FinePoints. CVMC improves healthy outcomes for physical and rehab therapy. Provider relations: ready with the answers. Practice Profile: Spring 2015

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1 A Newsletter from In This Issue Volume 10 Issue 1 Spring 2015 CVMC improves healthy outcomes for physical rehab therapy Genetic testing requires prior approval...3 BCBSVT's outcomes summit draws local, national and international experts Provider Resource Center no longer works in IE8...5 Helping patients understand zero-cost preventive care What would you like to see on our website?...7 BCBSVT CEO recognized for health and wellness leadership... 8 Mailing to highlight importance of mammograms... 9 View current status of prior approvals through Provider Resource Center... 9 BCBSVT earns high praise for its commitment to member experiences...10 Blue Cross and Blue Shield of Vermont Practice Profile: CVMC improves healthy outcomes for physical and rehab therapy By Tim Simard One of the more difficult aspects of being a health care provider is determining whether you have helped a patient achieve the best results from a treatment. When that patient leaves your office or hospital, will he or she return again and again for the same ailment? Did he or she receive the best outcome from the experience with your practice? These were some of the many questions Central Vermont Medical Center s Rehabilitation Therapy Department wrestled with when it came to helping its patients. Too often, providers at CVMC would see the same patients returning to their clinics with similar ailments and health needs. Were they missing something in their initial visits? Was there something going on in their patients lives that resulted in reoccurring injuries? We needed to find a better way to assess how we were doing and a better way to assess how our patients felt during their therapy and after, explains Robert Patterson, physical therapist and CVMC s vice president of human resources and rehabilitation. It was time to find a better assessment tool that would effectively measure outcomes for patients. Patterson gives an example of what CVMC hoped to achieve with new outcomes data. If I m doing a chart audit and I see it took 25 visits to help a person and our benchmark was only eight [visits], Preferred Brand-Name Drug List...11 Provider relations: ready with the answers When questions, comments or concerns arise, Blue Cross and Blue Shield of Vermont s (BCBSVT) provider relations staff is available to help with your practice s needs. You can always call your provider relations representative, or contact the provider relations department at (888) You can also them at providerrelations@bcbsvt.com. Business hours are Monday through Friday, 8 a.m. through 4:30 p.m. Above: Michelle Alberghini and Robert Patterson. Continued on page 2

2 Continued from page 1 is published by Blue Cross and Blue Shield of Vermont for its Pro vi ders and other interested parties. Correspondence should be addressed to: Tim Simard Managing Editor BCBSVT P.O. Box 186 Montpelier, VT or Wendy York Provider Relations Communications Consultant BCBSVT P.O. Box 186 Montpelier, VT (802) Send your comments, questions and suggestions about to: communications@bcbsvt.com We'd like to hear from you. Blue Cross and Blue Shield of Vermont is an independent, nonprofit corporation with a community based Board of Directors including Vermonters from all walks of life. The Company is licensed to use the Blue Cross and Blue Shield symbols by the national Blue Cross and Blue Shield Association, which establishes uniform financial and performance standards for the 39* individual, independent Plans that are part of the Blue Cross and Blue Shield system. The Association does not act as a guarantor of individual Plans financial obligations, but rather establishes standards intended to foster a system in which each Plan maintains adequate resources to meet its obligations to its customers. * as of June 2010 we need to figure out what we can do to get our patient the help he or she needs over fewer visits, Patterson says. A new measurement Two years ago, CVMC physical therapy department staff began a search for a new way to measure outcomes. It needed to be a tool that could effectively gauge physical and occupational therapies across a broad spectrum, says Michelle Alberghini, a physical therapist with CVMC. They also needed something that all staff could use; CVMC s rehabilitation department features nine sites throughout Central Vermont, employing nearly 40 clinicians as part of the University of Vermont Medical Center network. At its peak, the clinics can see well over 200 patients a day. Previously, CVMC had been using guidelines set forth by