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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 Disease Management Phone Number For Fully-Insured MembersStarting September 1, employees participating in Wellmark Blue Cross and Blue Shield’s Disease Management program have a new phone number to call for help managing their chronic health conditions — 1-866-816-5264.Fully-insured members currently participating in a Disease Management program will receive a letter in late August explaining the change, followed by a phone call with more information. Wellmark’s Disease Management services provide help to plan members with diabetes, chronic respiratory diseases, and heart conditions to coordinate their health care, understand and follow their physician’s treatment plans, and maintain healthy behaviors. |
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Wellmark Blue Cross and Blue Shield changed the way BlueCard claims are paid for members receiving services from non-participating providers located in states other
than Iowa and South Dakota. As of July 1, for BlueCard claims associated with non-participating providers, Wellmark now pays the lesser of the:
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The National Committee for Quality Assurance (NCQA) is changing the naming convention for HEDIS® or “Health Plan Employer Data and Information Set.” NCQA is retaining the HEDIS acronym, but changing the underlying name to “Health Care Effectiveness Data and Information Set” to reflect an expanded scope of health care performance measures. |
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New Pharmacy Prior Authorization ProgramsWellmark Blue Cross and Blue Shield is implementing three new pharmacy prior authorization programs to encourage generic drug use andsupport the most clinically effective drug therapy at the lowest net spend. Sedative Hypnotics Prior Authorization Under the new program, a member must try and fail generic Ambien (zolpidem tartrate) before coverage is available for Ambien CR, Sonata, Lunesta, and Rozerem. This program goes into effect for all members currently taking a sedative hypnotic, as well as new users. If the physician would like the member to continue on their current sedative hypnotic drug rather than move to generic Ambien and there is no claims history in the system for Ambien or its generic equivalent, the physician will need to request approval from Wellmark. Approval will be granted if the physician can document that the member has tried and failed Ambien in the past. Generic Ambien is a Tier 1 drug on the Wellmark Drug List, while the other sedative hypnotics are on Tier 3. In May, Wellmark sent a postcard to all members taking a sedative hypnotic to inform them about the availability of generic Ambien and how this new option may help decrease their out-of-pocket costs.
Non-Sedating Antihistamine Prior Authorization To encourage the use of established non-sedating antihistamines, Wellmark has implemented a prior authorization for Xyzal. Members will be required to try and fail generic Allegra and Zyrtec before coverage is available for Xyzal. Because the prior authorization was in place before Xyzal was available to purchase (although the drug has been approved by the FDA, it was not being sold at the time this newsletter was published), this prior authorization does not impact current users of non-sedating antihistamines. Antifungal Prior Authorization Change If the antifungal is being prescribed for medical rather than cosmetic purposes, the physician will need to submit a prior authorization request to Wellmark for approval. Wellmark currently has similar prior authorization policies in place for drugs such as Retin-A. Coverage for Retin-A is not available if it is being prescribed for treatment of wrinkles, which is considered a cosmetic condition. But Retin-A is covered for a diagnosis such as skin cancer, for example, if prior authorization approval is received. |
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Sending Kids Off to College?Do your employees have dependent children who will attend college full-time out-of-state? Wellmark Health Plan of Iowa has an added benefit for employees and their family members while away from home for 90 or more consecutive days. Guest Memberships include access to Blue Cross and Blue Shield participating hospitals, physicians, and other related health care providers from which members can receive covered services. Important: Preventive services are not covered unless performed by the member’s designated Wellmark Health Plan of Iowa primary care provider. |
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Compare Cost and QualityHelp making health care choicesInformation is critical in helping your employees manage their health care and make informed decisions. Members have access to a growing range of data on health care cost and quality on www.wellmark.com to help them decide where to seek medical care. Visit Health Care Quality & Cost on the Member or Employer Sections to find these health care resources:
More Employer Tools |
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