January to June 2004 Department of Health & Social Services Table of Contents Executive Summary 1 Overview 1 Enrollment Criteria 2 Benefit Coverage 3 Demographics 4 Enrollment by Eligibility Category 4 County 4 County 5 Race 5 Applications Received 6 Applications Approved 7 Applications Denied 8 Phone Lines 9 Monthly Phone Calls 9 Outreach Activities 10 Application Distribution 10 Special Events 11 DPAP Information Distributed July - December 2003 11 Financials 12 Paid Amount 12 Program Expenditures 13 Number of Prescriptions 14 Percent of Clients Using Benefits 14 Average Number of Prescriptions Per Client Per Month 15 Average Cost Per Prescription 15 Per Member Per Month Cost 16 Member Expenditure 17 Benefit Dollars Spent 17 Drug Expenditure by Category 18 Number of Prescriptions by Category 18 Drug Utilization Review 19 Prospective Drug Utilization Review 19 Retrospective Drug Utilization Review 20 In Summary 21 Contact Information 22 Delaware Prescription Assistance Program January to June 2004 Executive Summary Overview The Delaware Prescription Assistance Program (DPAP) began on January 14, 2000 through the passage of Senate Bill 6, during the 1999 legislative session. DPAP is paid for with tobacco settlement funds through the Delaware Health Fund. The program provides up to $2,500 per person, per State fiscal year for prescription assistance to qualified Delaware citizens who are over 65 years old and those under 65 years with disabilities. The Division of Social Services contracts with Electronic Data Systems (EDS), the Delaware Medical Assistance Program (DMAP) fiscal agent, to conduct outreach, manage the application process, determine eligibility, and pay the prescription drug claims submitted from participating pharmacies. DPAP leverages the existing Department of Health and Social Services (DHSS) pharmacy provider network. Pharmacy providers servicing other DHSS clients also submit claims for DPAP clients. All of the major chains and independent pharmacies in the state are enrolled as DHSS providers. The claims are submitted electronically in a real-time processing environment. Eligibility and medication coverage is verified and the pharmacies are notified within seconds of the claim status (paid or denied). These drug claims are also subject to all DMAP processing edits, audits and Drug Utilization Review (DUR) alerts. See page 18 for more details. As of June 30, 2004, the program had 6,639 members statewide, which includes 16% in Kent County, 53% in New Castle County, and 31% in Sussex County. These percentages changed by only two percentage points for Kent (decreasing by 2%) and Sussex (increasing by 2%) counties over the previous six months. Of the 1,620 new applications received during the first half of 2003, approximately 74% were approved. Of the 26% that were denied coverage, 45% were because of incomplete applications and 39% were either above the income level or qualified for alternative insurance, such as the Nemours Health Clinic Pharmaceutical benefit. The remaining 16% were because they were enrolled in Medicaid, had other prescription coverage or were not 65 or Social Security Disability Income (SSDI). There are eight clients enrolled in the program under the eligibility provision of having prescription costs that exceed 40% of their annual income. As these clients represent less than one-half of one percent of the population, and in order to secure their confidentiality these clients are not included in the program analysis. From January to June 2004, DPAP provided 122,489 prescriptions at a total cost of $3,811,139. State DPAP funds were used to fill an average of 3.99 prescriptions per member, per month. There was average monthly cost to the client for those four Delaware Prescription Assistance Program January to June 2004 2 prescriptions of $58.85, representing their co-payment. The percentage of members using their benefit has increased steadily over the life of the program, from 58% during the first six months of its inception, to its current level of 79%. This represents a 1% decrease over the prior six months. A total of $1,048,905 was received for the DPAP in the last six months in drug rebate dollars from the drug manufacturers participating in the State Drug Rebate Program. A total of $3,754,299 has been received in DPAP drug rebate dollars since the programs inception. The Drug Utilization Review process, mandated by the Federal government to ensure safe, appropriate and efficient pharmaceutical coverage for DMAP clients, was applied both prospectively and retrospectively to all the DPAP prescriptions. DUR activities have included physician notifications and the addition of new drugs to prior authorization. The same clinical alerts generated under the Delaware Medical Assistance Program were applied to DPAP. Enrollment Criteria To be qualified for the Delaware Prescription Assistance Program, the applicant must meet all the following criteria: _ Applicant must be a resident of the State of Delaware _ Applicant must be at