ 1. Individual Deductible is increasing to $750. 2. Family Deductible is increasing to $2,250 3. Individual Out ‐ of ‐ Pocket is increasing to $3,000. 4. Family Out ‐ of ‐ Pocket is increasing to $9,000. IN ‐ NETWORK BENEFITS harrishealth.org 6

FY19 MEDICAL PLAN DESIGN CHANGES (Continued) High Deductible Plan Option – Individual Out ‐ of ‐ Pocket is increasing to $3,750. All 3 Medical Plan Options ‐ Autism related Speech, Physical and Occupational Therapy & Applied Behavior Analysis (ABA) – these services are no longer subject to Annual Limits, but will be subject to Medical Necessity review (a/k/a Prior Authorization). IN ‐ NETWORK BENEFITS harrishealth.org 7

FY19 MEDICAL PLAN DESIGN CHANGES (Continued) Available to both our Pre ‐ 65 The Telehealth Copay is being reduced to and Post ‐ 65 $10 across all 3 Medical Plan options. covered Retiree population. harrishealth.org 8

PHARMACY CLAIM COST What % of our total Medical Plan spend last year was used to pay for our Pharmacy claims only? A. 33.6% B. 10.5% C. 20.8% harrishealth.org 9

FY 17 TOTAL PHARMACY COST ANSWER: C. 20.8% WHICH EQUALED $24,960,000 harrishealth.org 10

HOW DID OUR PHARMACY COST COMPARE TO 32 OTHER HOSPITAL SYSTEMS? (For Retail Pharmacy and Mail Order.) Are our outpatient prescription drug costs A. HIGHER or B. LOWER? harrishealth.org 11

HOSPITAL PHARMACY BENCHMARK 32 HOSPITAL HARRIS HEALTH BENCHMARK METRICS SYSTEMS IN SYSTEM VARIANCE GULF REGION Gross Cost PMPM $127.26 $113.76 ‐ $13.50 Plan Cost PMPM $113.82 $94.10 ‐ $19.72 PMPM = Per Member Per Month Rx = Prescriptions ANSWER: A. HIGHER harrishealth.org 12

NEW BRAND NAME DRUG DEDUCTIBLE Why is Harris Health implementing a Brand Name Drug Deductible? ANSWER: Our Harris Health prescription drug cost is above Benchmark as evidenced by the slide we just reviewed. harrishealth.org 13

NEW BRAND NAME DRUG DEDUCTIBLE How much will the new Brand Name Drug Deductible cost me? ANSWER: $100 Per Member Per Year harrishealth.org 14

GENERIC VS BRAND NAME DRUG COSTS Are Generic medications cheaper than Brand name drugs? If so, why? ANSWER: YES. The Reasons : • Brand name makers often invented the drug, a process that can cost hundreds of millions of dollars. This is the rationale for drug patents. • Patents give pharmaceutical companies a period of years when only they can make money on a product. Their investment includes advertising, like TV commercials and billboards, that’s why you don’t generally see Generic ads. harrishealth.org 15

GENERIC FILL RATE What is our generic dispense fill rate? A. 82.33% B. 85.11% C. 94.17% harrishealth.org 16

OUR GENERIC DISPENSE FILL RATE IS: Hospital Pharmacy Benchmark Harris 32 Hospital Hospital Metrics Health Systems in Benchmark System Gulf Region Variance Generic Fill % 82.33% 85.11% 2.78% NOTE: For every 1% that the Generic fill rate increases, the gross cost for Pharmacy will decrease by 3% or approximately $663,303.01. ANSWER: A. 82.33% harrishealth.org 17

FY19 REFERENCE BASED PRICING ‐ ELIMINATED 1. The Mandatory Generic Drug Program will now apply to all medications filled under the Plan (with certain exceptions tied to Diabetic medications/supplies). 2. All Drug Therapy Classes currently covered under our Reference Based Pricing (RBP) program will now fall under our Mandatory Generic Drug Program. harrishealth.org 18