the American Physical Therapy Association, but the data range and information was too broad for CVMC s needs. By reaching out to similar organizations, Alberghini learned of an assessment tool called FOTO, or Focus on Therapeutic Outcomes. FOTO allows physical therapists to measure the effectiveness of the therapy they are providing patients and compare with other hospitals and clinics that use the same tool. It stood out to me because it was the only rehab-specific benchmark tool I could find, Alberghini says. With the support of medical center administrators, Alberghini brought FOTO to her staff and co-workers. As with any change, there is some hesitancy in the beginning, but CVMC therapists quickly embraced the data that FOTO compiled. 2 Spring 2015

3 Right from the beginning, it was really nice to get meaningful results, she says. When patients visit CVMC for rehabilitation services, they fill out a FOTO survey about their functional abilities and ailments. Throughout treatment, usually near the end of the course of therapy, patients fill out follow-up FOTO surveys specific to their treatment. The pinpointed data collected through these surveys has already improved CVMC s outcomes with neurological rehabilitation, which was an area with which the clinics sometimes struggled. FOTO also asks patients questions about reoccurring injuries are they afraid that they ll reinjure themselves by returning to work or by attempting sports or other activities that injured them in the first place? Getting a patient mentally over his or her fear can be a challenge, and rehabilitation specialists have used FOTO in conjunction with occupational medical providers and psychologists. We want our patients to be able to return to work without this fear hanging over them. The same goes with patients who had a bad accident while biking or on the [ski] slopes, Patterson explains. FOTO also measures a patient s satisfaction with CVMC itself. For instance, it measures the friendliness of the staff, the convenience of the clinic locations and atmosphere of the rehab centers. We want all of that data. Providers really do want their patients to get the best overall experience, Alberghini says. Expanding FOTO "We want all of that data. Providers really do want their patients to get the best overall experience," Michelle Alberghini FOTO has become popular among CVMC s therapy specialists and now staff are looking at ways to expand its usage. For starters, CVMC is now including FOTO measurements within a patient s electronic medical record for other providers and specialists to use. Now, it will be a part of the actual health record. It makes treatment a little more seamless and a little more practical, says Patterson. Alberghini also wants to expand FOTO into CVMC s sports medicine clinics. She would like local athletes to fill out FOTO surveys during pre-season practices to better prepare CVMC in case someone seeks treatment for an injury. CVMC s improved outcomes have also attracted local, national and international notice. Patterson and Alberghini both presented at Blue Cross and Blue Shield of Vermont s outcomes summit last December. They spoke about how the new outcomes measurements have led to changes in patient treatments and improved data. (See page 4 5 for an article about the summit.) We re really just starting out with FOTO, and there are so many different uses for it. Our goal is just to keep getting better and better for our patients, says Alberghini. Would you like your practice featured in a future edition of? We re interested to see what providers are doing to provide the best care possible. If you re interested in having your practice and office featured in, give us a shout. Send your ideas to communications@bcbsvt.com. AAAT TCGA Genetic testing requires GCTA prior approval CAGT Blue Cross and Blue Shield of Vermont reviewed and revised all prior approval ACGC listings for genetic testing and is now keeping an updated list on its provider TGTT website. We will update this list of CPT and HCPS codes periodically, so please TGGA refer to bcbsvt.com/provider/priorapproval-authorization anytime you GCTA have a patient who will need a genetic AGAT test. We have found there is confusion as ATAC to what BCBSVT considers genetic testing and what procedures do and do not require prior approval. We hope keeping a current list will clear up any discrepancies. If you have any questions regarding these changes, please feel free to contact your provider relations consultant. CGTT ACTT TAGA AACA AAAG GGTT AAATGTTCGTAGGCATT TCGAGCTCCACTGATGA GCTACCCTACGCTTATG CAGTGCGTCGTCGCAAT ACGCCTAGAAGCCACGG TGTTCTCGTGCCGAGAC TGGATTTACAGCCGTTG GCTACTACCCGGCGGTT AGATCAACTGAACATAA ATACTGAGTTAAGATGA CGTTAACCGCTCTATGA ACTTCTATTCCGACGCC TAGATTGCGCCCTTTAC AACAAAAAGAACGAAGT AAAGACTCGTGTGAGAA GGTTCAGATAGGGTTGA 3

