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The Catalyst

Catamaran selected as MUSC Health Plan's new pharmacy manager


By Mikie Hayes
Public Relations

As of Jan. 1, all MUSC and MUHA employees who were previously enrolled in the Standard State Health Plan were automatically enrolled in the new MUSC Health Plan. On that same day, yet unrelated to the rollout of the new MUSC plan, the entire state changed to Catamaran when it replaced Medco/Express Scripts as the pharmacy benefit manager for all state employees covered by the State Health Plan. 

As the entity responsible for the state plan, the South Carolina Public Employee Benefit Authority issued the request for proposals for the pharmacy benefits manager contract and evaluated several potential vendors. Ultimately, PEBA chose Catamaran, the nation’s fourth-largest pharmacy benefit manager, deeming Catamaran the most advantageous plan for the state.

While the timing of the simultaneous rollouts was purely coincidental, it has caused some confusion for those participating in the new MUSC Health Plan. Since the Jan. 1 introduction of both new programs, employees have noticed that the change to Catamaran has sometimes resulted in higher copays for prescriptions. As such, they have sought answers about the cost increases.

According to Mark Lyles, M.D., MUSC chief strategic officer, when PEBA decided to increase the prescription copayments beginning Jan.1, they stated publicly that copayments would have gone up regardless of the PBM vendor.

“The move to Catamaran was not associated with the new MUSC Health Plan; it just so happened that the rollouts for both programs took place on Jan.1.  South Carolina Public Employee Benefit Authority selected Catamaran as the new pharmacy benefit manager for all state employees and dependents, and this change affects MUSC employees in the new MUSC Health Plan,” said Lyles.
Another concern that has been expressed by some in the new MUSC Health Plan relates to the changes to prescription tiers. The formulary and its associated tiers are based on recommendations made by Catamaran.

Lyles explained, “Because there is a formulary — a list of prescription drugs — associated with the prescription plan, some medications may have changed tiers (copay levels) from the Medco/Express Scripts Plan in 2013 to the Catamaran Plan in 2014. It’s important to note that this change will affect all state employees and dependents, not just those at MUSC. However, those of us covered by the new MUSC Health Plan do have the advantage of lower copays when we fill prescriptions at MUSC’s on-campus retail pharmacies.”

Under Catamaran, prescription drugs are classified in three categories, Lyles explained: Tier 1 includes generic drugs, Tier 2 includes preferred name brand drugs and Tier 3 includes non-preferred name brand drugs.

Off–campus pharmacies are considered either “preferred” or “participating.” If an employee/dependent uses a preferred or participating pharmacy, they will pay the following (see table).

Preferred Pharmacy Copays:

30-day supply                  90-day supply

Tier 1                         $9                                    $22                 

Tier 2                       $36                                    $90

Tier 3                       $60                                  $150


Participating Pharmacy Copays:

30-day supply                  90-day supply

Tier 1                        $  9                                 $  27                 

Tier 2                        $36                                 $108

Tier 3                        $60                                 $180

The MUSC pharmacies discount copays of members with the PEBACOMM group code on their card:

30-day supply                  90 day-supply

Tier 1                         $ 6                                    $15                 

Tier 2                         $30                                   $80

Tier 3                         $50                                 $140


Currently, the MUSC discount is a manual process done at the pharmacies. As such, the Catamaran website will not reflect the MUSC pharmacy discount. As always, if the cost of the drug is lower than the copay, the employee will pay the lower amount.

Employees can visit mycatamaranrx.com to determine if their pharmacy is considered preferred or participating. At this site, the employee is able to set up a free account with their card ID and password of their choice and enter their medication name, strength and day-supply to see what the medication copay will be (brand vs generic, as well as at various pharmacies.) Retirees are a different classification as it relates to copays and should check with the Catamaran site (listed above) for further details.

The move to the new plan and introduction of added benefits for participants has been a relatively smooth one, and the leadership associated with the rollout remains committed to its success.

“While we continue to address a few minor issues, the rollout of the MUSC Health Plan has been proceeding incredibly well,” said Lyles. “Employees are getting accustomed to the changes and the many benefits associated with the patient-centered medical home design, and as always, we continue to welcome feedback, questions, and concerns.”

For information on Catamaran, visit https://www.musc.edu/medcenter/MUSChealthplan/index.html

January 24, 2014
 
 
 

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