October 10, 2003

Outpatient pharmacy bargains begin Jan. 1

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Phillip Taylor, a pharmacist in the Medical Art Building, finds a medicine for a patient. Dana Johnson

Outpatient pharmacy bargains begin Jan. 1

In the employee benefits year that starts Jan. 1, 2004 the VUMC Outpatient Pharmacy will offer new savings for people enrolled in Vanderbilt’s employee health insurance plans, said Walt Woods, manager of Ambulatory Pharmacy Services. Enrollees will save up to $5 each time they fill a prescription. The pharmacy will also match the discounts that apply to mail order prescriptions.

Some background information is required to explain these bargains. Health plans often engage separate companies to manage drug benefits. These pharmacy benefits managers in turn negotiate discounts from drug companies, and the list of discounted drugs is called a formulary.

With a formulary in hand, pharmacy benefits managers impose patient co-pays that are tiered to influence prescribing and purchasing patterns and help keep costs down. In addition, these companies are often themselves in the mail order prescription business, limiting all other prescription coverage to a 31-day supply per co-pay and offering members a large discount on 90-day supplies by mail order.

For next year, Vanderbilt has arranged it so that all three health plans are using the same pharmacy benefits manager, Caremark Inc., and the same discount drug formulary will thus apply to all plans.

To fill a prescription up to a 31-day supply, the Vanderbilt Outpatient Pharmacy will charge a $10 co-pay for generic drugs, a $25 co-pay for drugs on the Caremark formulary, and a $40 co-pay for non-formulary brand name drugs. All other pharmacies will charge the normal $15, $30 and $45 co-pays that have been published for all three health plans offered for next year by Vanderbilt.

In addition, the Vanderbilt Outpatient Pharmacy will dispense 90-day supplies of prescription drugs at co-pays of $30, $60 and $90, matching the discounted co-pays that apply to Caremark bulk prescription mail orders.

Again, the discounts will only be available to people enrolled in Vanderbilt’s contracted health plans for 2004.

The benefits of this arrangement to Vanderbilt include a single formulary for prescribing clinicians to keep track of (when treating enrolled employees and family members), and significant benefit cost savings. “Vanderbilt carries financial risk for employee health benefits and we will save money if we can use our pharmacy rather than pay other pharmacies,” Woods said.

Vanderbilt Outpatient Pharmacy locations are on the ground floors of The Vanderbilt Clinic and the Medical Arts Building.

An upcoming renovation to the TVC location will support future volume growth. A third location will open in December in the new Vanderbilt Children’s Hospital.

The pharmacy accepts cash, checks, credit cards and payroll deduction vouchers.