4 BCBSVT s outcomes summit draws local, national and international experts By Kristin Fletcher The conversation around health care reform in the state often begins and ends with cost what is the best way to reduce costs and make health care more affordable for everyone? But cost is only one part of the equation. Increasingly, Vermont health care advocates are focusing on improving the value of health care. Harvard Business School professors Michael E. Porter and Elizabeth O. Teisberg, in their 2006 book Redefining Health Care, judge the value of health care through the favorable outcomes that come from the dollars spent. It is not enough to keep costs low if patients suffer in the long run. In December, Blue Cross and Blue Shield of Vermont invited local, national and international experts at increasing health care value to speak at an outcomes summit in Montpelier. You can t talk about high-value health care unless you have important-to-patients outcomes measures, said Dr. Robert Wheeler, chief medical officer and vice president at BCBSVT. The conversation we would like to see is a provider-led and stakeholder-involved process [to tell us] which metrics are out there that are important to patients. Speakers at the summit, attended by Vermont s clinicians and lawmakers, included representatives from the International Consortium for Health Outcomes Measurement (ICHOM), a nonprofit organization founded in part by Michael Porter to create worldwide standards to measure patient outcomes for specific medical conditions. ICHOM President Dr. Christina Rangemark Akerman and Vice President of Implementation Jean Stoefs were joined by Scott Miller, founder and director of the International Center for Clinical Excellence, and Central Vermont Medical Center physical therapists Robert Patterson and Michelle Alberghini. During the panel discussion following the presentations, Stoefs pointed to a program at Stanford Health Care in its neurosurgical spine division that asks the patient to complete a quality of life questionnaire prior to consultation. The questionnaire gets the patient thinking about what outcomes matter to him or her and allows the physician to review the information ahead of time. Stanford staffers told us they are seeing more patients per day because they focus the discussion on what matters for the patient and the satisfaction of the patient goes up, Stoefs said. The physical therapy department at Central Vermont Medical Center uses a similar assessment tool, called FOTO (Focus on Therapeutic Outcomes), prior to or during the initial visit. The tool allows CVMC physical therapists to measure a patient s functional status, predict realistic goals and compare the practice s outcomes to 2,000 other clinics and hospitals. (See the Practice Profile on page 1 3 for more information.) The tool also allows the practice to identify and address a patient s fear that might interfere with the treatment. In CVMC s Work Hardening program, which often handles the most complicated cases, the practice s rehab specialists work closely with occupational medicine "You can t talk about highvalue health care unless you have important-to-patients outcomes measures," Dr. Robert Wheeler physicians and clinical psychologists to help patients return to work in over 90 percent of the cases, according to Patterson, who is CVMC s vice president of human resources and rehab. Why it works is there are weekly meetings where they discuss the patients, there are check-ins on a daily basis, they round together. They are co located so it s a really integrated model, Patterson said. I think that s the way to go forward. There are a lot of people who have multiple comorbidities and psychological issues and fear issues. Several attendees pointed out the need to engage consumers, as well, to understand their role in achieving the best outcomes. Researcher and psychologist Scott Miller developed an assessment tool of his own, called Feedback 4 Spring 2015

