Medicare Part D MTM: A Medicare PDP s Perspective

2. Medi-CareFirst�sPart D Plan Options

3. Medi-CareFirst�sPreferred Drug List

4. MTMS: How we got here�Regulations for MTMS Cost-effective drug utilization management program (UM) Quality assurance measures (QA) MTMS Program CMS recognizes the overlapping nature of these 3 types of programs and how they may complement each other Regulations site all three of these modalities are necessary in Part D. The Outcomes Program is a system that addresses all of them.Regulations site all three of these modalities are necessary in Part D. The Outcomes Program is a system that addresses all of them.

5. Medi-CareFirst Targeted Beneficiaries Patients who have 3 or more chronic diseases Patients who at taking 3 or more chronic medications Patients who are identified as likely to incur annual costs that exceeds $4000 Regulations site all three of these modalities are necessary in Part D. The Outcomes Program is a system that addresses all of them.Regulations site all three of these modalities are necessary in Part D. The Outcomes Program is a system that addresses all of them.

6. The PDP and MA-PDAdministrator�s Options Use traditional programs utilized to managed pharmacy benefits and label them as our MTM program Build a new program Buy an existing program � why re-create the wheel

7. Traditional Pharmacy Management Tools Prior Authorization/Step Therapies Preferred Drug Lists Copay Design Dear Doctor Letters Dear Patient Letters Nurse Call Centers Nurse Case Management

8. Our Decision to Out-Source Outcomes Pharmaceutical Health Care Face-to-face approach Utilizing community pharmacists/pharmacies Over 6 years of experience Turn-key program Performance-based system(pay-for-performance)

12. Comprehensive Medication Review Prescriber Consultation Cost Efficacy Management Identifying & Resolving Drug Therapy Problems Patient Compliance Consultation Patient Education & Monitoring MTMS: Covered Services Describe servicesDescribe services

13. Medi-CareFirst Outcomes Encounter Applies to ALL covered members � not just the targeted beneficiaries Why? Effective January 1, 2006 Why? Regulations site all three of these modalities are necessary in Part D. The Outcomes Program is a system that addresses all of them.Regulations site all three of these modalities are necessary in Part D. The Outcomes Program is a system that addresses all of them.

14. Medi-CareFirst Outcomes Encounter Operational Challenges for face-to-face approach Why spend 6 months and several thousand dollars to target patients rather than starting a meaningful program immediately Systematically separating out �targeted beneficiaries� New ID cards? Enrollment packets? On-line message? Regulations site all three of these modalities are necessary in Part D. The Outcomes Program is a system that addresses all of them.Regulations site all three of these modalities are necessary in Part D. The Outcomes Program is a system that addresses all of them.

15. Medication Waste Waste occurs whenever a high cost medication is used when a lower cost alternative was available, when a patient is non-compliant, when a patient requires additional medical treatment due to a side effect or reaction to a medication, or when a medication fails to achieve its intended results. GIVE EXAMPLES OF EACH TYPE OF WASTE >>>>>> (to lead into the next slide)Waste occurs whenever a high cost medication is used when a lower cost alternative was available, when a patient is non-compliant, when a patient requires additional medical treatment due to a side effect or reaction to a medication, or when a medication fails to achieve its intended results. GIVE EXAMPLES OF EACH TYPE OF WASTE >>>>>> (to lead into the next slide)

16. Pharmacy Network Outreach

17. Patient Outreach

20. Questions?