a prescription for success …expanding your pbm know-how 2009 retiree symposium making the...

A Prescription for Success …expanding your PBM know-how

2009 Retiree SymposiumMaking the Prescription Drug Benefit Work for You

Presented by:Ashley BlevinsPeter OrlaskeyJudi Middleton


World Bank Catalyst Rx Team

• Ashley Blevins, Director of Client Services, 7 years of healthcare experience

• Judi Middleton, Sr. Client Services Manager, over 25 years of healthcare experience

• Peter Orlaskey, Pharm D., Clinical Manager, 5 years of pharmacy experience

• Erin Picariello, Client Services Representative, 6 years of healthcare experience

2A Prescription for Success …expanding your PBM know-how


Catalyst Rx Corporate Overview

• Catalyst Rx is a full-service national pharmacy benefit management company providing benefits since 1994

• 4th largest publicly traded PBM (NASDAQ: CHSI)

• Manage pharmacy benefits for 6 million members

Our mission is to deliver unbiased pharmacy benefit management solutions that improve patient safety, achieve the highest standards

of care, and effectively manage our clients’ drug costs

Our mission is to deliver unbiased pharmacy benefit management solutions that improve patient safety, achieve the highest standards

of care, and effectively manage our clients’ drug costs



Catalyst Rx Customer Service • Dedicated team of experienced Nationally Certified Pharmacy

Technicians via fully integrated 24/7/365 service centers located in Las Vegas, NV, Ft. Lauderdale, FL, San Juan, PR, Avon Lake, OH, and Des Moines, IA

• Immediate access to benefit parameters, eligibility, retail and specialty data

• Q1 2009 Service Level Validation

– Consistently exceeding industry standards in all key categories

• Average speed to answer : <22 seconds

• Call abandonment rate: < 2.8%

• First call resolution: 99.7%

• Comprehensive prior authorization processing: < 24 hours



Mail Order Statistics

• January 1, 2009 – April 30, 2009– 5,706 Total Scripts Filled– 1.32 Average Days in House– 96.41% 2-day Turn Around



Generic Medications

• Accounted for over 72% of all drugs filled in 2008 vs. 56% for World Bank

• Saved an estimated $121 billion for the healthcare system in 2008

• Regulated by the Food & Drug Administration (FDA)

• Contain the same active ingredient as the Brand drug

• Manufactured in FDA approved facilities



Cholesterol Drugs• Generics

– Simvastatin, Pravastatin, Lovastatin– Average Yearly Cost: Member - $0, World Bank - $105

• Preferred Brand Names– Lipitor, Crestor, Advicor, Simcor– Average Yearly Cost: Member - $228, World Bank - $913

• Non-Preferred Brand Names– Lescol, Altocor, Vytorin, Altoprev– Average Yearly Cost: Member - $333, World Bank - $776



GERD/Heartburn Drugs• Generics

– Omeprazole, Pantoprazole– Average Yearly Cost: Member - $0, World Bank - $882– Omeprazole: $407– Pantoprazole : $ 1200

• Preferred Brand Names– Nexium, Prevacid– Average Yearly Cost: Member - $413, World Bank - $1,700

• Non-Preferred Brand Names– Aciphex, Protonix– Average Yearly Cost: Member - $632, World Bank - $1,500



Chronic Disease Non-Compliance

• What percentage of prescriptions written for chronic diseases are never picked up?

– A. 25%– B. 50%– C. 75%– D. 100%



Non-Compliance leads to:

• Unnecessary disease progression• Disease complications• Reduced functional abilities• Lower quality of life• Increased medical costs• Premature death



I forgot to take the drugs. 64%

I had no symptoms/symptoms went away. 36%

I wanted to save money. 35%

I didn’t believe the drugs were effective. 33%

I didn’t think I needed to take them. 31%

I had painful or frightening side effects. 28%

The drugs kept me from doing what I wanted to do. 25%

Nobody reminded me to keep taking them or to get refills. 20%

I had trouble getting the script filled. 20%

The drugs tasted or smelled unpleasant. 19%

I had trouble opening the bottle or swallowing the drug. 16%

I was confused by all the drugs I had to take. 15%

Reasons for Non-Compliance



How Catalyst Improves Compliance

• Education• Generics• Simplify the medication regimen• Patient reminder aids

– Auto-refill– Refill reminders– Behavioral support– Devices/Programs



Three Things to Remember!

• Share your Preferred Drug List with your Doctor

• Always ask for Generics when possible• If you are prescribed a non-preferred drug,

ask if a generic or preferred brand is available


a prescription for success …expanding your pbm know-how 2009 retiree symposium making the...

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