least 65 years of age, or qualify for SSDI benefits _ Applicant must meet the income guidelines (200% of the federal poverty level) or have prescription costs that exceed 40% of their annual income _ Must submit proof of income and/or SSDI benefits _ Applicant must not have or be eligible for prescription coverage through Federal, State, or private sources regardless of any annual limitations to the benefits There are several ways a client can enroll into DPAP: by phone (1-800-996-9969 ext. 17), by picking up an application (at any of the locations listed on page 10), or online at www.state.de.us/inscom/pillbill.htm. Beginning in April of each year, DPAP clients must re-apply to the program to confirm eligibility for the start of the next state fiscal year (July 1st). Through the redetermination process, a client’s income is reviewed to ensure they still meet program eligibility requirements. Benefit Coverage The Delaware Prescription Assistance Program has a full benefit coverage. There are a few limitations. Brand name drugs are only covered when there is no generic equivalent or in cases where verification of medical necessity for the brand name drug is provided by the prescribing practitioner. The program covers medically necessary drugs manufactured by companies that agree to pay the State a rebate for the right to participate. Drug manufacturers provide a rebate to the State, based on the units of each drug that have been dispensed to DPAP clients. For each unit in which the DPAP program reimburses the pharmacy, the drug manufacturer pays a rebate to the State at a percentage of the drug cost or unit rebate amount. The rebate program assists the State in obtaining the best prices for the covered drugs, and is modeled after the federal drug rebate program operated by the Centers for Medicare and Medicaid Services (CMS). The EDS rebate analyst and the pharmacist consultant actively monitor rebate participation. DPAP does not pay for any of the drugs covered by Medicare, including diabetic supplies. Medicare currently covers these supplies for both insulin and non- insulin dependent patients. By encouraging the use of Medicare, DPAP dollars are saved for future use on non-Medicare covered pharmaceuticals. Clients must make a co-pay of $5 or 25% of the cost of the prescription whichever is greater. The co-pay is collected by the dispensing pharmacy. A total of $1,530,466 was collected in co-payment for this period. The co-payments represent 41% of the State’s drug expenditures for this period. The DPAP Rebates collected for this program represented 28% of the drug cost for this period. These offsets saved the State a total of $2,628,195 for the first six months of 2004. Details on the program’s demographics, outreach, and financials follow. Demographics The Delaware Prescription Assistance Program enrollment began on January 14, 2000. As of June 30, 2004, there were 6,639 clients enrolled in the program. With the 2004 reenrollment process, 20% of the clients were not re-enrolled, compared to 22% for the 2003 re-enrollment. The largest reasons for the drop in re-enrollment is incomplete application or change of income due to the death of the client’s spouse. January 6,639 February 6,549 March 6,423 April 6,248 May 6,100 June 5,979 Enrollment by Eligibility Category DPAP enrolls senior citizens who are 65 years or older; and individuals with disabilities who are receiving Social Security Disability benefits under Title II of the Social Security Act. Both eligible categories must have an income equal to or less than 200% of the Federal Poverty Level. The chart below shows the distribution of members by eligibility category. As of June 30, 2004, there were 3,285 seniors and 3,354 individuals with disabilities enrolled into the DPAP program. The chart below represents the average new enrollments across the previous six months. Seniors 56% Individuals with Disabilities 44% County As of June 30, 2004, 1,087 enrollees were from Kent County, 2,049 from Sussex County, and 3,503 from New Castle County. The percent of enrollees from each county is reflected in the adjacent chart. These percentages remain consistent with previous reporting periods. 53% 16% 31% Race Reporting membership by race is complex because not all clients are willing to specify race and ethnicity. Based on those that provided race information from the list provided, the racial composition of clients enrolled in the program was: 4,096 Caucasian, 1,160 African American, 934 Hispanic, 5 Native American, 18 Asian, and a total of 426 did not specify their race. The chart below shows the corresponding percentages of clients that have enrolled into the program in the past six months. Those who reported their race/ethnicity as either Native American or Asian represent less than 1% of the total population and are not represented below. White 62% Not Specified 6% African American 17% Hispanic 14% Gender Since the start of the program, women have outnumbered men. Of the total clients enrolling in the program between