5 Informed Treatment, which encourages that engagement by tailoring each session to meet the client s needs. You re talking about outcomes that are predictive of care, that are associated with fewer negative or adverse events, but the idea is also relatively new, Miller said. And I think that s what is so incredible about ICHOM and the individual examples. They are providing that larger vision and leadership beyond simply counting the number of widgets served. Dr. Wheeler said BCBSVT would like to see Vermont providers work together to decide which outcomes matter the most to patients and to standardize the metrics used to measure those outcomes. ICHOM is hoping to standardize those outcomes at a global level and already has set standards for outcomes for 12 conditions, such as prostate cancer, depression and anxiety, and lower back pain. The goal is to publish 50 standard sets covering more than 50 percent of the global disease burden by Dr. Akerman cited an example from Sweden where providers began to track their outcomes on hip and knee replacements using the standard set. What they could see is that the cost came down quite significantly because you focus on doing the right things instead of only doing things right, Dr. Akerman said. And if you get that situation then you can, of course, start discussing how can that money then be used in a much better way because you have the same or even better outcomes at the lower cost. Provider Resource Center no longer works in IE8 If you re running an older version of Internet Explorer, you won t be able to use our Provider Resource Center. HealthTrio, our partner that hosts our secure resource center for members, employers and providers, no longer supports Internet Explorer 8 (IE8). HealthTrio recently upgraded its Web browser capabilities to Internet Explorer 9 (IE9). The Provider Resource Center also works on all latest versions of Mozilla Firefox, Safari and Chrome. If you have trouble accessing the resource center, please contact your provider relations consultant. 5

6 Helping patients understand zero-cost preventive care Since implementation of the Affordable Care Act, we ve received feedback from our members and our providers that the new preventive care benefit can be difficult to understand. Knowing what services are available at no cost, including any gender or age restrictions, is murky at best. Preventive care has different definitions for different stakeholders, which further confuses the issue. Preventive care, by definition, is designed to avert and avoid disease, regardless of whether or not the patient has been exposed to, or has risk factors for, a disease or illness. Blue Cross and Blue Shield of Vermont follows the definition for zero-cost preventive care established by the Affordable Care Act (ACA). For members whose plans are not grandfathered with respect to the ACA, we use the United States Preventive Services Task Force A and B recommendations, The Centers for Disease Control s Advisory Committee on Immunization Practices, the Health Resources and Services Administration and Bright Futures, along with applicable state mandates, to determine the services we cover with no cost sharing for our members because they are preventive. The list of ACA-defined zero-cost preventive services can change as new research becomes available. To view the current listing of zero-cost preventive services, you may visit gov/preventive-care-benefits/. When processing claims, the zero-cost preventive benefit is code-dependent, meaning that the procedure code and the diagnosis code must be a one-to-one preventive match. If you re interested in reviewing our zero-cost preventive code list, please visit Our members are still learning what constitutes a zero-cost preventive service and our customer service team provides education every day to help clarify this benefit. In many cases, members believe they are receiving zero-cost preventive services when they re not. To the right are the most common services and circumstances for which zero-cost preventive benefits are not available. To verify that a patient s health plan is not grandfathered with respect to the ACA, you may log into our Provider Resource Center at and check eligibility. If you have questions about the zero-cost preventive services for which your patients may qualify, you may contact our customer service team or our provider relations consultants for assistance. 6 Spring 2015

7 Services and code numbers Metabolic panels, basic and comprehensive CPT 80048, Lipid panel CPT Evaluation and management (E&M) of an established patient CPT CPT Complete blood count hem (CBC) hemogram and platelet count, automated CPT Description A metabolic panel is a blood test that measures a patient s sugar level, electrolyte and fluid balance, kidney function and liver function. The metabolic panels are commonly used to monitor known health conditions or diagnose suspected conditions, such as high blood pressure or diabetes. While metabolic panels are powerful diagnostic tools, they do not qualify members for zero-cost benefits under the ACA, regardless of the member s gender or age group. The ACA zero-cost preventive benefit includes a cholesterol screening for men and women. Often, a lipid panel may be ordered for a patient who already has high cholesterol, whether or not the patient is on maintenance medications, or who is