Wellmark Drug List Changes

AB-Rated Generics Available
Wellmark is moving the following brand-name medications from Tier 2 to Tier 3 because AB-rated generics are now available.  The pharmacist can make the change; no new prescription is needed.

Discontinued Drugs
In addition, three drugs are being removed from the Wellmark Drug List because the drugs are no longer being made by the manufacturer. Another drug is moving to Tier 3 because it is in the process of being discontinued. 

Only members taking Tilade were notified.  Notification for the other three drugs was unnecessary because of the lack of utilization.

Audiologists Added to Wellmark's Networks

Please note benefits are not expanding with this change. This will not change your groups’ health plan benefits; for example, if your group does not cover hearing tests today, hearing tests will not be covered starting July 1, 2008, unless benefits are changed.  All employer groups 101+ will receive an updated coverage manual at renewal.

Wellmark is implementing this change for the following reasons:

• Audiologists already provide audiology services your plan covers
• Rather than billing Wellmark using their employing participating provider’s number (i.e. an ear, nose, and throat (ENT) physician), a practice Wellmark allows, this will allow audiologists to contract directly with Wellmark and bill under their own provider number
• Wellmark will have a more accurate representation of who is actually providing the services when audiologists bill under their own provider number
• Groups may actually have lower costs for covered audiology services because Wellmark is reimbursing audiologists at 66 percent of the reimbursement rate physicians receive when audiologists bill under their own provider number
• This is a benefit enhancement
• There is no premium impact
• Other Blue Plans and competitors, as well as Medicare, currently contract with audiologists

Help Employees Complete Applications for Coordination of Benefits

One section often overlooked is Other Carrier Information. The Other Carrier Information section needs to be completed to properly process the application and ensure Wellmark has the most current information. This section provides Wellmark with valuable information including:

• Policyholder name
• Employee and/or dependents who have other coverage
• Which coverage is to pay as primary
• Name and address of insurance company providing health insurance coverage

Employer Reporting Can Maximize Health Benefits
Information is important when it comes to maximizing your investment to provide health benefits to your employees. Through data, analysis, and consultation, Wellmark Blue Cross and Blue Shield’s employer reporting can help you effectively track costs and improve quality and affordability of your health care benefits.

Many Whole Health Dimensions programs and services offer employer reporting, dependent on group size and funding arrangement. Results are incorporated into Executive Summaries with financial and utilization information to provide a comprehensive snapshot of the account. Employer reporting also allows you to track program participation and activity and plan for specific wellness activities.

Whole Health Dimensions programs and services offering the following employer reports:

Personal Health Assistant 24/7
Detail the number and demographics of the caller, as well as the reasons for the call. Employers will also receive call summary reports displaying the callers original intent to act compared with the nurse’s recommendation for care. 

Wellness Clinics and Personal Health Assessment (PHA)
After the close of a PHA program, employers will receive a corporate report summarizing the PHA responses and biometric data as well as participation rates and demographics. Risks are identified based on lifestyle related factors and lab results. Wellness staff can use results to plan educational programs and campaigns. 

Interactive Behavior Change Program
Reports are available to identify the number and percentage of PHA participants eligible for programs and activity in programs. In addition, you’ll received details on the migration of participants through various stages of change and the completion of behavior modules.

Telephonic Coaching (Buy-Up Option)
Reports for this program show the percentage of eligible participants and the number enrolled in programs. Risk improvement and elimination is also tracked as well as how participants migrate through the stages of change. 

QuitNet®
Reports show the percentage of eligible participants, the number enrolled in programs, and how participants migrate through the stages of change. 

Disease Management
Quarterly status reports display the interactions with members, the number of eligible members, new members, and their risk stratification by disease condition. 

Need Help for Good Health? Try Our Wellness Stations!

This month’s topic, Provide Information/Smoking Cessation, offers resources to help employees quit smoking and provides suggestions on how employees can make more informed health care decisions to avoid future problems and higher costs.

First Steps to Wellness

The PHA creates a personalized report based on various lifestyle and health factors, including medical history, biometric data (blood profiles, body measurements), and other measures of health risks. Once all data is gathered, the PHA directs the user to resources to help him or her make healthier decisions and positive lifestyle changes. Resources include interactive behavior change programs on areas such as stress management and smoking cessation, online community health forums to get support and advice from others, and information on products and services for healthy lifestyles.