January and June 2004, 1,441 are females and 812 are male. The percent of enrollees is reflected in the adjacent chart. Males 36% Females 64% Applications Received The number of applications received and processed by the DPAP program continues to increase. Excluding re-enrollments, a total of 2,885 applications were processed for the first six months of 2004. This is an average of 481 applications reviewed per month. This is a increase of 1,097 applications over the same period last year and a monthly average increase of 183 applications. The chart below reflects the comparison of applications processed for January through June of 2002, 2003 and 2004. Month 2002 2003 2004 Januaruy 664 589 132 February 358 384 174 March 355 331 226 April 289 304 265 May 223 218 138 June 221 235 215 Applications Approved The DPAP ended State Fiscal Year 2004 with 6,639 client enrollments, our highest yearend number since the program’s inception. Client enrollments begin increasing each July, after re-enrollment and continue through June. The graph below details the number of enrollments over the last three years for the first six months of the year. Month 2002 2003 2004 January 3,325 5,336 5979 February 3,547 5,430 6100 March 3,741 5,569 6248 April 3,934 5,743 6423 May 4,130 5,882 6549 June 4,316 5,975 6639 Applications Denied The primary purpose of the program is to provide prescription coverage to lower income seniors, age 65 and older, and individuals with disabilities, or those who are receiving Social Security Disability Income (SSDI) benefits. Therefore, those who were not receiving SSDI or are not over 65 years of age, and whose income was not within the program guidelines, were denied coverage. For the last six months of state fiscal year 2003, 27% of the applications received were denied. Of those, 40% were denied due to incomplete applications and 31% were denied because they were Nemours eligible, above income, or were enrolled in Medicaid. The chart below details the application denials and the number of applications denied for each reason. There were 6 applications denied, as their prescription costs were less than 40% of their income. This represents less than one half of one percent of the denials and is not included in the chart below. Not 65; not SSDI 64 Other RX coverage 34 Above income; over 65 65 Nemours eligible 105 Application not complete 218 Enrolled in Delaware Medicaid 52 Phone Lines Monthly Phone Calls The Delaware Prescription Assistance Program successfully handled a monthly average of 1,136 incoming calls in the first half of 2004. Calls were answered in an average of 21 seconds with an average abandon rate of 2 percent. Calls centered on enrollment, reenrollment and eligibility questions. Call volumes increased in April, May and June due to the annual re-enrollment activities. Month 2004 2003 2002 January 654 836 754 February 618 668 730 March 755 864 886 April 1,147 1,372 1,386 May 1,558 1,371 2,239 June 2,084 2,678 2,024 0 The DPAP program received a total of 6,816 calls during the January to June 2004 time period. During the previous six-month period, July to December 2003, 5,391 calls were received and for the same period last year the call volume was 7,783. Over the same period last year, the call volumes decreased by 967 calls. Outreach Activities DPAP outreach activities have engaged government, public and medical professionals throughout Delaware. Outreach channels have consisted of advertising, information dissemination, special events, and application assistance opportunities. Continuous areas of focus have included Senior Citizen Centers, State Service Centers, community mental health facilities, and all pharmacies in the state. Large, colorful, and informational posters with the DPAP toll free number were delivered to various and appropriate sites for display. Application Distribution From January to June 2004, over 4,500 applications were distributed through community contacts and training sessions. Applications were distributed to all of the pharmacies in the state, state service centers, hospitals and more (a list of community locations where applications can be obtained is on page 10). The pharmacy community has been supportive in identifying potential clients for the program. Clients in the program use 195 pharmacies across Delaware to obtain their prescriptions. The chart below shows applicants’ responses regarding how they heard about DPAP from January to June 2004. Provider/ Pharmacy 8% State DHSS/DSS 29% Grapevine 25% Government Reps 6% Media 5% Senior Centers 1% Social Security & Medicare 6% Insurance Agent 2% *Grapevine is noted as a referral source when a caller identifies that they have heard about the program through a friend, family member, the phone book, Internet or have previously applied. Special Events The Delaware Prescription Assistance Program leveraged several well-publicized health care events to promote the program. Hundreds of individuals were introduced to the program at the events. The DPAP team participated