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December 2006
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Wellmark Drug List Changes Effective January 1, 2007

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Updated Form - Common Law Affidavit


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pharmacy news

Wellmark Drug List Changes Effective January 1, 2007

A primary goal of Pharmacy InsightsSM is to deliver a clinically effective pharmacy program that achieves lowest total net spend. Several months of evaluation of clinical, safety, utilization, and drug alternative data has resulted in some changes to the Wellmark Drug List in January 2007. The changes fall into three categories:
  • Drugs moving from Tier 2 to Tier 3 because AB-rated generics are now available
  • Drugs moving from Tier 2 to Tier 3 because therapeutically similar options are available on Tier 1 and/or Tier 2 and/or over-the-counter
  • Drugs requiring prior authorization

TIER CHANGES

Drugs moving from a Tier 2 to Tier 3 because AB-rated generics are now available do not require a new prescription; members can simply ask their pharmacist to start filling their prescription with the generic option.

Generic Drug List Letter

Drugs moving from Tier 2 to Tier 3 because no AB-rated generic is available will require members to obtain a new prescription for the preferred alternative to prevent a possible increase in out-of-pocket costs at the pharmacy.

Wellmark Drug List Letter

PRIOR AUTHORIZATION CHANGES

Three new drugs require prior authorization — Differin, Penlac, and Daytrana:
  • Differin is similar to Retin-A, an acne drug that also can reduce wrinkles and currently requires prior authorization for members 35 years of age and older
  • Penlac is a topical anti-fungal drug similar to Sporanex and Lamisil, which currently require prior authorization
  • Daytrana is a patch used to treat ADHD; added because of safety, clinical effectiveness, and cost concerns; approximately 30 percent of drug remains in patch after removal and the cost is about $5 per patch, which is more expensive than other ADHD drugs that are clinically the same

ONE TOUCH AND ACCU-CHEK: BLOOD GLUCOSE TEST STRIPS ON TIER 2

Effective January 1, your employees can take steps to lower their out of pocket costs by choosing One Touch or Accu-Chek blood glucose test strips. All other blood glucose test strips will move to Tier 3. Because changing test strips will require using a new blood glucose monitor, those affected by the change will receive a letter with instructions on how to receive a new monitor at no charge.
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Letters were mailed to affected members in late November. If you or your employees have questions or need additional information, contact your Wellmark agent or direct representative.
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managing your plan

Updated Form — Common Law Affidavit

The updated Joint Affidavit Common Law Marriage form (PDF) provides more details to assist you in validating eligibility. Forms are available on the Employer Toolkit on Wellmark.com. Wellmark recommends that the notarized form accompany the application if Common Law status is indicated on the application. Electronically enrolled groups (such as those utilizing Blues EnrollSM or STEP), should also utilize the affidavit form along with their member enrollment material in the normal manner.

Note: Dissolution of a legally established common law marriage requires the couple to petition the court for a divorce.

References to Common Law Marriage as it relates to member enrollment processes are located in the Large Group (101+) Enrollment and Administrative Guide which can be found on the Employer section of Wellmark.com under Procedures and Guides.
contact Find additional legislative information on common law marriage at the National Conference of State Legislatures website.
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