COMMISSIONERS'  COURT WORKSHOP AGENDA
							MONDAY, AUGUST 9, 2010, 1:00 P.M.
						 	COMMISSIONERS'  COURTROOM
						   	KERR COUNTY COURTHOUSE
								KERRVILLE, TEXAS 78028
			  	THIS NOTICE IS POSTED PURSUANT TO THE TEXAS OPEN
		     	MEETINGS ACT.  (TITLE 5, CHAPTER 551, GOVERNMENT CODE
				 	AND TITLE 5, CHAPTER 552, GOVERNMENT CODE.)
					This  Commissioners'  Court  will  hold  a  workshop  at  1:00  P.M.,
		     	Monday,  August  9,  2010,  in  the  Kerr  County  Commissioners'  Courtroom,
		     	Kerr County Courthouse.
					Review  and  discuss  FY  2010 -11  Budgets  and  fiscal,  capital
					expenditure and personnel matters related thereto including, but
					not    	limited    	to,    	Cost    	of   	Living    	Adjustment,    	Salary
					Considerations,  Staffing Levels, Health Benefits and Insurance.
												 	Filed 5  Day o	 	A.D. 2010
												 	JANNETT PIEPER, KE   	CO. CLERK TIME
												 	By!! I !   	_'   	!J&   	JA
    	HRA History
				     	168		    	78		    	28		  	274			 	20% less than
				    	600		 	1200		 	1800							08 -09 Year
					     	EE +Spouse
						    	OR												Total
    	2009/2010		EE Only		EE +Child(ren)     	EE +Family	 	Total 2010	 	Carry Over     	Liability /Cost
			  	$100,800.00	 	$93,600.00	 	$50,400.00		$244,800.00		$118,527.07		$363,327.07
				    	167		    	78		    	35		  	280			 	15% less than
				    	600		 	1200		 	1800							07 -08 Year
					     	EE +Spouse
						    	OR												Total
    	2008/2009		EE Only		EE +Child(ren)     	EE +Family	 	Total 2010	 	Carry Over     	Liability /Cost
			  	$100,200.00	 	$93,600.00	 	$63,000.00		$256,800.00		$196,465.10		$453,265.10
				    	172		    	90		    	14		  	276
				    	600		 	1800		 	1800
					     	EE +Spouse
						   	OR
					    	EE +Child(ren)											Total
    	2007/2008		EE Only		OR EE +Family	 	Retiree	   	Total 2010	 	Carry Over     	Liability /Cost
			  	$103,200.00		$162,000.00	 	$25,200.00		$290,400.00		$239,828.70		$530,228.70
		   	Trend began with a 20% increase in expense 08 -09 and then another 15% in 09 -10.
		   	Liabilty Cost has decreased almost $200,000 due to increased USE and not being
		   	carried over.  So the liability is down but the actual expense is $200K higher.
     	•		j
   	HRA Card  - Cost Scenarios
				    	168		   	78		    	28		  	274
				    	600		 	1200		 	1800
					     	EE +Spouse
    	2009/2010				  	OR											 	Total
     	Actual	  	EE Only		EE +Child(ren)     	EE +Family	 	Total 2010	  	Carry Over		Liability /Cost
			 	$100,800.00	 	$93,600.00	 	$50,400.00		$244,800.00	 	$118,527.07		$363,327.07
   	Scenario 1  - Employee Only HRA
				    	274								 	274
				    	600		 	1200		 	1800
					    	EE +Spouse
						   	OR											 	Total
    	2010/2011		EE Only		EE +Child(ren)     	EE +Family	 	Total 2010	  	Carry Over		Liability /Cost
			 	$164,400.00			$0.00		 	$0.00		$164,400.00	 	$118;527.07		$282,927.07
															Potential Savings	   	$80,400.00
		   	Used 09 -10 Carryover in its entirity as you cannot split it out.
		   	Carryover is potentially high as EE +child and EE +Spouse and EE +Family is included.
   	Scenario 2 - Employee Only, No Carryover
				   	274								 	274
				   	600		 	1200		 	1800
					    	EE +Spouse
						   	OR											 	Total
   	2010/2011		EE Only		EE +Child(ren)     	EE +Family	 	Total 2010	  	Carry Over		Liability /Cost
			 	$164,400.00		 	$0.00		 	$0.00		$164,400.00		  	$0.00		$164,400.00
															Potential Savings	  	$198,927.07
   	Scenario 3 - Remove Co -Pay Option on HRA card
				    	168		    	78		    	28		  	274
				   	600		 	1200		 	1800
					    	EE +Spouse
   	2009/2010				  	OR											 	Total
     	Actual	  	EE Only		EE +Child(ren)     	EE +Family	 	Total 2010	  	Carry Over		Liability /Cost
		   	CANNOT give this information as DPAS is attempting to split out this information.