in joint programs with other agencies and their clients throughout the last six months. Some of these special events are summarized below. At these events, 400 applications were distributed. Event Number of Attendees Date Medicare Roadshow – Camden Fire Hall 80 April 2004 Medicare Roadshow – Newark Senior Center 350 April 2004 Medicare Roadshow – Millsboro VFW 70 May 2004 Medicare Roadshow – Seaford Fire Hall 50 May 2004 Medicare Roadshow – Mt. Carmal United Methodist Church 50 May 2004 Claymore Senior Center Health Fair 75 May 2004 Newark Senior Center Health Fair 125 May 2004 Annual Senior Health & Fitness Day 200 May 2004 Additional locations where presentations were made on DPAP eligibility and enrollment: _ People’s Settlement – Enterprise Community _ Ministry of Caring _ Delaware Medicare Fraud Alert Volunteers _ Stonegates Community Center DPAP Information Distributed January - June 2004 The list below shows many of the diverse locations where DPAP information and applications were distributed in the past six months. Over 1,200 applications were distributed to these facilities. Provider/Hospital/RX Sussex Mental Health Clinic Christiana Care Community Centers and Residential Locations Catholic Charities Claymont Community Centers Women to Women Group C.L.I.M.B. Businesses Dr. Sternberg Delaware Community Briefing State/Government Agencies Division of Unemployment State Service Centers - Statewide Financials From January 1 to June 30, 2004, the Delaware Prescription Assistance Program provided 122,489 prescriptions for an average of 6,323 clients at a cost of $3,811,139. Since the program started (a 48-month period), DPAP has provided 707,915 prescriptions at a cost of $23,618,185. It is important to note that there are eight clients enrolled in DPAP under the eligibility provision of having prescription costs that exceed 40% of their annual income as of June 30, 2004. They are not represented in the following financial analyses in order to protect their privacy, and because these clients significantly skew the data. Paid Amount In the first half of 2004, the average monthly amount paid in DPAP prescriptions was $635,190 per month. For the same time period last year (January to July 2003), the average amount paid per month in prescriptions was $544,717. This is an average monthly increase of $90,473 or 17%. The aged and disabled, since the start of the program, continue to remain close in the dollars spent. This graph represents the actual dollars spent, by month for the second half of 2003. Month Total January $636,808 February $597,390 March $704,357 April $544,425 May $664,080 June $664,080 Program Expenditures The following chart depicts the growth in monthly expenditures since the program inception. There has been a steady increase in the annual cost of the program attributed to the increase in the cost of prescription drugs, the increase in enrolled clients and an increase in the usage of the benefit. Graph Unavailable Number of Prescriptions From January to June 2004, the average number of prescriptions filled in a month was 19,637, an average increase of 2,709 prescriptions per month compared to the same period last year. Overall, the number of prescriptions filled by eligibility category was very similar between the individuals with disabilities and the elderly. This has been a consistent trend over the life of the program. Month Aged Disabled January 8,581 9,905 February 8,206 9,487 March 10,634 11,845 April 8,482 9,741 May 10,559 12,245 June 8,329 9,805 Percent of Clients Using Benefits On a monthly average, between January and June, 78% of the clients used their benefit during the month. This average has decreased over the previous six-month period by 2%. Again during this six month period, when comparing those over 65 with the disabled, the average number of clients using their benefits is almost identical to the prior six-month period. Month Total percentage January 78% February 77% March 80% April 76% May 80% June 75% Average Number of Prescriptions Per Client Per Month The number of prescriptions filled per member, per month has decreased slightly over the past six-month period. From January to June 2004, the average number of prescriptions for each DPAP member was 3.99 per month compared with 3.96 in the previous six months. The average number of prescriptions per month, by eligibility category, is noted in the chart below. While slightly more aged clients use their benefit, the disabled population on average receives a greater number of prescriptions each month. Month Prescriptions January 3.95 February 3.77 March4.48 April 3.74 May 4.37 June 3.66 Average Cost Per Prescription In general, the average cost per prescription was consistent between the elderly and the individuals with disabilities. During this period, the average cost to the program per prescription was $36.44. There was an average increase of $6.94 per prescription compared to the previous six months; and a $2.91 increase this year compared to the same time last year (July to