Friday, July 29, 2011

Medco sending letters to 286,000 BCBSNC members next week

Medco, on behalf of BCBSNC, will send letters to approximately 286,000 members who are currently taking three or more maintenance medications. The letters are scheduled to go out next week. This mailing is an extension of the Therapeutic Resource Center program.

The letters are tailored to address a member’s specific health condition(s). Medco will send letters to members with diabetes, cardiovascular disease, pulmonary disease, cancer, neurological and/or psychological disorders, women’s health issues and general health conditions. Letters to members under the age of 18 will be sent to a parent or guardian.

The letters are further customized based on where the member is in the management of their condition. For example, Medco will send letters to members who are newly diagnosed with a condition, changing therapy for an existing condition, addressing multiple conditions or working to maintain their health.

Medco will not send letters to members in groups that have asked to be excluded from Therapeutic Resource Center initiatives. The Therapeutic Resource Center is a group of pharmacists and benefit specialists employed by Medco who contact members meeting certain criteria and provide prescription drug advice. The goals of this program are to improve medical adherence and reduce costs by encouraging generic and mail order utilization.

BCBSNC has provided sample letters in the following documents.  The first document contains four letters, each for a different stage of care, for members with cardiovascular disease. The second document is a sample of a letter that would be sent to the parent or guardian of a member under the age of 18.

Webinar on health reform: exchange regulations and 2012 implementation issues

Senn Dunn invites you to participate in an Assurex Global webinar on August 25 from 12:00 to 1:30 PM EST.
Reserve your seat now at:
https://www1.gotomeeting.com/register/656512945

There is so much change going on related to health reform that we will be doing a health reform update webinar at least once every few months. Already since our last Health Reform Update webinar in March 2011, a number of things have changed, including the repeal of the free choice voucher rule, and another delay in the release of the uniform benefit statement. The IRS has also provided some initial hints on how full-time employees will be defined. A number of important regulations are due to be released in 2011. This session will cover any new rules released and also prepare employers for upcoming heath reform implementation issues.

Some of the topics expected to be covered in this session include:

• Exchange regulations
• 2012 health reform implementation issues such as the uniform benefit statement and preparing for changes to Section 125 plans

Please note: times for AG webinars vary and are listed for the Eastern time zone.

Presented by: Bob Radecki, President, Benefit Comply, LLC
Bob Radecki has more than 25 years experience in the HR and employee benefits industry helping employers deal with difficult benefit and compliance matters. Previously, Bob founded and served as President of A.E. Roberts Company, a nationally recognized compliance consulting and training firm. He has served as the principal HIPAA consultant to a number of health insurance companies, and is recognized as a leading expert on a variety of benefit compliance issues including COBRA, FMLA, Health Reform and more. Bob has been the featured speaker at numerous industry events and conferences, and has published a number of articles concerning various compliance issues.

After registering you will receive a confirmation email containing information about joining the Webinar.

Wednesday, July 27, 2011

Several popular prescription drugs to be available as generics

(CNN Health report, 7/26/2011) According to the mail-order pharmacy Medco, at least 22 prescribed medications may be available as generics in the next year.

When drug companies develop a drug, the FDA usually grants them exclusive rights to market that drug for a set period of time. When those rights expire, other companies can make the exact same drug. Since there is competition, the generics are cheaper. The FDA says the regulations are “designed to promote a balance between new drug innovation and generic drug competition.”

The major drugs on the list for next year include:
Lipitor, a popular cholesterol drug, goes generic in November.
Solodyn, used to treat bacterial infections, November.
Zyprexa, which treats schizophrenia, October.
Lexapro, used to treat depression, March
Provigil, which treats sleep problems, April
Plavix, an antiplatelet drug which can prevent blood clots, May.
Singulair, an Asthma drug, August 2012.

Many of these drugs currently run between $100 and $400 for a 30-day supply.  There’s no clear indication how much cheaper the generic versions of the drugs will be, but for comparison the well-known depression drug Prozac, which became generic 10 years ago, now sells for less than $16 dollars for a one-month supply.

