POAH 2017 APR Final

2017 BlueKC Approved Key Recommendations -

Savings Opportunities

Estimated Plan Cost

PMPM Savings

Description

Estimated Claim PMPM

Savings based on Blue KC

BOB

Disruption

Time to

Implement

Home Delivery Options

Select Home Delivery (SHD) –

Active Choice

Members must call ESI to elect

retail or mail after 2 fills at retail of

maintenance meds

$1.37 PMPM

Medium

120 days

SHD – Incentive Choice

($10 Copay Penalty)

N/A for HDHP plans

Members who remain at retail pay a

higher copay for their maintenance

meds

$2.19 PMPM

Medium

120 days

Exclusive Home Delivery –

(EHD)

Members must elect mail after 2

fills at retail or pay full cost of their

maintenance meds

$2.57 PMPM

High

120 days

Before implementing a home delivery program, please review benefit structure to ensure the appropriate member copays/coinsurance are in place for

mail and retail or the savings achieved through better mail pricing may be offset due to loss in member cost share. Estimated savings is based on a

minimum of 2.5 to 3x copay/coinsurance at mail (3 month supply) compared to retail (1 month supply). ESI can assist with group specific analysis for

savings and benefit structure.