Monday, June 25, 2012

Webinar on Supreme Court Decisions' Impact on Health Reform (two sessions available)

Join us for a webinar on July 11th or July 26th at 2:00 to 3:30 PM EST to reveiw the implications of the Supreme Court's ruling on health reform.

Choose your date and click one of these links to reserve your seat EARLY:
Wed, Jul 11, 2012 2:00 PM - 3:30 PM EDT
Thu, Jul 26, 2012 2:00 PM - 3:30 PM EDT

The Supreme Court decisions on health reform issues are expected in late June or early July 2012. This webinar will review the decisions and discuss the impact on the future of health reform with a focus on how employers may, or may not, be effected by the decisions.

Please note: times for AG webinars vary and are listed for various time zones – find your local time above.

Presented by: Bob Radecki, President, Benefit Comply, LLC
Bob Radecki has more than 30 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 an 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.



BCBSNC Announces the Launch of the Patient Care Summary

Blue Cross Blue Shield of North Carolina (BCBSNC) launched the Patient Care Summary (PCS) with the goal aimed at improving health care delivery. The PCS is a new way to share information with doctors.

Important Information:
  • The PCS is a report accessed through Blue e that provides information to health care providers on an individual patient level.
  • This report will enhance the quality of care as it identifies gaps between individual patient information and evidence-based guidelines; therefore generating conversation between the patient and physician.
  • The PCS will provide information on prescription medications and most recent medical care that the patient has received to give the physician a quick summary snapshot of the patient’s health care experience.
For additional details, please read the attached document with an overview and frequently asked questions.






Monday, June 18, 2012

UHC: Specialty Medication Tier Correction and Lipitor Update

Specialty Medication Tier Correction: View the three corrections on the Specialty Medication Cost Share List effective August 1, 2012.  

Lipitor Update: Read how UnitedHealthcare has adjusted the Tier Placement for Lipitor and its generic atorvastatin.

UHC: Contraception Coverage Update

The Patient Protection and Affordable Care Act  requires coverage of FDA-approved contraceptive methods for women at 100 percent, without charging a copayment, coinsurance or deductible, when filled at a network pharmacy. The new coverage will affect different groups at different times.

Please view the brief summary from UnitedHealthcare of what is occurring along with when, and how they will manage the additional costs represented by this new coverage requirement.

BCBSNC Explanation of Benefits Available Online June 11

Blue Cross Blue Shield of North Carolina (BCBSNC) has added an online viewing feature for members to view their Explanation of Benefits (EOB) documents. This feature will provide quick reference to EOBs, making it easier for members to manage their benefits.

Important Information:
  • To access EOBs members should navigate to http://www.mybcbsnc.com/. After logging in to Member Services, members can access their EOBs via the explanded claim details within the claims section.
  • EOBs will be available to the policy subcriber only, for all processed claims from January 2012 and beyond.
  • EOBs do not include claims for services covered under a Dental Blue plan. Members can view these claims by clicking the "benefits claims" link on the dental tab on the claims page.
  • At this time, EOBs will only be available to subcribers on the under-65 plans for individuals and groups, excluding Federal Employee Program subscribers.

UHC Announces PDL Revisions

UnitedHealthcare released a recap of changes made outside the January 1 and July 1 pharmacy updates.

View the PDL Tracker to view these revisions.

Friday, June 15, 2012

BCBSNC Releases Health Care Reform Update: Uniform Coverage Documents

Blue Cross Blue Shield of North Carolina released a statement concerning the government ruling for complying with the Uniform Coverage Documents (UCD) regulations under the Patient Protection and Affordable Care Act.

An important point in the UCD requirements is that BCBSNC is responsible to meet the notice requirements for our fully-insured groups.  On the other hand, ASO groups are responsible for meeting their member notice requirements. 

BCBSNC will meet their obligations by providing the following notices for fully-insured groups:
  • Send Summary of Benefits and Coverage (SBC) to group administrator within prescribed time frames after any of these events occurring after September 23, 2012:
    • Upon application for coverage
    • By first day of coverage (if information has changed)
    • Upon enrollment of Special Enrollees (participants/beneficiaries only)
    • Upon renewal
    • Upon request
  • Post SBCs to the Member Services section of bcbsnc.com
  • Send postcards to all employees telling them the SBC is posted on-line and the location (this is a notice requirement)
 The group is responsible for providing SBCs to new hires, to special enrollees and to eligible employees who are not enrolled. 

The group is responsible for providing paper SBCs to employees who do not have reasonable online access in the workplace, to new hires, and to special enrollees.

A document summarizing these requirements is attached, including an overview and frequently asked questions.

Wednesday, June 13, 2012

Webinar on Supreme Court decisions' impact on future of health reform

Join us for a webinar on July 26th from 2:00 - 3:30 PM EST on the Supreme Court decision and how it will impact the health reform law.

