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| October 5, 2023 - Regular School Board Meeting | ||
| Title C13 - Advantage Package for Clinical Rules in Pharmacy Program | ||
| Description The Clay County School Board transitioned to a self-insured health program effective October 1, 2022. As part of the program, it was the recommendation of The Bailey Group and the School Board to carve out the Pharmacy Insurance through ExpressScripts. It is important that the District review clinical pharmacy rules and programs annually to maintain the financial integrity of the pharmacy program cost and member safety as it relates to pharmacy usage. | ||
| Gap Analysis In conjunction with the Bailey Group, the District’s third-party administrators, and the Crumdale Partners, the pharmacy insurance underwriting firm, a thorough review of pharmacy utilization took place, along with a constant review of new pharmaceuticals that could put the integrity of the pharmacy plan cost and the member’s safety at risk. Accordingly, it is their professional opinion that we increase the clinical rules from the Limited Package to the Advantage package, which will provide further protection of the pharmacy plan and safety for members. The Advantage Package for Clinical Rules is expected to save the District upwards of $799,519. This change will be implemented and monitored by ExpressScripts and The Bailey Group. The annual cost of the Clinical Rules Advantage package will be $41,227, increasing from a $0.32 PMPM cost to a $0.84 PMPM cost.
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| Previous Outcomes The Clay County School Board voted and approved the recommendation of carving out pharmacy to ExpressScripts as the carrier upon becoming Self-Funded on October 1st, 2022. | ||
| Expected Outcomes The Board to approve the recommendation of the Insurance Committee, Superintendent, and the district's third-party administrator, the Bailey Group, to implement the Advantage Package for Clinical Rules for the integrity of the pharmacy plan cost as well as the safety of the member. | ||
| Strategic Plan Goal The District ensures fiscal responsibility & equitable distribution of resources. | ||
| Recommendation The Board to approve the recommendation of the Insurance Committee, Superintendent, and the district's third-party administrator, the Bailey Group, to implement the Advantage Package for Clinical Rules for the integrity of the pharmacy plan cost as well as the safety of the member. | ||
| Contact Dr. Susan Legutko, Assistant Superintendent of Business Affairs. (904) 336-6721; Susan.Legutko@myoneclay.net | ||
| Financial Impact Reviewing Savings vs. Costs: the Advantage Package for Clinical Rules is expected to save the District upwards of $799,519, net of annual cost. The annual cost of the Clinical Rules Advantage package is estimated to be $41,227 annually, increasing from a $0.32 PMPM cost to a $0.84 PMPM cost. | ||
| Review Comments | ||
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Attachments No attachments available |
