On page 11 of this report, the payments made by the
Trust over the most recent 10 years (with separate totals
for medical and life insurance benefits in each of those
years) are also set forth in detail. In recent years there
has been a decline in net claims payments made by the
Trust. With the reduction in the number of employees in
the industry, there has been a corresponding reduction
in the number of participants in the Trust. Since 2006,
the number of participants has dropped by almost 10%,
which has been a contributing factor to the drop in
claims payments.
First Health Network.
In 2009, the Trust contracted
with First Health to provide network discounts to non-
Medicare Indemnity program participants who use
health care providers within its network. Both the Trust
and those Indemnity program participants who use First
Health network providers are able to realize lower costs.
In 2011, the Trust and its participants realized over $1.3
million in savings when participants visited First Health
Network providers.
Prescription Drug Claims.
For the seventh consecutive
year, prescription drug claims payments were lower
than the previous year. The increased use of generic
drugs, and their greater availability and acceptance
by Trust participants, combined with the economies
of ordering prescriptions by mail order, has had
much to do with these declines. The requirement
that participants receive maintenance medications
through the mail order program (i.e., the mandatory
mail provision of the plan) has also been a contributing
factor to this decline.
Medicare Part D Subsidy.
In addition, the Trust receives
an average of over $4 million each year from Medicare
for its sponsorship of a prescription drug program that is
at least as valuable as the Medicare Part D program.
Early Retiree Reinsurance Program.
The Affordable
Care Act has affected the Trust through its Early Retiree
Reinsurance Program (ERRP), established as part of health
care reform. The Trust received a $1.5 million payment
for 2010 claims in 2011 for ERRP; about $375,000 was
returned to the federal government. The Trust has not
yet determined if additional funds for 2011 claims will
be available. At this time, it is uncertain whether any
additional funds will be received for 2011 claims.
Disease Management Program.
The Nurtur disease
management program is another example of an
investment paying off for the Trust and its participants.
The purpose of the Nurtur program is to help participants
avoid costly hospitalizations. The Trust pays Nurtur for
each participant who uses the program. For every dollar
spent by the Trust in this program, $2–$3 is saved due to
fewer hospitalizations and related health care expenses.
The Trust and its participants avoid costly hospital bills,
with the added benefit of participants who are healthier
and enjoy an improved quality of life.
Medco Health Store.
Trust participants can also save
time and money with access to the Medco Health
Store™, which offers discounts on over-the-counter
medicines, cosmetics, diabetes supplies, vitamins,
supplements, and more. Purchases are checked against
participants’ Medco prescription drug history to help
avoid drug interaction risks. Medco reduces prices an
average of 15% on nearly 30,000 products, and standard
shipping is 99 cents.
Cancer Nutrition Program.
Another recent addition is
Medco’s Cancer Nutrition Program. Proper nutrition
is a critical element of patient care that supports
recovery from chemotherapy, radiation and other cancer
treatments. With one in five cancer deaths related
to severe malnutrition, weight loss, and nutritional
needs that are often overlooked by overburdened
health care providers, this program offers a safety
net. Early detection of malnourished patients or those
at risk for malnutrition can promote recovery and
improve prognoses. The Trust also makes available to
participants access to Medco’s Advanced Oncology
Solutions to optimize pharmaceutical therapy.
Participants receive assistance from Medco Specialist
Pharmacists in learning to take their medications safely,
how to get essential nutrition, and how to reduce side
effects of cancer treatments. Further, TherapEase Cusine
is a Medco company that provides personalized, online
nutritional counseling and meal planning from registered
dieticians who specialize in oncology.
Simplifying Life for Participants in Nursing Homes.
When our participants require nursing home care, they
should not have to worry about their prescriptions
being covered. Nursing homes generally use a single
pharmacy for receiving prescriptions, and the orders must
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