December 2002). The increase in costs can be attributed to beginning of the new benefit year, as clients have not reached their benefit limit as compared to the January to June time frame when members are more likely to have exhausted their benefit limit. No graph available Per Member Per Month Cost The average cost per member, per month for the program remains similar between the two eligibility categories. The calculation per member, per month uses all eligible clients as a denominator. From January to July, the average cost was $96.46 per member, per month. This is a $20.01 a month decrease in costs per member in comparison to the last half of 2003 average; and $0.98 a month decrease over last year at this same time (January to July 2003). The per member, per month cost is consistently higher in the second half of the calendar year over the first half. The chart below shows the monthly average cost per member by eligibility category. These represent the State’s dollars and do not include the client’s co-payment. Month Amount June $74.61 May $101.57 April $84.93 March $112.92 February $98.07 January $106.69 The overall amount paid per member, per month has decreased 17% over the previous six months, it has decreased 1% over last year at this time (January to July 2003). Therefore, the program has seen an overall decrease in prescription expenditures of $96,546 in the past six months compared to the total paid amount from the previous six month period (July to December 2003). The program has seen an increase of $373,104 for the first half of 2004 compared to the first half of 2003. The chart below is a summary of expenditures during the four and a half years of the program. Dates (Semi Annual) Per Member Per Month Average Cost Per Prescription Total Expenditures Jan-Jun 2004 $96.46 $31.08 $3,641,403 Jul-Dec 2003 $116.47 $36.44 $3,737,949 Jan-Jun 2003 $97.44 $29.50 $3,268,299 Jul-Dec 2002 $131.13 $36.81 $3,562,296 Jan-Jun 2002 $90.17 $32.14 $3,006,984 Jul-Dec 2001 $103.09 $34.93 $2,731,678 Jan-Jun 2001 $81.36 $30.25 $1,860,792 Jul-Dec 2000 $85.31 $31.83 $1,350,244 Jan-Jun 2000 $74.41 $30.42 $565,785 Member Expenditure Benefit Dollars Spent The $2,500 annual limit accommodates most members as noted in the benefit expenditure chart below. Compared to the same period last year, there was little change in how much of their benefit dollars a client uses. In fact, for each benefit dollar, consumption ranges described in the chart below, there was only a 2% variance over the same period last year. This is typical for the last six months of the fiscal year as the clients are reaching their $2,500 annual limit. Out of the 5,854 clients enrolled in DPAP: _ 93.2% of clients have used some portion of their benefits. _ 12.6% of the clients used all their benefit dollars. _ 72.7% of the clients used up to $2,000. _ 62.7% used up to $1,500. _ 40.4% of the clients used between $100 and $1,000. _ 6.8% have not used any of the DPAP benefits. Range Amount $0.00 6.8% $0.01 to $49.99 4.3% $50.00 to $74.99 1.7% $75.00 to $99.99 1.4% $100.00 to $249.99 9.4% $250.00 to $499.99 11.2% $500.00 to $749.99 10.6% $750.00 to $999.99 9.2% $1,000.00 to $1,249.99 7.7% $1,250.00 to $1,499.00 7.1% $1,500.00 to $1,749.99 5.4% $1,750.00 to $1,999.99 4.5% $2,000.00 to $2,499.99 8.0% $2,500.00 12.6% Drug Expenditure by Category DPAP spent 81% of the prescription drug dollars on the therapeutic class categories listed below. This percentage decreased by 1% over the previous six- months and the same period last year. Most represent treatment for chronic illnesses that would be expected with either the elderly or individuals with disabilities. Cardiovascular Preps $1,074,139 Behavioral Health Therapies $506,091 Analgesics-Narcotics $297,538 Diabetic Therapy $283,772 Analeptics $214,702 Hematinics & Clotting Products $160,217 Osteoporosis/Parkinson/UTI and Other Natural Products $135,685 CNS, General (Muscle Relaxants, Vascular Modifiers, Anitcholinergic) $119,118 Anti-Ulcer/Other Gastrointestinal Preps $80,248 Antibiotics $78,588 Number of Prescriptions by Category The top ten therapeutic classes account for 73% of the drugs that are filled through DPAP. This represents an 4% decrease over the previous six-month period and a 5% decrease over the same period last year. Cardiovascular Preps 30,343 Analgesics-Narcotics 11,287 Behavioral Health Therapies 10,648 Nutritional Supplement/Mineral/ Electrolytes 6,847 Diabetic Therapy 6,688 CNS Depressants 5,041 Anti-Ulcer/Other Gastrointestinal Preps 4,676 CNS, General (Muscle Relaxants, Vascular Modifiers, Anitcholinergic) 4,501 Analeptics 3,188 Antibiotics 2,781 Drug Utilization Review All prescriptions that are filled for DPAP clients are automatically reviewed for clinical appropriateness. This process is called Drug Utilization Review (DUR). There are two types of DUR: prospective and retrospective. Prospective DUR alerts the dispensing pharmacist before the prescription is filled. Retrospective analysis looks at prescription use over a long period of time. The