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WELCOME TO NEWS FROM BLUE,SM CREATED TO HELP YOU BETTER MANAGE YOUR HEALTH PLAN BY KEEPING YOU UP-TO-DATE ON THE LATEST INFORMATION FROM WELLMARK BLUE CROSS AND BLUE SHIELD. NEWS FROM BLUE WILL BE E-MAILED TO YOU MONTHLY, AND ARCHIVED ON WWW.WELLMARK.COM.
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Prilosec OTC Program Offers Pharmacy Savings
Beginning September 25, 2006, Wellmark Blue Cross and Blue Shield will cover the over-the-counter drug Prilosec OTC for the cost of a generic copayment or coinsurance. Prilosec OTC is a proton pump inhibitor (PPI), which costs about 71 cents a pill. Brand-name prescription PPIs cost six times as much. In fact, two PPIs, Nexium and Prevacid, are among the top five drugs dispensed to Wellmark members and account for 4.5 percent of Wellmark’s total drug spend.
Here’s how the program works:
- Members get a prescription for Prilosec OTC; no prior authorization is required. Other prescription PPIs require a prior authorization after a 90-day supply is filled in a rolling calendar year.
- Members fill the prescription at a participating pharmacy.
- The pharmacist collects the member’s generic copayment or coinsurance.
Covering Prilosec OTC helps to drive Wellmark’s consumerism strategy of designing benefits that empower members and physicians to make the best decision from a cost and quality standpoint. The Prilosec OTC program also supports the Pharmacy InsightsSM goal of helping groups achieve lowest total net spend and clinical quality. One of the strengths of the program is that savings opportunities are available for both groups and members.
Members who have filled a PPI prescription since January 2006 will receive a letter in mid-September explaining the program and encouraging them to ask their doctor to call in a prescription for Prilosec OTC to a network pharmacy. An office visit is not required to switch to Prilosec OTC. |
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Contact your Wellmark account manager or broker for more information on the Prilosec OTC program. |
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Wellmark Now Covers RotaTeq® Vaccine
Wellmark now covers RotaTeq® (Rotavirus Vaccine, Live, Oral), a vaccine to protect against rotavirus, a viral infection that can cause severe diarrhea, vomiting, fever, and dehydration (gastroenteritis) in infants and children. Wellmark began covering this vaccine in August when the ACIP (Advisory Committee on Immunization Practices) published its recommendations in the Morbidity and Mortality Weekly Report (MMWR) on the CDC Web site www.cdc.gov/mmwr. |
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To be covered, your group plan must have coverage for vaccinations. Members can confirm their coverage by calling Customer Service or logging into myhealth@wellmark, and choosing View Eligibility and Benefits. |
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Redesigned EOB Provides a Clearer Picture for Employees
We asked our members what they thought about our Explanation of Benefits (EOB) form, and then redesigned it to better meet their needs.
The new EOB is easier to read and helps members understand how their health claims were processed. There are some cosmetic changes that make the new EOB clearer and more customer-friendly: new headings and definitions, and we maximized the available space on the document.
The new EOB also provides claims information for all family members within a health plan contract, on one page. This gives employees
a better picture of their
family’s total health benefits utilization.
For employers, the EOB is an excellent resource to help educate employees about their responsibility in the health care cost equation. It provides employees the financial claims information helpful for understanding how to best use their current health plan. Data on the EOB is also helpful for
making future enrollment decisions.
Below is a sneak peak at the new Explanation of Benefits (EOB) form members will start seeing in October as they use health care services, along with some notable key changes:
- New landscape format takes better advantage of document space
- Rewritten column headings reduce reader confusion
- Term definitions are easier to understand
- Employee’s financial responsibility highlighted with a bold-lined box
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Let your employees know they’ll see the new Explanation of Benefits (EOB) in October, as they use health care services. More information on the new EOB and tools for teaching employees how to read their EOB will be included in the October issue of NEWS FROM BLUE. |
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Blue Health Intelligence in Pilot Phase
The Blue Cross and Blue Shield Association recently began a pilot program for Blue Health Intelligence (BHI). With BHI, Blue Plans can provide employers with information and recommendations on how to modify their benefits and get greater value out of their health care dollars.
The database of claims on 79 million enrollees is pulled from participating Blue Plans, allowing employer groups to receive more comprehensive data for comparison purposes. Wellmark will evaluate the effectiveness of the program throughout the pilot phase, and move swiftly to participate when the program is fully operational if it proves to deliver value that we believe will benefit our customers. |
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Keep an eye out for more information on Blue Health Intelligence in future issues of NEWS FROM BLUE. |
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Employer Toolkit Gets a Fresh, New Look
Later this fall, you'll notice some exciting changes to the Employer Toolkit on www.wellmark.com, including:
- More user-friendly design
- Enhanced search functions
- Centralized ordering
- Extra features (i.e. Favorites Page, Order History, Downloadable PDFs)
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Watch for more information on the new and improved Employer Toolkit in the October issue of NEWS FROM BLUE. |
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