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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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New Health and Wellness Phone Service Now Available
The new health and wellness phone service is just one part of Wellmark Blue Cross and Blue Shield’s comprehensive suite of health management programs for your employees. All fully insured Wellmark customers now have a new resource for answers to their health and wellness questions. Whether they need advice on what to do about an urgent health issue, or insight about an upcoming surgery, 1-888-826-0011 is their source for health care information.
One call gives your employees the health care support they need including:
- Care Navigation 24/7 — Customer can call 1-888-826-0011 and choose option #1 if they need an advocate to help guide them through the health care system.
- Nurse Support 24/7 - Customers can call 1-888-826-0011 and choose option #2 if they need help for immediate health questions. Nurse support 24/7 provides around-the-clock answers from a registered nurse.
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Postcards will mail later this spring to you and your employees announcing this new service. |
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Wellmark Ranks High in Customer Satisfaction
The 2007 National Health Insurance Plan Satisfaction Study issued by J.D. Power and Associates shows that Wellmark Blue Cross and Blue Shield’s member satisfaction ratings rank high — coming in third in the Midwest Region. The study identifies coverage and benefits, choice of doctors, hospitals and pharmacies, and information and communication as the most significant factors in driving member satisfaction. Additional factors examined in the study include approval processes, insurance statements, customer service and claims processing. |
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For more information on the performance of national health insurance plans, visit the J.D. Power Consumer Center at www.jdpower.com/healthcare. |
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Wellmark Health Plan of Iowa Grows to 80 Counties on April 1st
The recent addition of several counties has greatly expanded the availability of Wellmark’s lower cost managed care products Blue Choice,® Blue Access and Blue Advantage® in North Central and Southeast Iowa. A total of 13 counties have been added, meaning that 80 of the state’s 99 counties are now included in the Wellmark Health Plan of Iowa network — encompassing 95 percent of physicians and 100 percent of hospitals in the state that are located in the open counties. All of Wellmark’s Health Plan of Iowa products are a great choice for employers looking for affordable health care, along with choice, flexibility, and network strength.
New Counties Effective April 1, 2007 include:
| Cerro Gordo |
Henry |
Mitchell |
| Chickasaw |
Howard |
Palo Alto |
| Floyd |
Kossuth |
Winnebago |
| Franklin |
Lee |
Worth |
| Hancock |
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Click here for a map of all WHPI counties. Contact your Wellmark account team about offering a Wellmark Health Plan of Iowa product to your employees. |
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New Proton Pump Inhibitor (PPI) Step Therapy Program
Launches May 1
Wellmark members’ utilization of brand name proton pump inhibitors (PPIs) drugs to treat heartburn and other stomach disorders remains high even though two generic PPIs are now available — omeprazole and Prilosec OTC. To encourage greater use of omeprazole and Prilosec OTC, Wellmark is implementing a new prior authorization (PA) process for PPIs effective May 1, 2007. Wellmark is implementing new PPI criteria to encourage the use of a Tier 1 PPI before trying Tier 2 or Tier 3 options. Evidence-based guidelines indicate that all PPIs are therapeutically equivalent at equal doses, and the cost savings for Wellmark groups and members is significant: Tier 3 PPIs average $140 per prescription while
omeprazole and Prilosec OTC are less than $30 per prescription.
How the Program Works
- The current Prior Authorization (PA) edit will be modified to require members to try and fail either generic omeprazole or Prilosec OTC prior to obtaining Prevacid, which is a Tier 2 drug; all Tier 3 PPIs (Nexium, Aciphex, Prilosec, Protonix, and Zegerid) can only be obtained after trial and failure of Tier 1 and Tier 2 PPIs
- The 90-day standard allowance will be removed; PA will be required immediately rather than after 90 days
- Omeprazole & Prilosec OTC will continue to NOT require a PA
- The change goes into effect May 1 for all PPI prescriptions that currently do not have a PA in place; if a PA is in place, the change goes into effect when the current PA expires
- Current Prevacid users will not be affected
Communications About the Change
Wellmark is sending letters about the PPI Step Therapy program to:
- Physicians who have patients that will need a new PPI prescription; included with the letter is a list of their patients and the name of the PPI they are currently taking
- Members who are currently taking a Tier 3 PPI who will need to move to a Tier 1 PPI when their current PA expires; the letter includes their PA expiration date
- Members taking a Tier 3 PPI who are in the 90-day standard allowance window and do not currently have a PA in place
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To help remind your employees that Prilosec OTC is a covered benefit, visit the Employer Toolkit on www.wellmark.com to order a poster about Prilosec OTC (M-20178). You’ll also find other materials to help your employees become smarter drug consumers.
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New Process for Groups Submitting Electronic Eligibility Records
In order to allow Wellmark Blue Cross and Blue Shield’s membership system to remain synchronized with those of you who are submitting electronic eligibility files, we will be sending you a letter, along with a copy of your employee’s request. This new process will assist all of us in maintaining consistent membership information, and it will also provide the opportunity for you to educate your employees about the electronic enrollment process. |
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If you have any questions, please contact your dedicated Membership and Enrollment specialist.
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Wear Your Walking Shoes to Work on April 18
On Wednesday, April 18, thousands of Americans across the nation will champion wellness by taking a 30 minute walk during their lunch break as part of National Walk@Lunch DaySM — an exciting, all-new workplace walking initiative brought to you by The Blues®! Along with encouraging walkers to wear athletic shoes to work, Wellmark will provide printable posters, tent cards, and awards, among other materials, to all
participating groups. Each walker will also receive a free giveaway item — compliments of Wellmark!
National Walk@Lunch Day is an extension of WalkingWorks,® a Blue company program created to help consumers live healthier lives and reduce unnecessary medical costs due to physical inactivity. The WalkingWorks program was developed in cooperation with the Presidents Council on Physical Fitness and Sports. |
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WalkingWorks is available year round for you and your employees. To find out more about this program, visit the Decisions Count® section of the Employer toolkit on www.wellmark.com. |
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Taking an Active Role in Health Care Starts with
Understanding the True Costs
One way to help curb health care spending is for your employees to make their health care spending decisions as if they are spending their own money. The real cost of health care is often hidden. Most people don’t have a clear understanding of how much health care services cost because they are not the direct payers for health care.
Many people do not realize that a visit to the emergency room costs on average $1,049 or that a brand-name prescription drug can cost more than $150 for a 30-day supply. In fact, even though most people can estimate the cost of a new Honda Accord to within $300, most consumers greatly underestimate the costs of many health-related services and procedures. When folks shop for other goods and services, they want to know what they are getting, how much it costs, and how they will benefit. The same should hold true for health care needs. |
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Wellmark’s “Understanding the True Cost of Health Care” fact sheet (M-2373) is a great tool for educating your employees, and it is available on the Decisions Count section of the Employer Toolkit. |
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