suspected to have high cholesterol due to risk factors or lifestyle. When billed with a medical diagnosis such as high cholesterol, the lipid panel no longer fits the definition of a screening, so it may not qualify every patient for zero-cost preventive benefits. The American Medical Association designed and incorporated CPT codes for preventive medicine exams, which qualify a member for zero-cost preventive benefits when the exam is performed as a screening exam. Often, a provider may need to perform and bill for a medical (E&M) service either in place of or in conjunction with a preventive medicine exam. E&M services are coded based on complexity and are not, by definition, preventive. A complete blood count gives important information about the kinds and numbers of cells in the blood, including red blood cells, white blood cells and platelets. The CBC can help check symptoms such as weakness, fatigue or bruising, and can help diagnose medical issues like anemia, infections and other disorders. The United States Preventive Services Task Force recommends a routine screening for anemia in asymptomatic pregnant women. The CBC test is not part of the zero-cost preventive benefit for children, women who are not pregnant or men. What would you like to see on our website? Blue Cross and Blue Shield of Vermont is looking to make our provider website ( more user-friendly and we d like to hear from you. Specifically, what can we add to our provider site that would improve the service we offer to our provider community? Currently through our website, we offer the most up-to-date news and updates to our provider manual and medical policies. Within our secure Provider Resource Center, we also offer ways for you to check a patient s eligibility, claims status and online prior approvals. But we know we can offer more. Please let us know what we can add to our provider website by ing providerrelations@bcbsvt.com. Hepatic function panel CPT The hepatic function panel helps to determine how well a patient s liver is functioning by measuring the blood levels of total protein, enzymes, albumin and bilirubin. This test is commonly ordered when a patient exhibits signs of liver disease or other risk factors. The test may also be performed for patients who have been exposed to hepatitis or who are taking medications that may cause liver damage. This test, while common, does not qualify the member for zero-cost preventive benefits under the ACA. 7

8 BCBSVT CEO recognized for health and wellness leadership Vermont officials recognized BCBSVT President and CEO Don George for his leadership in developing a culture of health and wellness at BCBSVT and, by example, for other workplaces in the state. George received the Business Leadership Award from the Governor's Council on Physical Fitness and Sports at the annual Worksite Wellness Conference in Burlington on Wednesday, March 25. Health and wellness is part of the everyday culture of Blue Cross and Blue Shield of Vermont, said Gov. Peter Shumlin, who presented the award. What Don s been doing as an insurance executive isn t being done by any insurance executive in the country. The Governor s Council presented worksite wellness awards to 92 businesses, including many BCBSVT large and small group customers. The awards highlight companies and organizations that promote the health and wellness of their employees through worksite wellness programs. The Brattleboro Retreat, Central Vermont Medical Center, Grace Cottage Hospital, Porter Medical Center, Rutland Regional Medical Center and the University of Vermont Medical Center were among the award winners. Graham Lowe, a prominent Canadian expert on wellness and productivity who was the keynote speaker for the event, told the businesses that they were pioneering new programs in worksite wellness. There is no other state or Canadian province that has this kind of leadership support, he said. What you re doing here is something that I think needs to be emulated in North America and beyond. George told the business leaders that their worksite wellness programs have benefits that go beyond the immediate health improvements they produce. You re creating these vibrant organizations that achieve results at a very high level and creating jobs that help this economy, he said. 8 Spring 2015

