AlaskaCare Employee News | June 2019

• Getting to Know Your Benefits: Pharmacy
• Generic Vs. Brand Drugs
• AlaskaCare Opioid Guidelines
• News from the Health Benefit Evaluation Committee
• Recipe of the Month
• Exercise of the Month
• Health Fact of the Month
• Health Benefit Contact Information

Getting to Know Your Benefits: Pharmacy

Maximize your AlaskaCare Pharmacy Benefits
The AlaskaCare Employee Health Plan includes a three-tier pharmacy structure featuring different coinsurance and copayments for medications based on drug type:

• Tier One: Generic Drugs
  Generic drugs are therapeutically, and often chemically, identical to brand name medications and are widely available at competitive prices. This is the lowest cost tier.
• Tier Two: Preferred Brand Name Drugs
  Preferred brand name drugs are brand name medications for which a generic option is not available. This is the medium cost tier.
• Tier Three: Non-preferred Brand Name Drugs
  Non-preferred brand name drugs are brand name medications, and are available in an equivalent generic form, or as a preferred brand drug. These drugs cost more to both the plan and the member. This is the highest cost tier.

Members using generic medications may experience a decrease in the cost-share for their prescription, while members using a preferred brand name or non-preferred brand name medication may pay more. Be sure to check the 2019 Pharmacy Drug Guide and the Pharmacy Quantity Limit Guide to see where your prescription is listed. Check with your provider for lower cost alternatives on your medications.

How are Drugs Assigned to a Tier?
A tool called a “formulary” is used to assign medications to different tiers. The formulary for the employee plan is the 2019 Pharmacy Drug Guide. This guide was developed not only with overall value of the medication in mind, but also drug safety, effectiveness and current use in therapy. You are free to choose a generic, preferred brand name or non-preferred brand name medication. Choosing a lower tiered drug when appropriate can provide access to the necessary medications to stay healthy, at a cost that is more affordable. Choosing a generic medication means your out-of-pocket cost will be less than if you choose a preferred brand name. Remember the lower the tier, the lower the out-of-pocket costs!

Generic vs. Brand Drugs

A generic drug is a medication created to be the same as an existing and approved brand name drug in dosage, form, safety, strength, route of administration, quality, and effectiveness. Generic medication works in the same way and provides the same clinical benefit as its brand name version. This standard applies to all FDA-approved generic medicines.

• Active Ingredients
• Safety
• Effectiveness
• Strength
• Quality
• Benefit

Generic medicines cost less than brand-name medicines Generic medications tend to cost less than their brand name counterparts because they do not have to repeat animal and clinical (human) studies that were required of the brand name to demonstrate safety and effectiveness. The reduction in upfront research costs means that, although generic medicines have the same therapeutic effect as their branded counterparts, they are typically sold at substantially lower costs. When multiple generic companies market a single approved product, market competition typically results in prices about 85% less than the brand name.

To learn more about generic drugs, visit the U.S. Food & Drug Administration's website.

AlaskaCare Opioid Guidelines

State and federal guidelines were developed to address the opioid epidemic in the United States and Alaska. New safety guidelines were adopted for the AlaskaCare plans on January 1, 2018 and were further enhanced on January 1, 2019. The guidelines limit the dispensing of opioids as follows:

• For patients that don’t normally use opioids:
  • The plan limits the maximum dosage per day to 50 mme(morphine milligram equivalent) and only allows up to a 7-day supply every 91-days.
  • A pre-authorization is required to obtain more than a 7-day supply within any 91-day period.
• For patients that regularly use opioids:
  • The plan limits the maximum dose per day to 90 mme and only allows up to a 30-day supply.
  • A pre-authorization is required periodically.
• For patients age 19 or under:
  • A pre-authorization is required for cough medications that contain opioids, and the prescription is limited to a 3-day supply.

Members are encouraged to discuss the effect of the AlaskaCare opioid dispensing policy with their providers and to contact OptumRx at (855) 409-6999 for support.

Opioids are a type of narcotic pain medication. They can have serious side effects if you don't use them correctly. For people who have an opioid addiction, their problem often started with a prescription.

Opioid Drugs Include:

Teladoc

Talk to a doctor by phone or video, anywhere, anytime.

Not feeling well? Sign up for Teladoc and you can talk to a doctor in minutes. AlaskaCare Employee Health Plan members have 24/7 access to health care for non-emergency conditions by web, phone or mobile app. The plan covers 100% of the cost for Teladoc general medical consultations. Effective June 1, 2019, your Teladoc visit copay is $0!

Teladoc is already part of your AlaskaCare Employee Health Plan, so make sure to set up your Teladoc account by July 31, 2019 for a chance to win one of 11 RTIC® Cooler prizes!