		 	1W1			   	SCRIPT CARE, LTD.
									 	Clinical Services
							  	6 380 Folsom Drive * Beaumont, TX 77706
						  	Customer Service 1-800 -880 -9988 or Fax 409 - 832,3109
	     	SCRIPT CARE, LTD.				  	www.scriptcare.com
													  	CVR Jr P LAJ
										Kerr County
					     	Alternative Tier Medication  Therapeutic Alternatives
					     	Aciphex  $223.56			omeprazole    	$50.69
										   	pantoprazole   	$75.01
										   	lansoprazole   	$130.60
					     	Celebrex $151.21			meloxicam    	$20.98
										   	diclofenac		$34.16
					     	Crestor   	$123.53			simvastatin    	$19.19
										   	pravastatin     	$10.12
										   	lovastatin     	$25.41
					     	Kapidex   	$115.62	     	omeprazole    	$50.69
										   	pantoprazole   	$75.01
										   	lansoprazole   	$130.60
					     	Lipitor   	$110.48		 	simvastatin    	$19.19
										   	pravastatin     	$10.12
										   	lovastatin     	$25.41
					     	Nexium $176.67		 	omeprazole    	$50.69
										   	pantoprazole   	$75.01
										   	lansoprazole   	$130.60
					     	Vytorin   	$108.64			simvastatin    	$19.19
										   	pravastatin     	$10.12
										   	lovastatin     	$25.41
						    	The costs identified above are for all strengths
						    	of the product for a 30 day supply. Cost will
						    	vary based on pharmacy and strength.
		   	Alternative Tier Medications Ca. $55.00 (Retail) OR Alternative $5.00 Generic
															  	e
				 	Alternative Tier				Therapeutic					Ft-A
				   	Medications .			 	Alternatives
				     	Aciphex	   	omeprazole,  pantoprazole,
							     	lansoprazole
				     	Celebrex	   	meloxicam, nonsteroidal anti -
							     	inflammatory agents
						Crestor	    	simvastatin, pravastatin, lovastatin
				     	Kapidex	   	omeprazole, pantoprazole,
							     	lansoprazole
						Lipitor	    	simvastatin, pravastatin, lovastatin
						Nexium	    	omeprazole, pantoprazole,
							     	lansoprazole
						Vytorin	    	simvastatin, pravastatin, lovastatin
				Over The Counter  (OTC) Zero Copavment Meds
				Current						   	New
		 	Prilosec OTC (20mg)				    	Prilosec OTC (20mg)
		 	Pepcid AC OTC (10mg and 20mg)		   	Pepcid AC OTC (10mg and 20mg)
		 	Pepcid Complete OTC (10mg)			 	Pepcid Complete OTC (10mg)
		 	Zantac OTC (75mg and 150mg)				Zantac OTC (75mg and 150mg)
		 	Tagament HB (200mg)				  	Tagament HB (200mg)
		 	Axid AR (75mg)					  	Axid AR (75mg)
		 	Claritin OTC (10mg)				    	Claritin OTC (10mg)
			Alavert OTC (10mg)				    	Alavert OTC (10mg)
		 	Loratidine OTC (10mg)				  	Loratidine OTC (10mg)
			Zyrtec OTC /Cetrizine OTC (effective			Zyrtec OTC /Cetrizine OTC (effective
		 	3/12/2008)						  	3/12/2008)
											Omeprazole ***N EW***
										 	Prevacid OTC ** *NEW***
											Nicotine Replacement Patches * *NEW***
	 	Eva Hyde					 	Page 2					  	8/9/2010
			•
				  	Recommended Modifications to the Prescription Plan for 2010
					 	Commissioners Court 12 -28 -09 (Approved Court Order #31579)
		   	OTC (add these]
		  	Omeprazole
		   	Prevacid OTC
		   	Nicotine Replacement Patches
		  	Tobacco Cessation Plan
		   	Limit to $500.00 Bi- Annual with a Lifetime Maximum Benefit of $2000.00 which includes OTC $0.00 Co-
		   	pay Items. (Bi- Annual = every other year) Non Formulary Cost
		  	SCL Diabetic Program (Change to SCL)
		  	Mandatory Program - currently have 19 diabetics acquiring medication for diabetes yet only 9 acquired
		  	supplies. (See attachment "SCL Diabetic Program Letter ")
		  	Co -Pay Structure (Change Plan)
				     	Current Plan					  	New Plan
	 	Retail (30 -Day Supply)  $10.00 Generic						$5.00
				     	$20.00 Formulary				    	$25.00
				     	$35.00 Non - formulary				 	$40.00
				     	$0.00  Alternative				    	$55.00
				     	Current Plan					  	New Plan