Reserve your seat through the link below:
https://www1.gotomeeting.com/register/134774016

The Supreme Court decisions on health reform issues are expected in late June or early July 2012. This webinar will review the decisions and discuss the impact on the future of health reform with a focus on how employers may, or may not, be effected by the decisions.

Please note: times for AG webinars vary and are listed for Eastern Standard Time.

Presented by: Bob Radecki, President, Benefit Comply, LLC
Bob Radecki has more than 30 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 an 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.

Thursday, June 7, 2012

BCBSNC's Pharmacy Program Changes Effective May 2012

Topical Retinoid Program Revised, New Drugs Added to Current Programs

Blue Cross Blue Shield  of North Carolina (BCBSNC) made the following changes to their pharmacy program.
  • Topical Retonoid Prior Plan Approval Program (Providers were notified of these changes on May 9.)
    • Adapalene products (Adapalene e.g. Differin; Adapalene/benzoyl peroxide e.g. Epiduo) – the age restriction was removed. Members will continue to be required to try a generic before they can use one of these brand drugs.
    • Tazarotene (Tazorac) – the age restriction was changed from age 25 to 35.  Patients aged 35 and younger who have recent claims history of obtaining a generic tretinoin product will not require review.
    • Tretinoin products (Tretinoin e.g. Retin-A, Tretin-X, Avita, Atralin; Tretinoin microsphere e.g. Retin-A Micro/Pump; Tretinoin/clindamycin phosphate gel e.g. Veltin, Ziana; Tretinoin bulk powder) – the age restriction was changed from age 25 to 35.  Patients aged 35 and younger with a current prescription for generic topical tretinoin or who have recent (within the past 365 days) claims history of obtaining a generic tretinoin product will not require review.
  • Subsys is a new drug that was added to the transmucosal fentanyl program.  It is a fentanyl drug in a spray form. 
  • Qnasl is a new drug that was added to the restricted access list of intranasal steroids. 
  • Provigil: this drug now has a generic, and both the brand AND generic will require prior plan approval. 

BCBSNC Announces Prime Network Changes in July

Blue Cross Blue Shield of North Carolina (BCBSNC) made the transition to Prime Therapeutics (Prime) as its new pharmacy benefits manager effective April 1, 2012.  At that time, all pharmacies were allowed (if they were willing and the doctor wrote the prescription that way), to dispense up to a 90 day supply of medication. Typically, pharmacies have to sign an additional contract with Prime in order to be able to dispense greater than a one month supply. In order to ease the transition for our members to Prime, BCBSNC asked Prime to waive this requirement, and allow members to continue to get a two or three month supply of medication at a pharmacy as long as they had a basic contract.

As of July 1, BCBSNC will have Prime enforce their contract requirements. What this means is that if a pharmacy does not have a contract with Prime to dispense greater than a one month supply, then the pharmacy will only be able to dispense a one month supply.

Key Points
  • Members whose pharmacy has not yet signed a contract with Prime to provide extended supplies of medications may need to visit a different pharmacy to receive an extended supply of their medication.
  • Member Mailing Began Last Week: Members who have received an extended supply of a medication within the last six months are being mailed the letter below starting May 25 to inform them of this change.
  • BCBSNC specialty pharmacies will continue to be able to dispense up to a 90 day supply through 12/31/12.  Please note that in late March, BCBSNC notified sales staff and agents that beginning July 1, 2012, specialty medications would only be dispensed in quantities equivalent to a 30 day supply to most members with BCBSNC pharmacy benefits. BCBSNC has amended the effective date of this change, so that all BCBSNC customers with BCBSNC pharmacy benefits will be able to receive up to a 90-day supply of specialty drugs through December 31, 2012.

Please see the FAQs and sample member letter for more information.

Monday, June 4, 2012

BCBSNC announces quantity limit changes and tier changes to take effect July 1

Blue Cross and Blue Shield of North Carolina (BCBSNC) is expanding its utilization management program for members with pharmacy benefits effective July 1, 2012.  These programs include prior review and quantity limit programs.  
Programs with changes for ALL users:
Prior review and quantity limitations will be required for:
  • Cambia™ (diclofenac potassium for oral solution) – used to treat acute migraines
Programs with changes for NEW users:
The following brand statins (drugs used to lower cholesterol) will require prior review for new users:
  • Crestor®1 5mg / 10 mg / 20 mg Crestor 40 mg will not be included in this program because it is the highest available dosage / potency of any statin on the market, and it is typically not used as a starting dose, which is what this program is targeting.
  • Vytorin ®1
  • Simcor ®1
  • Livalo ®1
  • Advicor ®1 
  • Lescol ®1  / Lescol XL ®1
  • Lipitor ®1 
Other changes:
Vytorin and Simcor will move from tier 2 to tier 3 on BCBSNC’s drug formulary.
Additional Resources