Express Scripts, based in St. Louis, MO, is one of the country's largest pharmacy benefits managers (PBM), providing pharmacy benefits to people across the US and Canada. The Fortune 500 company, which has held the GIC contract since July 1, 2000, employs over 9,000 across ten states.The decision to retain Express Scripts for at least three more years (contract contains two 1-year extensions) was generally well received by retirees, who for the most part have grown comfortable with the company. Over the last several years, Express Scripts has worked hard to earn a loyal customer base among GIC enrollees. This follows a rocky transition from Merck Medco to Express Scripts in 2000, when many retirees unfortunately had difficulties.

“Most members have a very positive relationship with Express Scripts. There are always going to be mistakes on some level, but from what we've observed more recently the company is quick to correct any problems that arise,” explains Association Insurance Coordinator Cheryl Stillman. “I would be remiss if I did not single out Jennifer Fairchild, who is my direct point of contact within Express Scripts. Over the years she and her coworkers have gone out of their way to assist our members and truly do a great job.”

Separate from its decision to retain Express Scripts as its PBM, the GIC has voted to make several changes to the pharmacy benefits available under the Indemnity Plan, including the Medicare OME carve out, which will take effect July 1, 2005.

The changes directly target three separate classes of medications: Statins, which are cholesterol lowering drugs (Lipitor/Zocor); Cox-2 inhibitors, known for their anti-inflammatory pain reducing qualities (Celabrex/Bextra/Vioxx); and Proton pump inhibitors, which are drugs that stop production of stomach acid (Nexium/Prevacid/Prilosec).

From October 1, 2003 through September 30, 2004, the GIC filed 350,000 prescriptions in the these three categories, costing some $37 million. Consumer awareness, which is a result of direct advertising by the pharmaceutical companies, is credited with the high usage of the drugs in the three categories.

“While we understand the need to control costs, we are urging the GIC to proceed cautiously with these changes to the pharmacy plan,” said Association Legislative Liaison Shawn Duhamel. “All things being equal, generics are obviously the way to go, but we must remember that everyone reacts differently.”

GIC officials appear to have realized the point when it comes to changes made with anti-cholesterol drugs. Statins, which are highly effective in reducing cholesterol levels, are credited with lowering overall health care costs by increasing the health of consumers. The GIC has opted to create a special $2 co-payment for generic statins, while maintaining the current co-payments for brand drugs.

However, members who take Cox-2 inhibitors for chronic pain will be forced to pay more for their prescription beginning in July. All Cox-2 inhibitors that are currently available have been moved to Tier 3, which is the non-preferred brand category carrying a $40 retail co-payment.

In recent months, FDA officials, along with pharmaceutical researchers have been investigating possible negative side effects associated with Cox-2 inhibitors. GIC officials are monitoring developments with this class of medication and may remove Cox-2 class medications from its formulary if government regulators eventually deem the drugs too risky.

Finally, the GIC has made several changes to the coverage offered to so-called Proton pump inhibitors (PPIs). As of July 1, all PPIs will be moved to the Tier 3 classification. However, over-the-counter Prilosec will be covered under Tier 1 ($7 co-pay) on a temporary basis.

GIC officials cite evidence that many of those taking prescription PPIs, such as Nexium and Prilosec, are doing so without a clear medical need. Studies have revealed that many of the ailments treated by these drugs can be effectively treated by other medications, costing a fraction of the cost. Again, officials point to successful advertising campaigns such as “The Purple Pill” that are steering health care consumers to high-cost brand names such as Nexium, rather than cheaper alternatives.