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May 2007
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New Dose Optimization Program Starts June 1

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New Blue Priority Flex Service Line

bullet Reminder: Pay as Billed
bullet Reminder of Eligibility Rules for Graduates
bullet New Decisions Count Materials

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pharmacy news

New Dose Optimization Program Starts June 1

Wellmark Blue Cross and Blue Shield is introducing a new, innovative pharmacy program designed to help slow the rising cost of prescription drugs and increase patient compliance with drug therapies. The Dose Optimization program goes into effect on June 1, 2007, and focuses on 15 drugs that have been approved by the Food and Drug Administration (FDA) for taking once daily at a higher strength instead of twice or more a day at a lower strength. This program supports two primary goals of Wellmark’s pharmacy program — clinical efficacy and lowest total net spend. If you have a coinsurance or CMM plan, your employees will have lower out-of-pocket costs at the pharmacy. Drugs in the program include:
Drug Name Used For Drug Name Used For
Coreg CR High Blood Pressure Sonata Sleep Disorders
Lotrel High Blood Pressure Lexapro Anti-Depressant
Norvasc* High Blood Pressure Paxil CR Anti-Depressant
Januvia Diabetes Effexor XR Anti-Depressant
Cenestin Hormone Replacement Therapy Crestor High Cholesterol
Premarin Hormone Replacement Therapy Lescol High Cholesterol
Ambien Sleep Disorders Lipitor High Cholesterol
Lunesta Sleep Disorders    

*Also applies to generic equivalent

Only certain dosages of these drugs are included in the dose optimization program. A complete list of drugs and dosages was included in the initial mailing to physicians and members and will be posted on Wellmark.com on June 1. New drugs will be added as appropriate.

How the Program Works
Wellmark sent letters to clinicians who have written a prescription for a twice a day or more dosage for any of the drugs included in the program.

  • If the clinician decides a single dose at a higher strength is the right therapy, the clinician will need to write a new prescription
  • If the clinician wants your employee to continue taking the drug at a lower dose more than once per day, the clinician will need to receive approval from Wellmark
  • Starting June 1, 2007, if your employee does not have a new prescription for the higher strength dosage, or if the clinician has not requested and received approval from Wellmark to continue on the current dosage, your employee will not be able to fill the current prescription, and the claim will deny
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Employees currently taking one of the drugs included in the program will receive a letter encouraging them to contact their clinician to determine if the program is appropriate for their current situation.
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what's new

New Blue PrioritySM Flex Service Line

Over the next few months Wellmark Blue Cross and Blue Shield will implement a new Blue Priority Flex Service Line that will be staffed with experienced Flexible Benefits Claim Technicians and Group Specialists. Calls that come in from you or your employees will be routed to these experienced staff members who can address your question(s) immediately — with a goal of first call resolution. This new process allows your assigned Group Specialist to continue the important processing functions for your account and remain available as an internal resource if needed to respond to your inquiry. Your employees will also benefit from the Flex Service line as their claim inquiries will be answered by a Claim Technician that actually handles claims and can have any applicable adjustments processed quickly.

New E-mail Box
Group administrators and support staff can now e-mail claim and administration questions to flexadmin@wellmark.com. Your employees should continue to use wellfsa@wellmark.com to e-mail their questions or claim information to our attention. By centralizing e-mail communications, our flex staff will be able to better respond to your questions in a timely manner.
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For more information on Blue Priority Flex, contact Wellmark’s Flexible Benefits department at (800) 624-2755.
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manage your plan

Reminder: Pay as Billed

Wellmark Blue Cross and Blue Shield’s Premium Billing Process makes it easy for you to do business with us. When you pay your group billing statement as billed, you will notice the following benefits:
  • You will not need to adjust the balances owed for membership changes because the changes will appear on the next month’s statement
  • You may pay for new members on the next statement rather than up front
  • You will save time and be assured claims are paid because the payments will match the billed amounts

Submitting Membership Changes to Wellmark
A quick way to submit cancellations and ensure that submitted activity appears on your next group statement is to register at Wellmark.com for access to BlueConnection® Tools and to utilize Maintain Member Records. If you are currently submitting membership information via electronic files or BluesEnrollSM system, please continue to do so. In addition, changes may be sent or faxed to:

Wellmark Blue Cross and Blue Shield
P.O. Box 9232, Station #24
Des Moines, IA 50306-9232
Fax: (515) 245-4813 or (515) 245-4973
E-mail: LargeGroupMembership@wellmark.com

Changes made via the web or electronic files will be processed within 2 business days. When faxing or e-mailing, changes will be processed on average within 5 business days. A duplicate paper copy is not needed unless requested by Wellmark. You are also able to access your group billing statements on Wellmark.com if you have registered for BlueConnection tools. This allows you to view your group statements earlier, which will give you more time to review before payment is due as well as assure timely payment by the fifth of the month to avoid late fees.
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If you have questions or need additional information on Wellmark’s Premium Billing process, please contact the phone number on your bill.
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Reminder of Eligibility Rules for Graduates

Are any of your employees parents of a recent or future graduate? If so, now is the time to review dependent eligibility requirements and/or the process for canceling dependents who are no longer eligible for benefits under their parent’s group policy. Dependents who reach the maximum age, get married, or who are no longer a full time student will need to be cancelled the first of the month following the date of ineligibility. Student verification letters are mailed yearly based on the dependents date of birth. If the letter is not returned they are automatically removed the first of the month
following their date of birth.
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Please refer to your Admin Guide for complete information on dependent eligibility. If you or your employees have questions, please contact Customer Service.
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decisions count

New Decisions Count® Materials Focus on What Members Can Do to Control Costs

As an employer, you are constantly seeking ways to help employees understand the important role they play in managing health care dollars. Health Care Consumerism 101: Putting Yourself in the Driver’s Seat is the first of several Decisions Count education modules designed to help you educate your employees on steps they can take to help manage their health care spending. Informed and motivated consumers:
  • Grasp the key drivers affecting health care costs
  • Manage their health and health care spending when making decisions
  • Understand how their choices affect their employer’s bottom line, as well as their own wallets

The first module contains several new and updated Decisions Count pieces, including a downloadable, interactive PowerPoint, a companion booklet, and fact sheets. There is also an implementation guide to give you ideas on how to use the different education pieces. All materials are available on the Employer Toolkit under Decisions Count. When you select Education Modules you will see the Health Care Consumerism 101 education module listed. Select the title and the full list of the materials available will appear. The PowerPoint is only available to download and save to your computer.

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Look for other Decisions Count education modules in the coming months, including: Using the Tools Your Health Plan Provides and Developing a Relationship with Your Doctor.
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Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.