DUR processes optimize medical and pharmaceutical care by reviewing the therapy of its recipients who are using prescription drugs. The DUR Board identifies criteria used. The Board consists of physicians, pharmacists and an advanced practice nurse. Prospective Drug Utilization Review Pharmacists submit claims electronically in a real-time environment, called the Point Of Service (POS) system. Eligibility and medication coverage is verified and the pharmacies are notified within seconds of the claim status. Clinical Concerns Alerts Filled 70% Alerts Not Dispensed 30% In the first half of 2003, 92% of all prescription claims submitted were filled. Twenty-seven percent or 22,411 generated a clinical concern or an alert as depicted in the chart below. Of the alerts, 30% were not filled, and 70% that were overridden and filled as depicted in the chart to the left. When faced with a clinical concern from the POS system, pharmacists take appropriate action, which can entail using their professional judgment, contacting the physician or simply talking to the patient. The prescriptions that were not filled may be related to a minor issue, such as it being too early for a refill. Major issues also arise, and are carefully screened by the appropriate medical professionals. Month Number of Prescriptions January 18,486 5476 3913 February 17,693 4865 3584 March 22,479 5558 3976 April 18,223 5289 3478 May 22,804 5417 3730 June 18,134 5417 3730 Retrospective Drug Utilization Review A retrospective drug review allows for an evaluation of drug usage over a long span of time, generally six months to a year. EDS contracts with Heritage Information Systems, Inc. for the retrospective drug utilization review. This type of review can alert practitioners to problems that may not be apparent at each visit or renewal of a prescription. Exceptions are identified when a patient’s therapy falls outside established guidelines. The Retrospective Drug Utilization Review for the first half of 2004, concentrated on two initiatives: the review of depression and Skeletal muscle relaxants. The depression intervention reviewed addressed the increased risk of Serotonin Syndrome with the concomitant use of SSRIs/Stimulants. There were 35 physician letters and 54 patient letters mailed. To date, 13 responses have been received. Of those responses, 3 physicians stated they would discuss the subject with their patients, 3 had previously discontinued therapy, 2 felt benefits outweighed the risks, 2 physicians did not consider the risk significant, and 3 stated they are no longer treating the client. The second review conducted, analyzed extended duration of therapy and over utilization of drugs such as carisoprodol, tizanidine, cyclobenzaprine, metaxalone. The analysis included 485 letters, impacting 386 patients. These result are not yet available. In Summary The July to December time period continued to see an increase in the number of applications made to the program. This resulted in a rise in the eligible population and in program utilization. Program expenditures continued to increase as seen in the chart on page 15. Since January of 2001, per member per month costs, average cost of prescription and total program expenditures where higher in the first half of the fiscal year. In part, this may be attributed to a new benefit year where clients are not reaching their benefit limit. Delaware Health and Social Services continues to review cost containment policies. While no new policies were implemented during this period, new drugs were added to prior authorization requirements. Some of the prior authorization additions include drugs that verify the practitioners are utilizing step therapies, an important part of patient care and cost containment. Step therapy is a process to ensure the most clinically appropriate medication for a condition is prescribed. Specific drug classifications are identified and are prescribed in a progression. Physicians must verify the patient’s failure to respond with a step drug progression, or provide medical documentation supporting the out of sequence dispensing. Client enrollment has almost tripled in the four years since the program’s inception. The program continues to be successful, helping Delawareans in need and without prescription coverage as evidenced by the continued increase in client interest and enrollments. This program provides assistance to part of our most vulnerable population, the elderly and disabled. It provides important and often necessary medications that might not otherwise be utilized. As much of the program expenditures represent treatment for chronic illnesses expected with this population, the quality and quantity of life is improved and healthcare costs related to these illnesses are reduced. Contact Information Please direct any questions or comments about this report to the EDS Project Manager, Kim Chappell, who is available at 302-454-7622, extension 177, or at: EDS Health Benefits Manager 248 Chapman Road, Suite 100 Newark, Delaware 19702