9 Mailing to highlight importance of mammograms We want our members to have the happiest and healthiest of birthdays and enjoy many birthdays to come. That s why we re sending our female members between the ages of 50 and 74 birthday cards. These cards will encourage our members to schedule their bi-annual mammograms with their providers. This mailing campaign begins in May and will remind women of the importance of this preventive screening and direct them to contact their primary care providers or obstetricians and gynecologists to discuss. The mailing will exclude any known female members who had mastectomies or have a claim on file for a mammogram since Oct. 1, View current status of prior approvals through Provider Resource Center We want to remind you that you can view all prior approval requests through our Provider Resource Center. Within this Web portal is one of our newer online tools called AcuExchange. This program allows you to submit prior approval requests for inpatient and outpatient services, attach electronic documents and send and receive messages to and from BCBSVT, all within this one, organized tool. In some instances, your requests will be eligible for automatic approval. You can easily create an account with AcuExchange by enrolling in the Provider Resource Center. Once you ve logged into AcuExchange, you ll find a personalized site where you can track requests by a number of criteria, including patient name, type of service and other factors. If a request needs follow-up documentation or the request is incomplete, BCBSVT will notify you within AcuExchange. You can also run reports on requests and see the letters BCBSVT sends to you and your patients in regard to these requests. Checking the status of prior approval requests through the Provider Resource Center and AcuExchange will save you time and energy in getting the most up-to-date information. 9

10 BCBSVT earns high praise for its commitment to member experiences Blue Cross and Blue Shield of Vermont earned high marks and international notice from two organizations for being a leader of member service in the country. In April, BCBSVT achieved the highest possible ranking in four important service measures, retaining its distinction as the number one BCBS plan in America in overall service to its members. This is the second year in a row that BCBSVT earned this distinguished ranking. BCBSVT s number-one ranking was based on the national Blue Cross and Blue Shield system s Member Touchpoint Measures (MTM), which Blue Cross and Blue Shield organizations use to track the service they provide to their members and assure industry-leading service levels. BCBSVT s affiliation in the national BCBS system assures members seamless coverage across the country and the world. The MTM program tracks four primary levels of member service: enrollment, claims processing, inquiries and first-call resolution of member inquiries. In 2014, BCBSVT achieved 98.6 percent results, the highest ranking of any Blue Plan nationally. 10 Spring 2015 The recognition by the BCBS system followed an announcement in January that BCBSVT s member service call center had received World Class Certification through the prestigious Service Quality Metrics (SQM) program. That national program, which surveyed more than 3,200 Vermonters about the service they received from BCBSVT, then recognized the company as one of the country s best member service organizations. BCBSVT also received the recognition in 2012; since then, SQM has raised its standards and requires even higher levels of service for World Class Certification. SQM has been conducting surveys since 1996 and benchmarks over 450 leading North American call centers annually. SQM s World Class call Certification Program is designed to determine if call centers, supervisors and customer service representatives within a call center are performing at the world-class performance level for customer satisfaction. Blue Cross and Blue Shield of Vermont s customer service call center is located in Berlin, Vermont and handles more than 250,000 calls a year. The call center representatives demonstrate a solid commitment to creating positive member experiences and rank in the top 25 percent of the 450 leading North American call centers that SQM surveys. To measure World Class Certification, SQM conducted 3,200 surveys with BCBSVT members, and 80 percent of members surveyed indicated that: their issue was resolved with one call they were very satisfied with the Customer Service Representative with whom they spoke; and they were very satisfied with their overall experience. BCBSVT performance ranks in the top quartile of the 450 call centers SQM surveys nationally and internally and is considered best-in-class. President and CEO Don George says these recognitions prove BCBSVT s efforts toward providing the best member experience. The focus of our company is on our members experience, and that commitment continues to be our guiding principle in everything that we do, George says. Our entire company focuses on putting our members experience first, which contributed to these remarkable achievements.

