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Humana Program Ties Employees' Payments to a Drug's Ability To Prevent Illness
During Humana’s 2003-04 open enrollment period, nearly 15 percent of Humana associates and their dependents chose the pharmacy allowance plan, a surprisingly high percentage for a first-of-its-kind model for pharmacy benefits, said Jonathan T. Lord, M.D., Humana’s senior vice president and chief clinical strategy and innovation officer.
"We expected only about five percent of our associates to select the RxAllowance benefit, but so far the plan has generated significant buzz, leading more associates to select this new model than we anticipated, " Lord said. "Humana's online tools and robust education and information about the RxAllowance are giving our associates and their families the freedom of another choice in pharmacy coverage based on their own prescription needs and how they decide to fund them."
With the RxAllowance benefit, drugs are grouped according to their ability to prevent a serious medical episode or the need for further medical care. Humana pays an allowance to a participating pharmacy for each prescription or refill and the consumer pays the balance, if any.
The drug groups are as follows:
Group A: Medical costs offset within one year. Among the prescription drugs included in Group A are antibiotics and insulin.
Group B: Medical costs offset greater than one year. Cholesterol-lowering medications and heart medications are examples of drugs in this group.
Group C: Drugs that may improve workplace productivity. Drugs used to treat allergies and indigestion are among the medications in this group.
Group D: Drugs that meet cosmetic and other lifestyle needs. Prescription medications that assist with acne and smoking cessation are examples of drugs in this group.
Humana members can use the Internet-based RxCalculator to research and calculate their anticipated pharmacy expenses with the RxAllowance benefit. During Humana’s 2003-04 open enrollment period, nearly 50 percent of associates and their dependents used this innovative Internet-based tool, resulting in more than 175,000 online research inquiries.
"Humana teaches the average patient how to be a good consumer of health care by using our Web-based tools such as the RxCalculator," said William Fleming, PharmD, Humana’s vice president of pharmacy management and emerging technologies. "This is part of the company’s overarching philosophy to move patients from being just users of health care to smart consumers of health care."
In conjunction with the RxAllowance benefit, Humana associates can use a HumanaAccess MasterCardÒ Card, a combined identification and payment card, to pay for medical services, among them prescription drugs. The card, issued by BANKFIRST, allows a member to access funds, which are automatically deducted from the member’s account. This is the only card available through any health benefits company that combines these functions and eliminates the need for members to have multiple cards for their health care needs.
"This has tremendous value, not only to consumers and employers, but also for physicians, their office staff and pharmacies because it lessens their administrative burden in submitting claims forms for reimbursement," Lord said. "By combining cutting-edge technology with state-of-the-art medical intelligence, Humana offers consumers and employers choice-driven solutions to today’s health care cost crisis."
Source: Humana, Inc.