Monday, July 25, 2011

UHC to make PBM change effective January 1, 2013

On July 21, Medco announced an agreement to merge with Express Scripts. At the same time, Medco announced that it will not renew its contract to provide pharmacy benefits administration services to UnitedHealthcare (UHC) customers. The contract ends December 31, 2012 and includes a transition period thereafter.

As such, UHC has announced that they will be prepared to transition services currently handled by Medco to UnitedHealth Group's in-house pharmacy benefits manager (PBM), Prescription Solutions by OptumRx, when the Medco contract ends.  This change will not occur for more than a year, and until that time it is business as usual for UnitedHealthcare members, who should continue to use their pharmacy benefits as they have been.

UHC is confident about all this change will offer UHC customers.  OptumRx has made significant investments in its infrastructure and technology to expand its capacity and strengthen its operations for continued growth.  We will continue to keep you informed as any updates on this transition are announced.

Friday, July 22, 2011

Some UNC hospitals will only require copays for BCBSNC members

Effective August 1, 2011, services received by eligible BCBSNC members at certain independent UNC clinics will be treated as a single office visit with only one applicable copayment due at the time of service for members enrolled in a copayment product. Individual and group UW, ASO, State Health Plan, Federal Employee Program, and Inter-Plan Home members will be eligible for this upfront cost-savings at these specific UNC Hospitals clinics.

BCBSNC members with appointments on or after August 1 at any of the newly designated independent clinics will receive a letter from UNC Hospitals explaining that they can expect to pay an estimated out-of-pocket amount upfront, for clinic services, that is equal to the amount of their copayment, if applicable.

Highly specialized care and services received at UNC clinics, such as oncology/cancer care, transplant services, MRIs, CT scans, etc., will be subject to the member’s applicable deductible and coinsurance amounts.

For more information, refer to the FAQ.

Tuesday, July 19, 2011

Webinar on benefit issues during FMLA leave

Senn Dunn invites you to participate in an Assurex Global webinar on July 28 from 3:00 to 4:00 PM EST.
Reserve your seat now at:
https://www1.gotomeeting.com/register/755894896

Employers face significant risk if benefits are not properly handled for employees taking FMLA leave. This session will discuss in detail the employer’s obligations, employee communication requirements, and other rules specific to employee benefits during and after FMLA leave. This session is designed for employers with at least 50 employees who are subject to FMLA.

Topics will include:
• Benefit reinstatement rules
• What to do if an employee does not return from FMLA
• When do you offer COBRA?

Presented by: Bob Radecki, President, Benefit Comply, LLC
Bob Radecki has more than 25 years experience in the HR and employee benefits industry helping employers deal with difficult benefit and compliance matters. Previously, Bob founded and served as President of A.E. Roberts Company, a nationally recognized compliance consulting and training firm. He has served as the principal HIPAA consultant to a number of health insurance companies, and is recognized as a leading expert on a variety of benefit compliance issues including COBRA, FMLA, Health Reform and more. Bob has been the featured speaker at numerous industry events and conferences, and has published a number of articles concerning various compliance issues.