	 	Mail (90 -Day Supply)    	$20.00 Generic						$10.00 (reduced $5.00 x 2 = $10)
				     	$25.00 Formulary				    	$50.00
				     	$40.00 Non - formulary				 	$80.00
				     	$0.00 Alternative				     	$110.00
	 	NOTE:  Mail Plan is set up to be 2 retail copays for a 90 day supply.  If the retail copay is $10.00, $10 x 2 = $20;
	 	$25 x 2 = $50 etc
							Current Plan					  	New Plan
	 	Natl Diabetic PharmacyNDP    	$5.00 Generic		     	SCL Pharmacy $0.00
							$5.00 Formulary				     	$5.00
							$35.00 Non- formulary				 	$35.00
							Current Plan					  	New Plan
		  	Specialty		  	$20.00 Generic						$10.00
							$40.00 Formulary				    	$45.00
							$70.00 Non - formulary				 	$75.00
							 	LUH L P -E-:		     	I°
	 	Eva Hyde					 	Page 1					  	8/9/2010
			 	SCRIPT  CARE
	     	Pi ovicrIng the ihnt in Phorrnocy Bcneftts Services hiJvcanwtde
									 	Kerr County
								2011  Modifications to Alternative Tier
	    	Over the last several months, there have been some new generics introduced into the market. These additions have
	    	created the opportunity to add to the existing alternative tier. As the generics mature in the market place and the number
	    	of manufacturers increase the price will continue to decrease. Based on data from 1/1/10 - 6/30/10 these are the projected
	    	differences in total cost (summation of plan cost and copay).
		     	Drug			Members Affected	    	Total Cost	   	Alternative Product	   	Total Cost
		   	Atacand				0			   	0		     	Losartan K		  	$64.96
		 	Atacand HCT		   	0			   	0		   	Losartan K/HCT			$73.58
		    	Avapro				0			   	0		     	Losartan K		  	$64.96
		    	Avalide				1				$102.43			Losartan K/HCT			$73.58
		    	Benicar				1			 	$59.90		  	Losartan K		  	$64.96
		  	Benicar HCT		    	3				$125.66			Losartan K/HCT			$73.58
		   	Cymbalta		     	7				$251.30			Venlafaxine ER			$144.17
		    	Diovan				0			   	0		     	Losartan K		  	$64.96
		  	Diovan HCT		    	5				$88.24			Losartan K/HCT			$73.58
		   	Micardis				0			   	0		     	Losartan K		  	$64.96
		 	Micardis HCT		   	2				$87.80			Losartan K/HCT			$73.58
		    	Pristiq			 	2				$221.00			Venlafaxine ER			$144.17
		   	Teveten				0			   	0		     	Losartan K		  	$64.96
		 	Teveten HCT		   	0			   	0		   	Losartan K/HCT			$73.58
						  	G 6 es --- c-e. .   	tbO   	5c-2 -■ ('S  -- 6     	C
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								 	Insurance Scenarios
	     	Scenario 1
											Monthly		Annually		Total
	     	Families $ 450/55				   	28	   	450.00     	5,400.00   	151,200.00
	     	Spouses $240/55				   	33	   	240.00     	2,880.00    	95,040.00
	     	Children $ 250/55				  	40	   	250.00     	3,000.00   	120,000.00
														 	366,240.00
	     	Employee Only $55					155	    	55.00	 	660.00   	102,300.00
	     	Emp Contrib						119	    	55.00	 	660.00    	78,540.00
														 	180,840.00
	     	Total Employee Contrib								    	547,080.00
	     	HRA CARD /County Contrib								  	200,000.00
	     	County Contribution									 	202,920.00
	     	Total County Contribution								   	402,920.00
	     	Scenario 2
											Monthly		Annually		Total
	     	Families $600/60				   	28	   	600.00     	7,200.00   	201,600.00
	     	Spouses $300/60				   	33	   	300.00     	3,600.00   	118,800.00
	     	Children $300/60				   	40	   	300.00     	3,600.00   	144,000.00
														 	464,400.00
	     	Employee Only $60					155	    	60.00	 	720.00   	111,600.00
	     	Emp Contrib						119	    	60.00	 	720.00    	85,680.00
														 	197,280.00
	     	Total Employee Contribution									661,680.00
	     	UNFUNDED AMOUNT									 	88,320.00
	     	HRA CARD /CO Contribution									200,000.00
	     	COUNTY CONTRIBUTION								  	288,320.00
			HICI4     	.00 60
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