11 BCBSVT and TVHP Preferred Brand-name Drugs (effective March 1, 2015) Members with our three-tier drug rider pay different co-payments or co-insurance for drugs based on whether they are: Generic Preferred brand-name Non-preferred brand-name The Plan changes the Preferred Brand-name Drug List in two circumstances: The list changes four times a year to reflect drugs entering or leaving the marketplace. The Plan automatically deletes drugs from the preferred brand-name list without notice throughout the year when generic forms become available. Co payments or co-insurance for generic drugs are significantly lower. Certain drugs require prior approval. For a list of these drugs and a complete Preferred Brand-name Drug List, read our three-tier drug rider or visit our website at The following medications have been added to our Preferred Brand-name Drug List: EVOTAZ FARYDAK GLEOSTINE IBRANCE LENVIMA PREZCOBIX VITEKTA ZYK ADIA 90-day notice for drugs being removed from the Preferred Brand name Drug List; medications to be removed on January 31, 2015 PRADAXA The following medication has been deleted from our Preferred Brand-name Drug List, effective immediately, as they are now available as generics: VIVELLE (EFF. 1/31/2015) This list is subject to change. We provide updates through newsletters and other mailings. The most up-to-date list is available on our website at: A complete paper copy of our formulary is available upon request by contacting: pharmacy@bcbsvt.com A ABILIFY ACTONEL ACULAR ADDERALL XR AGENERASE ALINIA ALPHAGAN P ANDRODERM ANDROGEL APRISO AZILECT B BENICAR BENICAR HCT BETASERON BRAVELLE* BYDUREON BYETTA C CANASA CARAC CEENU CELEBREX CETROTIDE* CIPRODEX CLIMARA PRO COMBIVENT COMBIVIR COMPLERA CONDYLOX GEL COPAXONE, 20mg/ml CORTIFOAM CREON CRESTOR CRIXIVAN CUPRIMINE D DAPSONE DILANTIN KAPSEALS DUAC CS KIT DULERA E EDURANT ELIQUIST ELMIRON EMCYT ENBREL ENTOCORT EC EPIPEN EPIVIR-HBV EPZICOM ERGAMISOL ERIVEDGE ESTRADERM ESTRATEST ESTRATEST HS EVOTAZ EVOXAC EXELON F FARESTON FARYDAK FINACEA FLOVENT, all forms FORADIL FORTOVASE FREESTYLE GLUCOMETER FREESTYLE TEST STRIPS G GENOTROPIN GILENYA GLEEVEC GLEOSTINE GLUCAGON H HEPSERA HEXALEN HIVID HUMALOG HUMULIN HUMIRA * Not covered by all prescription drug benefits. Call our customer service team for more information. I IBRANCE IMBRUVICA INCIVEK INNOPRAN XL INTAL INHALER INTRON A INVIRASE ISENTRESS J JANUMET JANUVIA JENTADUETO JEVTANA K KALETRA, capsule and solution L LANTUS LENVIMA LETAIRIS LEUKERAN LEVEMIR LEXIVA LOTEMAX LYSODREN M MEPHYTON METHERGINE MIGRANAL MYLERAN N NAMENDA XR NASONEX NEUPOGEN NEXAVAR NILANDRON NORDITROPIN NORVIR NOVOFINE (syringes and needles) NOVOLOG NOVOLIN NUVARING O ONE TOUCH GLUCOMETER ONE TOUCH TEST STRIP OXSORALEN ULTRA P PEGASYS PICATO PLAN B POTIGA PRADAXA (REMOVED EFF. 5/1/2015) PRECISION GLUCOMETER PRECISION TEST STRIPS PRED MILD PREMARIN PREMARIN CREAM PREMPHASE PREMPRO PREVEN PREZCOBIX PREZISTA PROAIR HFA PROCRIT PRODIGY (syringes and needles) PULMICORT RESPULES PULMOZYME Q QVAR R RAPAMUNE REBIF RENAGEL RESCRIPTOR RESTASIS REVLIMID RIDAURA S SAVELLA SEREVENT, all forms SPIRIVA SPRYCEL STALEVO STIBILD SUBOXONE SL, film SUSTIVA SUTENT SYLATRON SYMBICORT SYNVISC, all forms T TARCEVA TARGRETIN TAZORAC TECFIDERA TEMODAR TESLAC THIOGUANINE I TRACLEER TRAJENTA TRAVATAN Z TREXALL TRIVICAY TRIZIVIR TRUVADA TYKERB TYZEKA U V VAGIFEM VENTOLIN HFA VEPESID VIAGRA* VICTOZA VIDEX VIRACEPT VIRAMUNE VIREAD VITEKTA VOTRIENT VYVANSE W WELCHOL X XARELTO XENICAL XIFAXAN 550mg Y YERVOY Z ZOLADEX ZOLINZA ZYKADIA 11

12 P.O. Box 186 Montpelier, VT PRSRT STD U.S. POSTAGE PAID BARRE, VT PERMIT NO. 222 A Newsletter from Blue Cross and Blue Shield of Vermont Spring