How to Save Money With Prescription Drugs

Transcription

1 Fall 2012 Caring and Competent Clinical Management If you have ever been hospitalized or managed a chronic condition, you might know a thing or two about our clinical management services. Considering that most people never really know when a medical need might arise, it s good to understand the services that we offer, how they can help you, and the competency of the people providing them. Continued on page 2 Issue Highlights: Caring and Competent Clinical Management Prescription for Savings Be In the Know , 6-7 Medicare Part B A Money Back Opportunity Official Plan Brochures Savings and Discounts Galore Understanding Medical Deductibles... 6 Yes, We ve Got It Keep in Touch istockphoto.com/yuri_arcurs 1

2 Caring and Competent Clinical Management, continued from page 1 What is Clinical Management? Services provided through clinical management include inpatient precertification, prior authorization of certain medical tests and procedures, coordination with doctors and hospital staff, various levels of patient support, and so much more. Chiefly, our nurse case managers work with the member and their medical team to facilitate the member s recovery back to the highest level of pre-injury or pre-illness functioning possible. The key to meeting this objective is for us to become involved early on and coordinate medical care across multiple providers of health care services. Our clinical management programs aim to deliver optimal cost and quality outcomes for our members. Who are nurse case managers? Case managers are registered nurses, holding active state nursing licenses, who are employed by the health plan. Our nurse case managers are also required to become certified by one of ten professional certification case management organizations that are recognized by our accreditation agency, URAC, within four years of joining our company. Continuing education is also provided and required for our nurse case managers. URAC-Accredited Clinical Management Programs MHBP, through Coventry Health Care National Accounts, offers URAC-Accredited Case Management, Health Utilization Management and Disease Management (for six conditions: Congestive Heart Failure, Coronary Artery Disease, Chronic Obstructive Pulmonary Disease, Asthma, Diabetes and Chronic Kidney Disease). URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation. For more information, visit What do nurse case managers do? Basically, they work on your behalf as your advocate. A single nurse case manager is assigned to serve as a personal resource to offer guidance and education for any member needing an ongoing level of support. The level of their interactions corresponds to the specific needs of the individual. This approach allows them to maintain sensitivity to an Prescription for Savings The rising cost of prescription drugs is a widely acknowledged concern in the health care industry and for our health plan. Even with the rising costs, you need and depend on the lifeenhancing and life-sustaining benefits of prescription drugs. Our challenge and goal is to help keep these costs affordable for you. The programs described here offer you more ways to save on prescription drugs. Of course, the best way is to use the generic equivalent of a brand name drug whenever possible (see listing of Newly Released Generic Drugs). Generic Drug Incentive Program you have an opportunity to receive up to a 90-day supply of a generic drug at no cost to you from a network retail pharmacy or by mail order. If you are currently taking one of the brand medications that qualify for this program and you switch to the recommended generic replacement, you can experience savings. You will receive a letter from CVS Caremark providing the details you need to get started. Brand Name Requip XL Symbyax Ziagen Detrol Duac Clarinex Newly Released Generic Drugs Generic Name ropinirole olanzapine and fluoxetine abacavir tolterodine clindamycin phosphate and benzoyl peroxide desloratadine Please note: This listing is provided by our pharmacy benefit manager, CVS Caremark, and is not all inclusive of available generic drugs. This listing is also subject to change. For more information about your prescription drug coverage, please call CVS Caremark at or visit choose Benefit Plans and select Prescription Coverage. Maintenance and Long-Term Medications Program is an optional program that allows you to get up to a 90-day refill of a maintenance medication (treats conditions such as asthma, diabetes, high blood pressure, high cholesterol and others) at a CVS retail pharmacy for the same cost sharing as using mail order pharmacy. The 90-day refill is only available 2 Contact us at or visit us on the Web:

3 HealthBenefitPlanner individual s needs while promoting care that is medically appropriate, cost-effective and that yields quality outcomes. As part of ensuring members receive medically appropriate care, our case management program follows standards established by our accreditation agency, URAC. Nationally-recognized inpatient and outpatient criteria are also used to support medical case management. How would you come to work with a nurse case manager? There are a variety of pathways to interacting with a nurse case manager. If you are scheduled for surgery, the hospital might contact us before and after surgery to inquire about benefits or coordinate certain services. The case manager would follow up with the facility and with you as appropriate. Another way is when you have a chronic condition such as asthma, diabetes or congestive heart failure and you could benefit from extra support. Or, you might call us with a general health question like caring for a burn, a sprained ankle, or for information about a medical procedure. Please note: our nurses cannot diagnose, prescribe or give medical advice. As always, specific questions should be addressed to your doctor. at a CVS retail pharmacy. If a CVS pharmacy is not available in your area, you can use our mail-order pharmacy to refill your medication. If you do not wish to participate in this program, you must opt out by calling CVS Caremark at to ensure there is no delay in receiving your medication. If you wish to start using mail-order pharmacy, ask about FastStart. By using this service, the CVS Caremark representative will take the lead on getting you set up, including securing the prescriptions from your doctor(s). Dose Optimization Program encourages safe and appropriate use of once-daily medicines, resulting in increased medication compliance and possibly savings. Dose optimization applies to certain medications where a lower dose may be recommended multiple times a day, instead of a higher dose that could be taken once a day. If you are taking a drug that is part of this program, the pharmacy will contact your physician to assess the feasibility of prescribing the higher dose medication. If you have questions about any of these programs, please contact us at or visit What s a real-life example of case management? A member suffered a stroke with resulting physical deficits. The case manager supported the member by reinforcing the member s plan of care, locating PPO providers and working to maximize the Plan s benefits. The case manager also shared educational information about the illness, proper diet, medications, and exercise. Last, but not least, the case manager provided needed emotional support while helping the member through the initial recovery period. Our clinical programs have so much to offer our members. They go a long way towards helping ensure that members get the right care, at the right time and in the right place. Be In the Know We always want to ensure that you are kept up to date on anything that may affect the service or delivery of your benefits as well as any enhancements. Here are a few things to keep in mind: LinkWell Healthy Options Program We now provide a special quarterly mailing to participants in our voluntary disease management program who have the following conditions: Diabetes, Coronary Artery Disease (CAD), or Congestive Heart Failure (CHF). You will receive a personalized letter along with recipes and valuable coupons for savings on items (and foods) that may help improve your health condition. Look out for savings in your mailbox! ACS to Xerox We recently switched our business partner that provides our Coordination of Benefits (COB) questionnaire mailings. We were using ACS and they have since been acquired by Xerox. Eventually, the Xerox name and logo may be added to these mailings. Be assured that Xerox/ACS is an authorized vendor of MHBP. However, should you receive correspondence from Xerox/ACS or others that s questionable to you, please follow up directly with us at Continued on page 6 3

4 Medicare Part B A Money Back Opportunity MHBP offers an excellent opportunity for Standard Option members who retire and have Medicare Part A, but have not enrolled for Medicare Part B, to add Part B coverage at virtually no cost. Perhaps you ve heard about how we will reimburse qualifying individuals their Medicare Part B premium up to the standard amount ($99.90/mo in 2012) when they enroll in our Part B Premium Savings Program. So why might you want to enroll in our Part B Premium Savings Program? Here are a few good reasons: You can get Medicare Part B coverage at no cost to you (barring any late enrollment penalty). You like the idea of maximizing your benefits by having FEHB and Medicare coverage. You want to take advantage of enrolling for Medicare when first eligible to avoid paying the late enrollment penalty. You want to mitigate the added premium cost Medicare imposes for high-income earners. You want more certainty about your out-of-pocket expenses as a retiree on a more fixed income. You prefer the freedom that comes with having a national PPO plan over the restrictions of Medicare Advantage plan, which could also mean experiencing higher prescription drug charges. istockphoto.com/monkeybusinessimages These are all excellent reasons to enroll for Medicare Part B and in our Part B Premium Savings Program. By enrolling in both, you qualify to have your Part B premiums (nearly $1,200 a year) reimbursed to you. It s the best of all possibilities--you get the coverage you need and you lower your out-of-pocket expenses by having both MHBP and Medicare. There are some differences in how your benefits work under the Part B Premium Savings Program so it is important that you contact us to learn more. If you re wondering how to enroll in our Part B Premium Savings Program, how to enroll for Medicare, or what steps you need to take next, just call us at , 24 hours a day, seven days a week we ll help you get on your way to savings and more coverage Official Plan Brochures We are preparing for the upcoming Open Season and to share information about your 2013 benefits. So just the same as last year, if you would like a printed copy of the 2013 official Plan brochure mailed to you, simply request one by using a method listed here. If you do not wish to receive a printed brochure, or you do not request one, a brochure will not be mailed to you. For your convenience, the official Plan brochures for the upcoming, current and past years are provided on our website, click Benefit Plans and select Official Plan Brochures. Be a friend to the environment and choose to view the brochures online. Thanks for Supporting Go Green Starting September 1, you can follow these instructions to request a brochure, if you need one. If you already requested a 2013 brochure, it will be sent to you in time for Open Season so there s nothing more you need to do. Phone: Call and provide your current mailing address to the representative, or Online: Visit click the Request Information icon, and follow the instructions to complete the request form, or Mail: Complete the form, cut it out, place in an envelope, apply postage and mail. 4 Contact us at or visit us on the Web:

5 HealthBenefitPlanner Savings and Discounts Galore How long do you spend searching for savings only to discover that they were right under your nose? Yes indeed, the most obvious places for savings are often overlooked. Just like trekking across town to a big box grocer for a nice steak when your local grocer had a better cut, on sale. You re sorry when you find out later, right? So let us remind you about the discounts and savings* we offer you no need to look any further: Hearing Get discounts on hearing exams and save up to 25% on hearing aids when you visit a HearPO provider at the over 1,700 locations nationwide. They even offer no-interest financing for hearing aids if you qualify. Vision Save up to 40% with your EyeMed Vision Care discount program. MHBP members are eligible for discounts on exams, glasses and contact lenses at over 33,000 providers nationwide. LASIK (laser vision correction) U.S. Laser Network offers savings on LASIK that provide you up to 15% off the retail price, or 5% off the promotional price of LASIK or PRK procedures, whichever is the greater discount. QualSight LASIK offers you savings of up to 40% to 50% off the national average price for Traditional LASIK and significant savings on procedures such as Custom Bladeless LASIK using credentialed surgeons at over 800 locations nationwide. Weight Management Weight Watchers offers you an online program at a discounted rate to help you achieve better health through weight management. A three-month subscription is only $55, subject to the terms of participation. Any and Everyday Savings The ExtraCare Health Card provides savings on everyday health-related items, from cough and cold remedies to pain and allergy relief products. Get a 20 percent discount** on health care flexible spending account (HCFSA)-eligible items when you present your ExtraCare Health Card at the CVS drugstore checkout or online at If you never received a card, lost it, or you have questions, call CVS Caremark at The next time you are looking for savings on these services, look no further than MHBP. To learn more about these discount programs, visit or call Savings await you! * These benefits are neither offered nor guaranteed under the FEHB program, but are made available to all MHBP enrollees and their covered family members. You cannot file a FEHB disputed claim about them. The fees you pay for these services to not count toward the FEHB deductibles or out-of-pocket maximums. ** The 20 percent discount is restricted to items purchased for the cardholder, spouse or dependents. A health care flexible spending account (HCFSA) allows you to contribute pre-tax earnings toward your out-of-pocket medical expenses. The FSA summary of your receipt includes the items (and tax) that may be eligible for reimbursement from your HCFSA/HRA/HSA plan. Plan restrictions may apply. Check with MHBP or your HCFSA plan sponsor for more details. Excludes prescriptions, alcohol, tobacco, lottery tickets, postage stamps, gift cards, money orders, pre-paid cards and photo finishing, and are not valid on other items reimbursed by a governmental program. I require a printed 2013 MHBP official Plan brochure. Name: Address (and Apt. #): City: State/Region/Province: ZIP code or Postal code: Country (if outside the U.S.): Select desired Plan brochure: Standard Option and Value Plan Consumer Option Telephone: Mail to: MHBP, Attn: 2013 Brochure Request P.O. Box 8402, London, KY

6 Understanding Medical Deductibles MHBP offers three different health plans: Value Plan, Standard Option and Consumer Option. Each of these plans has a deductible. Depending on which plan you have, the deductible applies at different times and/or for certain services. Across all plans, the deductible does not apply to preventive care when using PPO providers. The amount of the deductible may also increase when non-ppo providers are used. This article focuses on how your medical deductible works for common situations when using PPO providers. You should refer to the official Plan brochures for complete information about when the deductible applies. What s a deductible? The deductible is the amount you typically must pay for health care before your health plan begins to pay. The deductible resets for each benefit year. The MHBP benefit year goes from January 1 through December 31. How does the deductible apply to your plan? Value Plan Your PPO medical deductible must generally be met for all services except Primary Care Physician Office Visits, Adult Preventive Care, Well-Child Care, Lab Savings Program, Maternity Care, Outpatient Surgery (performed in the outpatient hospital setting or ambulatory surgical facility), Convenient Care Centers, Tobacco Cessation, and Prescription Drugs. Standard Option Your PPO medical deductible must generally be met for all services except Doctors Office Visits (primary care and specialists), Adult Preventive Care, Well- Child Care, Lab Savings Program, Maternity Care, Allergy testing and treatment, Chiropractic, Inpatient Hospital Room and Board, Accidental Injury Emergency Room Care, Urgent Care Centers, Convenient Care Centers, Tobacco Cessation, and Prescription Drugs. Please note: The medical deductible is waived for Standard Option members who have Medicare Parts A and B as their primary coverage (this does not apply to the members enrolled in the Part B Premium Savings Program). Consumer Option Your medical deductible must be met for all services except Routine Physical Exams and Immunizations, Routine Preventive Screenings, and Tobacco Cessation. When PPO providers are not used for these services, no benefits apply and you will have to pay the entire cost. Do deductibles differ by network participation status of the provider? View the chart below to determine your PPO and non-ppo deductibles. When you use a combination of PPO and non-ppo providers, your plan will begin to pay benefits for the PPO providers once you reach the PPO deductible amount, and will begin to pay benefits for the non-ppo provider once you reach the non-ppo deductible amount. Plan Coverage and Level PPO Deductible Non-PPO Deductible Value Plan Self Only $600 $900 Value Plan Self and Family $1,200 $1,800 Standard Option Self Only $400 $600 Standard Option Self and Family $800 $1,500 Consumer Option Self Only $2,000 Consumer Option Self and Family $4,000 Please refer to the official Plan brochure for more information about your benefits, including information on when your deductible applies. If you have questions, please feel free to contact us anytime at or visit Be In the Know, continued from page 3 Blue Button is Coming Starting mid to late September you will be able to download your personal health record (PHR), medical and prescription drug claims and certain other information in text (ASCII) format, or in other formats offered. The Blue Button Initiative, as put forth by the U.S. Office of Personnel Management, requires FEHB carriers to make PHR information available in ASCII format to enable easier printing, transmitting and sharing. This initiative is one more step towards advancing Health Information Technology goals. 6 Contact us at or visit us on the Web:

