Joey Coats always liked chemistry, so she began college planning to major in chemical engineering. But after her final exam for second-year calculus class, she had a realization.
“I realized I was an adult now, and I never had to take a math class again if I didn’t want to!” she says.
With some helpful career guidance, Coats decided to combine her interest in chemistry with her fondness for working with people and pursue a career in pharmacy. Her decision stuck! She has been a pharmacist for 30 years, save for a brief time pursuing other interests (she earned her law degree at night, and spent a few years practicing law, but eventually returned to medicine).
Coats joined Premera about nine years ago to help build the company’s Medicare Advantage Part D program, and eventually found her way to her current position as Director of Pharmacy and Clinical Consulting.
We asked Coats to tell us about her role at Premera, the work of the Pharmacy team, and what she thinks readers should know about their Pharmacy benefit. Here’s what she shared:
Q: Please tell us about your role at Premera.
A: As Director of Pharmacy and Clinical Consulting, I oversee a team of about 30 people who work on all aspects of pharmacy, from designing our covered drug list and defining our preauthorization criteria, to helping employer group clients understand the ever-increasing costs of medications and what programs they can put in place to help manage that. We also oversee Premera’s relationship with our Pharmacy Benefit Manager, working with them, in concert with other Premera departments, to build our benefits and our programs.
Q: Your team designs Premera’s covered drug list. Can you explain what that means?
A: A covered drug list, often referred to as a formulary, lists all the medications that Premera covers and outlines how much a customer will pay for them. We work with an independent committee of pharmacists, physicians, and lay people (with no financial ties to Premera) or drug manufacturers to create a formulary based on which medications offer the most value. We look at each medication and ask three main questions: Is it effective? Is it safe? And what is its cost in relation to other medications on the market? Medications identified as having the most value are listed as preferred medications and are typically available to people at a lower cost.
Q: Speaking of the cost, what should Premera’s Medicare Advantage members expect regarding the Inflation Reduction Act’s impact on the cost of prescription medications?
A: There are many Inflation Reduction Act-related changes coming over the next few years for our Medicare Advantage (MA) members. For example, today Medicare coverage for vaccines is very confusing. Some vaccines, like flu and pneumococcal, are covered at zero dollars out of pocket. Other vaccines are covered under Medicare Part D and subject to deductibles and cost shares. This means our MA members are often surprised after the fact by vaccine costs that can be quite high. The Act’s new rules will change how vaccines are covered by Medicare. Starting in January 2023, Part D coverage will be in line with how Individual/Family and Employer Sponsored Health Plans cover vaccines today without cost sharing, based on recommendations from the Advisory Committee on Immunization Practices.
More changes will come in 2024, with elimination of the Part D catastrophic coverage level. Today, when Premera MA members reach the “catastrophic” phase of their benefit, they remain responsible for up to 5 percent of drug costs for the remainder of the year. Starting in 2024, Premera MA members will no longer pay anything once they reach the catastrophic phase of their benefit. These costs will instead be borne by the Part D plan and pharmaceutical companies.
One of the most anticipated changes, a cost share cap for insulin products, will not apply to Premera MA members because Premera has already implemented this benefit design. Premera was part of a Pacific Northwest benefit pilot with the Centers for Medicare and Medicaid Services that led the way for the larger change for Medicare beneficiaries.
Q: Premera’s mission is to make healthcare work better for everyone. How does your work contribute to achieving that goal?
A: Pharmacy is the first and most used benefit Premera offers, so anything we can do to improve the pharmacy experience has the potential to impact a great number of people.
Our team continually works to improve the pharmacy experience on a number of fronts. We continue to partner with our Pharmacy Benefit Manager and other teams at Premera to make cost information available so that customers know what to expect when they show up at the pharmacy. We also want to make sure we can help members proactively identify cost saving opportunities like having their medication delivered or providing options for lower cost drugs to talk about with their providers.
We are also working to address the ever-increasing cost of prescription drugs. Whether it’s on the legislative/policy side or looking at different delivery cost options, we are exploring ways to get involved with some of the disruption that’s happening so we can help ensure medications stay affordable for everybody.
Additionally, we are working to improve our outreach and opportunities for direct interaction with our members. Our team includes pharmacists who do direct outreach to our senior Medicare customers, answering their questions and helping them find ways to improve their medication therapy. We are also working to create a positive pharmacy onboarding experience for our incoming HMO members by offering a chance for new members to speak to a clinical pharmacist. Premera’s new partnership with Kinwell Clinics presents another opportunity for our pharmacists to help people directly.
Q: What do you want Premera members to know regarding their prescription benefit?
A: I encourage our members to take advantage of the tools we offer for managing their prescriptions and keeping costs low. Our website it a good place to start. Once you create a member account, you can connect to the Express Script system, where you can view your list of prescriptions, see how much they cost, and find out whether the same medicine might be cheaper elsewhere.
I also urge customers to ask their pharmacist questions. If your medication looks different than it did last time, if you’re not quite sure what your doctor wrote a prescription for, or if you have concerns about drug interactions, ask your pharmacist. They are there to help.
Finally, members should keep their eyes out for new opportunities over next couple of years. We are working hard to create new tools to improve the pharmacy experience at Premera.