Monday, July 18, 2011

BCBSNC releases details on 2011 flu shot program

BCBSNC announced that its flu shot program for 2011 will be administered as in past years, with the following changes:
  • BCBSNC will send an email about worksite clinics to groups of 51+
  • The email will include a link to the online Clinic Request Form
  • BCBSNC will send a follow-up email to those groups that have not yet signed up for a clinic
Like Last Year:
  • Groups with immunization/preventive care benefits that pay at 100 percent prior to meeting a deductible who meet certain criteria can work with BCBSNC to arrange a free flu shot clinic at their worksite(s).
  • Members who currently have a copayment plan and receive a flu shot either at an on-site Maxim clinic, pharmacy, Minute Clinic, or any applicable non-physician practitioner will be covered without a copay required. This is similar to the BCBSNC benefit for immunizations, where as long as a claim for a physician's visit is not filed, then the administration of the shot is available at no additional member cost.
  • Flu shots will be available from doctor’s offices, at worksite flu shot clinics, or by in-network pharmacists who are certified to provide certain immunizations, including the flu vaccine and participating in the BCBSNC network.
  • ASO groups will be responsible for paying for the cost of flu shots. Groups that participate in a Maxim worksite flu clinic can take advantage of the $25 per-shot fee that BCBSNC has negotiated with Maxim for covered BCBSNC members.
  • BCBSNC members can find information at www.bcbsnc.com/flu. Employer groups can find information, including tips, posters and FAQs documents, on the employer website.
  • If participating urgent care centers or convenience care centers submit member flu shot claims to BCBSNC and the member has 100 percent immunization/preventive care benefits, BCBSNC will pay for shots administered by these participating providers. Some members may pay a copayment, or deductible, depending on the location and their specific benefits.
  • Maxim requires 25 vaccinations per clinic. Groups that fall below this minimum will be charged for the shots that fall short of 25.
  • Any group that can meet the minimum requirement for vaccinations can participate, but BCBSNC is only actively promoting clinics to groups of 51+, since it is unlikely that smaller groups will meet this requirement. Groups can request flu shot clinics by using the online request form found at www.bcbsnc.com/fluclinic. This form is easier for the group and will allow Maxim to provide faster turnarounds to get clinics scheduled.
  • H1N1 is now included as part of the standard flu vaccination.

Wednesday, July 6, 2011

Blue Options HSA online changes effective July 18th

Beginning July 18, 2011, BCBSNC is making changes to the way that members view and access information about their Health Savings Account (HSA) online.

If plan participants are enrolled in a Blue Options HSA account and their fund administrator is ACS/BNY Mellon, subscribers in that plan will notice the following changes:

• Beginning July 18th, subscribers who log into BCBSNC’s Member Services (http://www.mybcbsnc.com/) will notice that the “My HSA Account” link is being replaced with a “Manage My HSA” link. This link will direct subscribers to http://www.hsamember.com/, a site hosted by ACS/BNY Mellon, the HSA fund administrator.
• Subscribers who are accessing http://www.hsamember.com/ for the first time will need to complete the e-registration process with ACS/BNY Mellon. Then, to access their HSA account information at any time, they simply log into their new hsamember.com account. (This account and log-in process is separate from their BCBSNC Member Services account.)
• With http://www.hsamember.com/, BCBSNC members will have more of their HSA information at their fingertips.
• “My HSA Account” pages will no longer be available on http://www.bcbsnc.com/. Members will be able to access similar information, and more, from the http://www.hsamember.com/ website.

For more information, click to access the Employer FAQs on this topic.

Tuesday, July 5, 2011

BCBSNC to cover sleeve gastrectomies

Beginning July 1, 2011, BCBSNC will cover the sleeve gastrectomy procedure for qualified members who meet the criteria outlined in their medical policy titled “Surgery for Morbid Obesity.” You can search the medical policy on http://www.bcbsnc.com/.

What is a sleeve gastrectomy?
A sleeve gastrectomy is an alternative approach to a standard gastrectomy that can be performed on its own or in combination with other procedures. In this procedure, a portion of the stomach is removed, leaving a stomach remnant shaped like a tube or sleeve. Additionally, the pyloric sphincter is preserved, resulting in a more normal transit of food from the stomach to the duodenum and avoiding some of the complications seen with other gastrectomy procedures. A sleeve gastrectomy procedure is relatively simple to perform, and can be done through an open or laparoscopic technique.

Who might undergo this procedure?
As stated in the medical policy, a member must have a body mass index greater than 40 or over 35 along with one or more co-morbid conditions. Also, the surgery must be part of a comprehensive pre-surgical, surgical and post-surgical program. Some surgeons have proposed this as the first in a two-stage procedure for very high-risk patients.

Why has BCBSNC decided to cover this procedure?
Previously, this procedure was considered investigational. Now, long-term follow-up data (up to six years after surgery) and comparative studies are available. The research shows resulting extensive weight loss. Weight loss following a sleeve gastrectomy may improve a patient’s overall medical status and, as a result, reduce the risk of a subsequent, more extensive procedure. It should be noted that as with other surgical weight-loss procedures, weight gain often recurs over time.