FY19 MANDATORY GENERIC PENALTY If you fill a Brand name medication under our Mandatory Generic Drug Program, you will pay the Brand Copay PLUS any amount over the Generic medication cost. The Medical Plan will NOT PAY this cost difference and this cost difference WILL NOT go toward your annual Out ‐ of ‐ Pocket maximum. harrishealth.org 19

MAINTENANCE MEDICATION FILLS What is the lowest cost way to fill your outpatient Maintenance Medications? A. RETAIL or B. MAIL ORDER Maintenance Medications are those drugs that you take for chronic or long ‐ term conditions, such as High Blood Pressure, Heart Disease, Asthma and Diabetes. harrishealth.org 20

MAINTENANCE MEDICATION FILLS ANSWER: B. MAIL ORDER Why? • Each time you purchase Maintenance Medication at an in ‐ network retail pharmacy you are paying a regular Copay for your medication. • With Mail Order you purchase a 3 ‐ month supply of medication but you pay 2.5 times your regular Copay . This means that you save 1 Copay every 6 months when you utilize Mail Order. In essence, you get a 1 ‐ month supply of medication free in each 6 ‐ month period or 2 months medication free each year. harrishealth.org 21

MAIL ORDER FILL RATE Knowing that Mail Order is cheaper than retail, what do you think our Mail Order fill rate is for Maintenance Medications? A. 3.66% B. 5.13% C. 15.62% harrishealth.org 22

MAIL ORDER FILL RATE Hospital Pharmacy Benchmark HARRIS 32 HOSPITAL BENCHMARK METRICS HEALTH SYSTEMS IN VARIANCE SYSTEM GULF REGION Mail % Rxs 3.66% 5.13% 1.48% Rx = Prescriptions ANSWER: A. 3.66% harrishealth.org 23

FY19 LIVONGO ENGAGEMENT – DIABETIC MEDICATION COST WAIVER Eligibility = Pre ‐ 65 Retirees and Spouses (with Harris Health primary coverage) Diabetic members actively engaged* in the Livongo program offered through Harris Health will receive their Generic Diabetic medications and Insulin at no cost as long as they remain engaged in the program. *Engagement is determined by the vendor. Why isn’t this same benefit being offered to Post ‐ 65 Retirees? Medicare is your primary payer. Harris Health, not Medicare, selected Livongo as our preferred Diabetic program and is rewarding our Pre ‐ 65 Plan participants for being actively engaged in their Diabetic care. harrishealth.org 24

FY19 PREVENTATIVE STATINS ‐ $0 COPAY The United States Prevention Services Task Force has recommended that adults without a history of Cardiovascular Disease use a low to moderate dose Statin for the prevention of Cardiovascular Disease events and mortality when all of the following criteria are met: (1) you are aged 40 to 75 years; (2) you have 1 or more Cardiovascular Disease risk factors (i.e., Dyslipidemia, Diabetes, Hypertension, or Smoking); and (3) you have a calculated 10 ‐ year risk of a cardiovascular event of 10% or greater. If you meet all of these criteria: 1. Lovastatin will now be covered at a $0 copay OR 2. With Prior Authorization you may be able to fill Simvastatin or Atorvastatin at this $0 copay. harrishealth.org 25

FY19 HARVONI HEPATITIS C PROGRAM The financial incentive program for using Harvoni to treat Hepatitis C was previously discontinued by the manufacturer and is therefore no longer available under our Harris Health sponsored medical plan. harrishealth.org 26

FY19 OPIOID – EARLY FILL WINDOW • A tighter Early Fill Window for Opioid medications will take effect 03/01/18. • The patient must utilize 90% of their prescription before it can be refilled. OPIOID USE IS AN EPIDEMIC IN THE U.S. TODAY In the Harris U.S. Health : So why are we tightening our Early Fill Window ? We have 261 Harris Health members receiving Opioids that are NOT in compliance with CDC Opioid guidelines and 7.4% of our Opioid utilizers (144 members) have significant clinical risks, taking doses above the recommended dose and/or duration period. harrishealth.org 27