Hello everyone, I’m Katrina Daniel, Chief Health Care Officer, and I’m thrilled to welcome you to the inaugural edition of The District Download for school district leaders.
Allow me to introduce myself and share a bit of my journey at TRS. I was born and raised in La Porte, Texas, nestled on the shore of Galveston Beach. The beauty of nature and a strong sense of community in La Porte helped raise me to be who I am today. One of my most cherished memories of growing up is of my exceptional biology teacher, whose engaging teaching style sparked my interest in science. He, and others, showed me the importance of educators. Because of the impact of my incredible teachers, I knew I wanted to help people, which led me to nursing.
My experiences working in a Houston public hospital opened my eyes to the struggles that patients face. This ignited me to find ways to help our community at the source – public policy focused on improving health outcomes. I got my master’s degree at The University of Texas at Austin in Health Policy, and I eventually worked at the Capitol, navigating the complexities of healthcare legislation. From working in a public hospital as a nurse, to now at TRS, I have always felt a strong calling to public service.
After nearly nine years with TRS, my commitment to public educators remains as strong as ever. Our purpose is to serve our Texas educators through efficient and high-quality healthcare. The dedication and passion of educators profoundly impact lives, and I am devoted to providing our members with the highest quality and most cost-effective healthcare.
TRS-ActiveCare ensures educators receive the benefits they deserve, and I am excited about the innovative plans we are developing to continue to meet their needs. Thank you for joining us on this journey. We look forward to bringing you valuable insights, updates, and stories through The District Download.
Katrina Daniel
Pharmacy Rebates: How we’re fighting to save you more
Pharmacy benefit managers are projected to save plans $1 trillion in drug costs over the next decade.1 Let's explore all the ways that TRS, along with Express Scripts, has you covered.
Rebates 101
Name brand drugs can be expensive. That's where Express Scripts comes in, working with pharmaceutical companies to get better prices for you. A key strategy is the application of larger rebates. Express Scripts uses its purchasing power to get you the largest rebates possible. Express Scripts negotiates special pricing on certain drugs with manufacturers and TRS, in turn, negotiates aggressive pricing with Express Scripts.
These savings are passed back to you. One hundred percent of all rebates are shared with TRS. TRS uses them to reduce member costs. The savings help produce lower drug costs and lower premiums for participants in TRS-ActiveCare plans. While rebates bring down the cost of drugs for you and your plan, there are other ways you can save on the cost of medications.
Other Ways You Can Save
Rebates allow you to save on brand name drugs, but they're not the only option. Generics and biosimilars begin with a lower sticker price. The Federal Drug Administration defines generics as medicines that work in the same way and provide the same clinical benefit and risks as their brand-name counterparts.
A generic medicine must be the same as a brand-name medicine in dosage, safety, effectiveness, strength, stability, and quality, and in the way it is taken. Generic medicines also have the same risks and benefits as their brand-name counterparts. Biosimilars are complex drug alternatives with a slightly different chemical composition but deliver the same therapeutic results. And like generics, they typically are less expensive than brand name medications.
Express Scripts works with TRS to offer you more choices and affordable options and make sure the latest medications are available to you when they enter the market. Rebates and generic options are just some of the ways we help you save. Taking specialty drugs? Some of our plans offer specialty drugs at $0 out of pocket. Use the Price Your Medication tool (navigate to your plan here https://www.express-scripts.com/trsactivecare) to take a look.
Pearland Independent School District (PISD) has taken significant strides promoting the health and well-being of its employees by collaborating with TRS-ActiveCare. This partnership has led to the implementation of several health support initiatives, ensuring a holistic approach to wellness within the district. Led by Blue Cross and Blue Shield of Texas' Wellness Coordinator, Heather Hamilton, here are some of the key programs introduced to Pearland ISD employees:
Blood Pressure Clinic
Recognizing the importance of cardiovascular health, PISD and TRS-ActiveCare organized a Blood Pressure Clinic. This initiative provided employees with the opportunity to have their blood pressure checked regularly, receive personalized advice on maintaining healthy levels, and learn about the risks associated with hypertension. The clinic aimed to raise awareness and encourage proactive management of blood pressure, ultimately contributing to the overall health of the school community.
Baby Shower
In a heartwarming gesture, PISD and TRS-ActiveCare hosted a Baby Shower event for both expecting and new parents within the district. This event offered a supportive environment where parents could receive valuable information on prenatal and postnatal care, nutrition and parenting tips. Additionally, attendees were gifted essential baby items, fostering a sense of community and support.
Well onTarget Presentation
The Well onTarget Presentation was another significant initiative aimed at promoting wellness. This presentation provided comprehensive insights into the Well onTarget program, which offers personalized wellness coaching, health assessments and a variety of resources to help individuals achieve their health goals. The presentation emphasized the importance of a balanced lifestyle and encouraged staff to take advantage of the resources available to them.
Table Day for Wellness Information During Open Enrollment
During the open enrollment period, PISD and TRS-ActiveCare set up a “Table Day” for Wellness. This event was designed to provide employees with easy access to information about the various health and wellness programs available through their TRS-ActiveCare benefits. Representatives were on hand to answer questions, distribute informational materials, and assist with enrollment, ensuring that district employees could make informed decisions about their health coverage.
What Does It Mean to You?
When you see your provider, they're in-network because they have a contract with Blue Cross and Blue Shield of Texas or UnitedHealthcare. It means your provider and the insurer agreed to a set price for each treatment or procedure in advance. The plan agrees to pay for the medical costs covered. Depending on the treatment or procedure, you might pay copays or coinsurance. Contracted providers can be a doctor, hospital, or other medical professionals and health care facilities. Contracts can be for a year or multiple years.
Why Do We Need Contracts?
Contracts give you access to high-quality providers, keep your costs down, and make it convenient for you to find a provider you can trust. If a contract didn't exist between the provider and your health plan, you might have to pay more or the full amount for your care. For the provider, it makes it easier for them to get paid after treating you. Your provider gathers information from you to submit the claim to the health plan. Then the health plan processes the claim and pays the provider.
How Does a Contract Negotiation Impact You?
Because contracts have term limits, the insurer needs to renew or update them when the contract ends. Please don't be surprised when you see announcements about negotiations. The insurers negotiate contracts to keep health care costs down for you. The insurers work with providers to find solutions in your best interest. They advocate on your behalf for high-quality, cost-effective health care. It's a responsibility they take seriously. District Download - Welcome Message District Download - Pearland ISD District Download - Pharmacy Rebates
How can you find out about negotiations?
TRS health plans notify participants about significant negotiations that could impact them. Usually, they resolve favorably and without cause for concern. But if the provider does go out of network, you still have access to other in-network providers, hospitals, and facilities. Your TRS health plan can help you find new care options or help continue your care. By understanding the negotiation process, participants can feel more at ease and confident in the continuous efforts to provide them with cost-effective and high-quality healthcare.