TAC HEBP's size enables extremely competitive prescription pricing. This helps stabilize and ultimately lower premiums for our members. The Pool uses a separately contracted prescription drug program to provide excellent services and keep drug costs in check.
CVS Caremark has several features designed to help contain costs for members and improve patient prescription drug access.
- Maintenance Prescription Choice — Through CVS Caremark, TAC HEBP offers mail-order service to all groups, regardless of size. Our mail-order program offers members a savings of one-third of the co-pay for a 90-day prescription, either through CVS Caremark’s mail order pharmacy or at CVS retail pharmacies. This is offset in cost because of the increased drug discount and decreased administration fee. The mail-order benefit can greatly reduce out-of-pocket costs for you and your employees.
- Specialty Guideline Management –This program helps ensure that members meet the appropriate criteria before specialty medication is first dispensed, experience the expected therapeutic outcomes while on therapy, and discontinue unsafe or ineffective therapy. The program includes the Specialty Preferred Drug Strategy that encourages providers to prescribe clinically-effective therapies at the lowest net cost via step therapy. Step therapy recommends the provider prescribe the least costly clinically effective therapy before prescribing a more expensive medication for the member. CVS Caremark considers current evidence-based guidelines, drug efficacy, FDA-approved indications, safety profile and prescribing patterns.
- Dispense As Written (DAW) — With this program, if a physician allows a generic to be substituted for a brand drug but the patient chooses the more expensive brand drug, they will pay the difference between the actual costs of the two drugs in addition to their co-pay, keeping plan costs affordable.
- Pharmacy Benefit Manager Services — At CVS Caremark, teams of skilled physicians, researchers and analysts work together to find new and better ways to optimize the delivery of patient care. The services include enhancing drug therapy protocols, creating physician education models, forecasting therapeutic impacts of drugs and finding better ways to address the health needs of specific populations.
Prescription Care Management
TAC HEBP has also partnered with Prescription Care Management (PCM) to implement a new prescription drug savings review program.
The program helps Pool members identify potential efficiencies and cost-saving opportunities to reduce prescription drug costs and keep the overall cost of the Pool down, too.
PCM’s system is currently only available for the Pool’s fully-insured members. The program does not change the current pharmacy benefits offered by TAC HEBP and administered by CVS/Caremark.
How it Works
PCM works in conjunction with your existing pharmacy plan to help doctors control prescription drug costs while increasing the overall level of care provided to members.
The focus of PCM the program is to present Pool members with the right drug for the right price while keeping drug interactions and safety a top priority. This involves regular communications with the patient’s doctor to ensure the correct drug at the right dose is provided.
Pool members may receive a phone call from PCM to share when safety improvements and cost-saving opportunities have been identified and approved by their doctor. As a member, no action is required unless contacted by PCM regarding an option to change from a high-cost drug to a lower-cost alternative. If contacted, a yes or no is all they ask.
Pool members are encouraged to contact PCM’s member services department at (800) 281-7050 with any questions or concerns. Pool members can also contact PCM directly for a complete medication review at any time. By contacting PCM for a free review, they can be proactive in identifying potential savings.
PCM is a leading provider of pharmacy engagement programs. For more information on this program, please visit PCM’s website www.pcmsavings.com.
Call or email your TAC Health and Benefits Services employee benefits consultant for more prescription benefits information, (800) 456-5974.
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