7 HealthBenefitPlanner Yes, We ve Got It You may or may not know it, but we ve certainly got it. Got what? you ask. We ve got a dental plan, a vision plan, and we offer identity theft protection, too. Even better, you can get it! You can enroll in any or all of these programs anytime you wish. Check out what each offers: MHBP Dental Plan* With our dental program you have great benefits, national coverage and affordable rates: Coverage ranges from basic preventive care to crowns, bridges and orthodontia Vast provider selection over 120,000 dental PPO locations nationwide No claim forms to file PPO dentists do it for you! Benefits that increase the longer you are enrolled Affordable rates and a special rate category for Self Plus One coverage Out-of-network benefits, too Call to learn your rate, or visit to use our Dental Rate Finder tool. Communication Preferences How you receive select health plan communications is now up to you. Using your My Online Services SM (MOS) account, you are able to set your communication preferences to receive notifications when there are new explanation of benefits (EOBs) and general health communications available online for you. This option saves paper and saves you time putting information at your fingertips. You must have a MOS account to use this service. Sign up today when you visit Please contact us if you have any questions about these announcements at MHBP Vision Plan* The MHBP Vision Plan gives you great coverage for low monthly rates of only $8.60 for Self-Only and $16.00 for Family. You get: Eye exams and lenses every 12 months for just a $10 copayment each Up to $120 for frames (every 24 months) or contact lenses (every 12 months) Discounted rates for laser vision correction Access to more than 42,000 VSP Choice Network provider locations nationwide Out-of-network benefits, too LifeLock Identity Theft Protection* LifeLock Identity Theft Protection works to safeguard your identity, 24 hours a day, seven days a week--helping protect you from identity theft before it happens. Lifelock protection services include (subject to terms of participation): Identity Threat Detection and Alerts Lost Wallet Protection Address Change Verification Advanced Internet Monitoring Reduced Pre-Approved Credit Offers 24/7/365 Member Service $1 Million Total Service Guarantee (in states where permitted) For more information about any of these programs, or to enroll please call or visit * These benefits are neither offered nor guaranteed under the FEHB program, but are made available to all federal employees and their covered family members. You cannot file a FEHB disputed claim about them. The fees you pay for these services do not count toward the FEHB deductibles or out-of-pocket maximums. Keep in Touch With a new year of benefits on the horizon, now is a great time to make sure all of your contact information is up to date. Please contact us at if you suspect that we may not have a current telephone number, mailing address, or address on record for you and/or your covered family members. 7

8 P.O. Box 8402 London, KY Contact Us MHBP Member Services TDD/TTY Overseas Enrollees (Toll-free numbers at MHBP Dental and Vision, and LifeLock CVS Caremark (Pharmacy benefit manager) U.S. Laser Network QualSight (Laser vision correction services) EyeMed Vision Care HearPO Network (888-HEARING) Quest Diagnostics United Behavioral Health My Online Services SM Net Support 2012 Coventry Health Care, Inc. All rights reserved. All other names and (registered) trademarks are the property of their respective owners. This newsletter summarizes the benefits of the Mail Handlers Benefit Plan (MHBP). For a complete description of all benefits, please read the 2012 official Plan brochures (RI and RI ). All benefits are subject to definitions, limitations and exclusions set forth in the 2012 official Plan brochures. 8 Contact us at or visit us on the Web: