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October 17th Blue Cross IL Updates


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3 Blue Cross Illinois Updates- Major Drug Card Changes, Free October 23rd Webinar on the NEW Wellness Program and Lost HMO Doctors

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October 17th Blue Cross IL Updates

  1. 1. October 17, 2012October Worksite Webinar Invitation: Overview of New Well onTargetSM Wellness ToolsYou are invited to attend a Worksite Wellness Webinar, hosted by Live Meeting.On Jan. 1, 2013, BCBSIL is launching Well onTargetSM. This innovative and affordable new wellness solutionoffers an expanded array of highly personalized tools and resources to help you increase employeeparticipation and enrich your companys wellness culture.When: Tuesday, Oct. 23, 10:00 a.m. Central Time (1 hour)What: Join this online forum about workplace wellness for employer groups. This series of one-hour webinarswill provide employer groups with tools you can use to help improve employee productivity and well-being.Who: The moderator for this webinar is Cheryl Pollard, CHES, Sr. Wellness Consultant at Blue Cross andBlue Shield of Illinois (BCBSIL). In her current role, primary responsibilities include consulting with clients topromote understanding of the integrated suite of Blue Cross and Blue Shield wellness program offerings,promoting engagement and participation in the wellness programs, and, ultimately, assisting clients to achievea wellness culture within their work environment. Cheryl has been with BCBSIL for more than two years andhas 10-plus years of experience in wellness consultation and employer-based health improvement programs.Where: Via a webinar, hosted by LiveMeeting.How to join: To join the Worksite Wellness Webinar, please use the website address below: logging in, you will receive further instructions for participating in the webinar.Below is information that you will need if you are having difficulty joining the webinar with the link above:Meeting URL: ID: 79WMMQAlso, we are providing a toll-free Audio Conferencing dial-in number:Audio Conferencing (Toll-free): 877- 440 - 4272Confirmation Number: 5571 734#After entering your passcode, you will be prompted to provide your name after the tone. This information isrequired to participate in a Question and Answer session at any time during the conference call.First-time users: To save time before the meeting, check your system to make sure it is compatible withMicrosoft Office Live Meeting: you miss our September wellness webinar featuring a wellness program case study? View the highlights. JEFF PETRO VP INSURANCE SALES ADVISER INDUSTRIAL INSURANCE 847.485.2202
  2. 2. October 17, 2012Pharmacy Program Changes Effective Jan. 1, 2013Standard Formulary ChangesBased on Primes National Pharmacy and Therapeutics Committees review of changes in thepharmaceuticals market, some revisions will be made to the standard Blue Cross and Blue Shield of Illinois(BCBSIL) formulary effective Jan. 1, 2013. Brand Medications Moving to a Higher Out-of-Pocket Payment Level Effective Jan. 1, 2013 Non-Formulary Condition Generic Formulary Brand Brand1 Used For Formulary Alternative(s)2 Alternative(s)1,2 Diovan High Blood Pressure irbesartan, losartan, valsartan Benicar irbesartan/HCTZ, losartan/HCTZ, Diovan HCT High Blood Pressure Benicar HCT valsartan/HCTZ Testim Low Testosterone N/A Androderm, AndrogelN/A = not applicable1 Third-party brand names are the property of their respective owners.2 This list is not all-inclusive. Other medications may be available in this drug class.Targeted mailings were sent to members affected by formulary changes per our usual process of notifyingmembers at least 60 days prior to implementation.Standard Formulary Dispensing Limit ChangesBCBSILs standard prescription drug benefit program includes coverage limits on certain medications anddrug categories. Dispensing limits are based on FDA-approved dosage regimens and product labeling.Effective Jan. 1, 2013, dispensing limits will be added for the following drugs:Drug Class and Medication* Dispensing LimitCOPD Arcapta Neohaler (indacaterol) 1 box (30 doses)/RxHereditary Angioedema Firazyr (icatibant) 3 syringes/RxHyperactivity Adderall 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 30 mg 60 tabs/30 days (amphetamine/dextroamphetamine) Adderall 20 mg (amphetamine/dextroamphetamine) 90 tabs/30 days Adderall XR (amphetamine/dextroamphetamine ext-release) 30 caps/30 days Concerta 18 mg, 27 mg, 54 mg (methylphenidate ext-release) 30 tabs/30 days Concerta 36 mg (methylphenidate ext-release) 60 tabs/30 days Daytrana (methylphenidate transdermal patch) 30 patches/30 days dextroamphetamine 5 mg 60 tabs/30 days dextroamphetamine 10 mg 180 tabs/30 days JEFF PETRO VP INSURANCE SALES ADVISER INDUSTRIAL INSURANCE 847.485.2202
  3. 3. Dexedrine 5 mg (dextroamphetamine ext-release) 90 caps/30 days Dexedrine 10 mg, 15 mg (dextroamphetamine ext-release) 120 caps/30 days Desoxyn 5 mg (methamphetamine) 150 tabs/30 days Focalin (dexmethylphenidate) 60 tabs/30 days Focalin XR (dexmethylphenidate ext-release) 30 caps/30 daysDrug Class and Medication* Dispensing Limit Intuniv (guanfacine ext-release) 30 tabs/30 days Kapvay 0.1 mg (clonidine ext-release) 120 tabs/30 days Kapvay 0.2 mg (clonidine ext-release) 60 tabs/30 days Metadate ER 10 mg, 20 mg (methylphenidate ext-release) 90 tabs/30 days Metadate CD (methylphenidate ext-release) 30 caps/30 days Methylin 2.5 mg chewable, 5 mg chewable (methylphenidate) 90 tabs/30 days Methylin 10 mg chewable (methylphenidate) 180 tabs/30 days Methylin 5 mg/5 ml (methylphenidate) 450 ml/30 days Methylin 10 mg/5 ml (methylphenidate) 900 ml/30 days Methylin ER 10 mg, 20 mg (methylphenidate ext-release) 90 tabs/30 days Procentra 5 mg/5 ml (dextroamphetamine) 1,800 ml/30 days Ritalin (methylphenidate) 90 tabs/30 days Ritalin LA 10 mg, 20 mg, 40 mg (methylphenidate ext-release) 30 caps/30 days Ritalin LA 30 mg (methylphenidate ext-release) 60 caps/30 days Ritalin SR 20 mg (methylphenidate ext-release) 90 tabs/30 days Straterra 10 mg, 18 mg, 25 mg, 40 mg, 60 mg (atomoxetine) 60 caps/30 days Straterra 80 mg, 100 mg (atomoxetine) 30 caps/30 days Vyvanse (lisdexamfetamine) 30 caps/30 daysMale Hormones Androderm 2 mg (testosterone) 30 patches/30 days Androgel 1.62% (testosterone) 2 bottles/30 days Axiron (testosterone) 2 bottles/30 days Delatestryl 100mg/ml, 200 mg/ml; 10 ml vial (testosterone) 1 vial/28 days Delatestryl 200 mg/ml; 1 ml vial (testosterone) 4 vials/28 days First-Testosterone ointment, cream (testosterone) 60 grams/30 days Fortesta (testosterone) 2 bottles/30 days Striant (testosterone) 2 buccal systems/30 daysNasal Products Qnasl (beclomethasone diproprionate) 1 bottle/30 days Zetonna (ciclesonide) 1 canister/30 days Dymista (azelastine/fluticasone) 1 bottle/30 daysNeuromuscular Drugs Gralise 300 mg (gabapentin ext-release) 30 tabs/30 days Gralise 600 mg (gabapentin ext-release) 90 tabs/30 days Gralise Starter Pack (gabapentin ext-release) 1 pack/30 days Horizant (gabapentin enacarbil) 30 tabs/30 days* Third-party brand names are the property of their respective owners.Review the most up-to-date list of drug dispensing limits.Targeted mailings were sent to members affected by changes in dispensing limits per our usualprocess of notifying members at least 60 days prior to implementation.If you have questions regarding these changes, please contact PPO (800) 541-2768 HMO (800) 892-2803 JEFF PETRO VP INSURANCE SALES ADVISER INDUSTRIAL INSURANCE 847.485.2202
  4. 4. October 17, 2012HMO Network Update: Tri County Physicians Association HMO Contract TerminatedIt is unfortunate that we must inform you that Tri County Physicians Association has officially terminatedBOTH its HMO Illinois and BlueAdvantageSM HMO agreements. It is important to note that this developmentaffects HMO members only, and only services provided by Tri County Physicians Association. This does notaffect our PPO members or contracts.The termination will become effective Jan. 1, 2013, and will impact approximately 3,200 HMO memberscurrently with Tri County Physicians Association. We will begin notifying our group administrators andmembers this week.Members will be given the opportunity to select new medical groups. Most of the doctors with Tri CountyPhysicians Association are affiliated with another network medical group, which means most members will beable to keep their current doctor. Our transition of care plan will also be put into place so we can ensure thatmembers treatment will not be negatively impacted and that we have appropriate time to transfer membershipto other groups.Members who have questions should call HMO (800) 892-2803 JEFF PETRO VP INSURANCE SALES ADVISER INDUSTRIAL INSURANCE 847.485.2202