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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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Pregnancy Care Program Changes
Health care costs for preterm babies average 15 times higher than the cost for full-term babies.1 Wellmark’s Pregnancy Care Program offers resources to engage members to have a healthy pregnancy through individualized programs and personal contact. Coming in 2008 are several program enhancements, designed to provide greater support for women at risk for prenatal health complications. Some of these changes include:
- Program outreach customized to a participant’s need
- Nursing contact monthly (or more frequently) based on risk level and compliance with treatment
- Outreach to primary clinician (for high-risk cases)
- More regular outreach to low-risk women, including a pregnancy workbook at enrollment, and monthly mailings customized by gestational age of baby
Current pregnancy care participants will receive a letter in late December with more information on the new program, including a new phone number to reach an obstetrical nurse for pregnancy or baby care questions. Newly identified pregnant women will enroll directly in the new Pregnancy Care Program starting January 1, 2008.
1 Thomson MedStat, March of Dimes, 2006
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Look for more details about Pregnancy Care and other integrated health management programs and services in future issues of NEWS FROM BLUE.
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Wellmark Drug List Changes
Effective January 1, 2008, Wellmark Blue Cross and Blue Shield is moving five medications from Tier 2 to Tier 3 on the Wellmark Drug List. In early December, Wellmark will mail notification of these changes to your employees on a three-tier drug plan who have recently filled a prescription for one of the listed drugs.*
Your employees continue to have benefits for Tier 3 drugs; however, their out-of-pocket costs may be higher.
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 for most of the strengths. The pharmacist can make the change; no new prescription is needed.
Brand Name Drugs Moving to Tier 3 |
Generic Equivalent on Tier 1 |
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| Lotrel |
amlodipine besylate and benazepril HCL |
| Trileptal |
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| Topicort LP |
desoximetasone topical cream |
Brand-Name Drug Moving to Tier 3
In addition, two brand-name drugs, Exelderm and Oxistat*, are moving to Tier 3 although AB-rated generics are not available. Both Exelderm and Oxistat are topical antifungals and are used for acute therapy. There is minimal utilization of these two drugs. Members were not notified about these drug tier changes because they are for acute use and have minimal utilization.
Brand-Name Drug Moving to Tier 2
Neupro, a drug used for Parkinson’s Disease, will move from Tier 3 to Tier 2 on January 1, 2008.
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The Wellmark Drug List on www.wellmark.com and the printable condensed version will be updated January 1 when the tier changes go into effect.
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Zyrtec Expected To Go Over-The-Counter
The popular allergy medicine Zyrtec is expected to become an over-the-counter (OTC) drug in late January 2008. In anticipation of this change, Wellmark Blue Cross and Blue Shield is studying options regarding its entire class of nonsedating antihistamines to support its Pharmacy Insights lowest total net spend strategy.
Currently, Zyrtec is a Tier 3 drug on Wellmark’s Drug List, and a generic option is not available. The pricing of Zyrtec’s OTC versions and prices of other allergy medications will help determine Wellmark’s strategy.
Although Zyrtec can be used to treat indoor allergies, it is popular in the spring and fall when seasonal outdoor allergies are more common.
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More information about Wellmark’s Zyrtec strategy will be shared in future issues of NEWS FROM BLUE.
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Educational Campaign Encourages Generic Statins
Statins, drugs that help lower cholesterol and the risk of heart disease, are the number one class of drug for Wellmark Blue Cross and Blue Shield members in terms of cost and number of prescriptions. In the first nine months of 2007, Wellmark members filled almost half of a million prescriptions for statins at a cost of more than $38 million.
Three generic statins are now available, providing the same reductions in LDL or “bad” cholesterol1, at lower out-of-pocket costs compared to some brand-name options such as Crestor, Lescol, Lescol XL, Lipitor, and Vytorin. Wellmark is starting an educational campaign to deliver this message to employers, physicians, and members.
Physician Campaign
Letters will be mailed to all physicians who are prescribing brand-name statins explaining how generic statins can potentially save their patients who have Wellmark drug coverage between $240 and $480 a year on out-of-pocket costs. Included will be a list of their Wellmark patients who are currently taking a lower dose of a brand-name statin.
In addition, pharmacists from Catalyst Rx, Wellmark’s pharmacy benefit manager, will visit physicians writing the highest number of brand-name statin prescriptions to re-emphasize the message and to provide additional tools to help physicians change prescriptions.
Member Campaign
This month, Wellmark will send postcards to members who are currently taking a lower strength brand-name statin letting them know that there are generic options that are clinically appropriate and could help them save on their out-of-pocket costs. Since most people who take a statin must do so for years, the cost of the drug is important.
The postcard encourages them to discuss generic statin options with their doctor and to let their doctor know how much money a generic could save based on their copayment or coinsurance. Because Lipitor, Crestor, Lescol, and Lescol XL currently do not have generic equivalents on the market, a new prescription is needed from your physician to move to a generic alternative.
Blue, Wellmark’s quarterly member magazine, will also feature a story in its winter issue about generic statins. In addition, several new Decisions Count pieces are being produced to further emphasize the message about generic statins and generic alternatives.
Lowest Net Spend
The chart below shows the average cost of popular statins, the typical copayment based on a $10, $30, and $50 three-tier plan design, and the member’s yearly out-of-pocket costs. With a maintenance medicine like statins, the savings potential for your employees is significant.
