(Behavioral Health) Monitor use of $0.7M $0.3M Pros: See above Implementation Timeline: Pharmacy (cont.) Suboxone 2 year to Anti-Psychotics in Ensures appropriate medication 6-12 mo. begin 1/1/2013 Children and Adults Cons: Savings Realization Timeline: Average Wholesale Price and Seniors Additional administrative 12-18 mo. – 16%: 4/1/12 (pending) PA required requirements for providers Changes: Systems Mandatory generic Communication: Providers substitution (pending) Document: Develop criteria Smoking cessation 50% reduction (pending) Medication Management Initiative No coverage for: Anorexic or certain weight loss drugs Most vitamins and herbal products Hexachlorophene (for nursing facility patients) Products listed as part of the per diem rate of reimbursement for Nursing Facility Services Discontinued or recalled drugs Less than Effective Drugs (defined by FDA) TB drugs OTC drugs (unless designated otherwise) Pharmacy (cont.) Fertility drugs
Pharmacy (cont.) Pharmacy (cont.) (Behavioral Health) Suboxone 2 year to begin 1/1/2013 Average Wholesale Price – 16%: 4/1/12 (pending) Mandatory generic substitution (pending) Smoking cessation 50% reduction (pending) Medication Management Initiative No coverage for: Anorexic or certain weight loss drugs Most vitamins and herbal products Hexachlorophene (for nursing facility patients) Products listed as part of the per diem rate of reimbursement for Nursing Facility Services Discontinued or recalled drugs Less than Effective Drugs (defined by FDA) TB drugs OTC drugs (unless designated otherwise) Fertility drugs Monitor use of Anti-Psychotics in Children and Adults and Seniors PA required $0.7M $0.3M Pros: Ensures appropriate medication Cons: Additional administrative requirements for providers See above Implementation Timeline: 6-12 mo. Savings Realization Timeline: 12-18 mo. Changes: Systems Communication: Providers Document: Develop criteria