Statin Medications |
Average Monthly Cost Script2 |
Typical Copayment |
Annual Out-of-Pocket Costs3 |
Lovastatin - generic Mevacor (Tier 1) |
$23 |
$10 |
$120 |
Pravastatin - generic Pravachol (Tier 1) |
$18 |
$10 |
$120 |
Simvastatin - generic Zocor (Tier 1) |
$28 |
$10 |
$120 |
Crestor (Tier 2) |
$108 |
$30 |
$360 |
Lipitor (Tier 2) |
$133 |
$30 |
$360 |
Lescol/Lescol XL (Tier 3) |
$86 |
$50 |
$600 |
Pravachol (Tier 3) |
$132 |
$50 |
$600 |
Vytorin (Tier 3) |
$100 |
$50 |
$600 |
1Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III Final Report) http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf
2Pricing from www.drugstore.com; November 5, 2007
3Based on monthly typical copayment over 12 months
Popularity of Statins Increases
The use of statins continues to grow – largely because guidelines for statin use have become more aggressive for treating people with elevated LDL levels. Three of the top 10 drugs in terms of spend for Wellmark members are statins for the first nine months of 2007 – Lipitor, Crestor, and Vytorin. From January through October 2007, Wellmark members filled nearly 491,000 prescriptions for statins. In comparison, in all of 2002, almost 419,000 statin prescriptions were filled.
| Drug Name |
Number of Prescriptions Filled* |
Total Costs* |
| Lipitor |
188,184 |
$19.6 million |
| Simvastatin |
95,528 |
$0.72 million |
| Vytorin |
59,450 |
$5.7 million |
| Crestor |
53,526 |
$5 million |
*Based on Wellmark claims data, January - October 2007
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The Decisions Count fact sheet, “High Cholesterol: Know Your Numbers” (M-2340), is a great way to educate your employees about the importance of knowing their cholesterol levels. Visit the Employer Toolkit on www.wellmark.com.
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New COBRA Administrative Services Agreements
A new COBRA Administrative Services Agreement (N-53168) is now available in the Employer Toolkit on www.wellmark.com. The form is completed when a group initially requests Wellmark administration of COBRA, and during each renewal.
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If you have any questions about Wellmark’s COBRA administration service, please contact 1-800-694-4105.
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New Group Applications for Wellmark Health Products
The Group Application for Health, Dental, and Life Insurance (N-5411) has been updated due to Blue Cross Blue Shield Association logo requirements, effective January 1, 2008.
Revisions include:
Application |
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Revision Description |
| N-5411 (version 7/07) |
Top of application |
Resized logos |
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B. Members Covered |
Added disclaimer for Fort Dearborn Life Insurance Company |
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E. Other Carrier Information |
Added information requests |
Please destroy any old forms you may have on hand and begin using the newest version.
Additionally, please destroy any application stock no longer supported by Wellmark including N-5408, N-5409, N-5411, and N-5412. For more details, review Changes in Membership and Enrollment Applications, from the July 2007 edition of NEWS FROM BLUE.
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Order printed copies of the new applications from the Employer Toolkit on www.wellmark.com. Contact your Wellmark representative or agent if you have questions.
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Easier Online Access for Self-Service Tools
Our enhanced registration process makes it easier for your employees to access online tools and resources at myhealth@wellmark on www.wellmark.com. Health plan members can register in just a few minutes, to receive access to online health and prescription plan information, and the Wellmark Drug List tool. Order our new promotional flyer (M-23217), available on the Employer Toolkit, to promote online, self-serve tools and resources to your employees.
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Look for more information about our enhanced online registration process in future issues of NEWS FROM BLUE.
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Free Workplace Wellness Wall Calendar
Many companies recognize the importance of creating workplace wellness programs so employees stay on top of their health physically, mentally, and emotionally. That’s why Wellmark Blue Cross Blue Shield chose the theme, The Year of Workplace Wellness, for their 2008 calendar. The free wall calendars, ideal for workstations and offices, are now available to employers.
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Visit the Employer Toolkit on www.wellmark.com to order your free calendars, while supplies last.
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Holiday Closings
In observance of Christmas, Wellmark offices will be closed on Monday, December 24 and Tuesday, December 25. In observance of the New Year, Wellmark offices will be closed on Tuesday, January 1, 2008. We hope you have a safe and happy holiday season!
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Facts on Dental Fillings
Getting a dental filling is something no one looks forward to, but it is necessary to maintain good oral health. Like any other health choice, it is important to understand your options so you can make an educated decision on what type of filling is right for you. Thanks to advances in dental materials and techniques, a consumer has more choices when a cavity needs to be filled. Here is a side-by-side comparison of dental filling options:
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Amalgams (silver fillings) |
Composites (white fillings) |
Ionomer fillings |
| History |
Used for over 150 years |
Used for over 30 years |
Relatively new |
| Average Life |
10-12 years |
5-6 years |
Not known |
| Advantages |
- Durable
- Economical
- Highly resistant to wear and tear
- Helps prevent tooth decay
- Well tolerated by patients
- Used on back teeth because of chewing load
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- Match to tooth color
- Used for cosmetic purposes
- Cures faster and patient can use right away
- Less tooth structure removed
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- Can be matched to tooth color
- Used for small fillings and cavity liners for crowns and bridges
- Less tooth structure removed
- Well tolerated by patients
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| Disadvantages |
- Silver or gray tooth color
- Allergy to mercury (less than 1% of population)
- Sensitivity to hot and cold foods and liquids is possible
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- Cost can be up to 25% - 30% more than amalgams
- More prone to wear and breakage (especially with back teeth)
- Requires area to be dry when placed
- Prone to staining
- More prone to tooth decay
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- Not able to withstand as much chewing load
- High wear when placed on chewing surfaces
- Color may lack natural translucence of enamel
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The American Dental Association (ADA) supports ongoing research for the development of new materials, but they continue to believe amalgam is a valuable and safe choice for dental patients.
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Please contact Wellmark customer service at 1-877-333-0164 if you have additional questions.
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