Blue Benefits Bulletin

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December 2009

Learn About Changes to the Preferred Drug List in 2010

Inline Image The Preferred Drug List (PDL) and other drug lists for 2010 are now available and can be reviewed in the Pharmacy section of bcbst.com.

Changes to the PDL for 2010
The following changes to the PDL will take effect Jan. 1, 2010, and are designed to help members and groups save money on prescription drugs. Because of the nature of the prescription drug market, additional changes may be made prior to Jan. 1, 2010.

The following generic (and branded generic) drugs will be added to Tier 1:

brimonidine (Alphagan P)
budesonide inhalation (Pulmicort inhalation)
lansoprazole (Prevacid)
miglitol (Glyset-no longer on the market)
repaglinide (Prandin)
valacyclovir (Valtrex)

The following drugs will cost members less. They will move from Tier 3 (highest copay) to Tier 2 (lower copay):

Astepro (added Oct. 1, 2009)
Boniva
Bystolic (added Oct. 1, 2009)
Coreg CR (added Oct. 1, 2009)
Savella (added Oct. 1, 2009)
Trilipix (added Oct. 1, 2009)
Venlafaxine ER
Ventolin HFA

The following drugs will cost members more. They are moving from Tier 2 (lower copay) to Tier 3 (highest copay). Preferred brands (alternatives) may be available for these drugs, and generic equivalents are indicated in bold.

Alphagan P (brimonidine)
Atacand (Avapro, Benicar, Micardis)
Atacand HCT (Avalide, Benicar HCT, Micardis HCT)
Copaxone
Miacalcin (calcitonin-salmon)
Prevacid (lansoprazole; the 15mg will be OTC)
Proventil HFA (ProAir HFA, Ventolin HFA)
Rebif
Valtrex (valacyclovir)

The following drugs are being added to the Prior Authorization list:

Cimzia
Enbrel
Humira
Kineret
Nuvigil
Provigil
Simponi

The PDL is reviewed annually to determine needed changes based on drugs’ clinical effectiveness, safety and affordability. This review includes an analysis to determine a long-term “Lowest Net Cost” for members and groups.

While many changes to the PDL occur at the beginning of the year, drugs on the PDL can change throughout the year due to market changes such as:

Release of new drugs to the market after FDA approval;
Removal of drugs from the market by the FDA; and
Release of new generic drugs to the market

For the most up-to-date information on prescription drugs, visit the Pharmacy section of bcbst.com.

In This Issue

Medicare Information

Medicare Supplement Changes for 2010

Medicare Supplements are scheduled for changes in 2010. The Medicare Improvements for Patients and Providers Act (MIPPA) was passed in an effort to streamline and modernize benefits and benefit plans, reduce beneficiary confusion and increase beneficiary choices. Read More »

Annual Credentialing Required to Receive Medicare Advantage Renewal Commissions

If you are one of our brokers who has sold BlueAdvantage products in previous years, we want to make sure you are eligible to receive future renewal commissions. New government regulations stipulate that only credentialed Medicare Advantage brokers can receive renewal commissions. Read More »

Important Information for Your Clients Changing from BlueAdvantage to BlueCross 65

With an economy that has been unpredictable and many questions about Medicare coverage, you may find more of your clients requesting a change from their BlueAdvantage Plan to a BlueCross 65 Plan. Read More »

Primary Coverage Reminder: Group vs. Medicare

Our staff receives questions from across the state on a daily basis, and one common question is: “Who is responsible for primary coverage on an employed group member who also has Medicare Parts A and B?” The answer depends on the size of the group. Read More »

Three Hospitals to Leave BlueCross65 Select Network at Year's End

Three provider hospitals have decided to leave the BlueCross65 Select network at the end of 2009. The departure will reduce the list of providers for BlueCross65 Select, a Medicare supplement product which is no longer available for new members. Read More »

Creditable Coverage Certificate Speeds BlueCross65 Application Process

When you submit BlueCross65 applications for your clients, you want the process to be quick and easy, and so do we. You can greatly reduce the amount of time your clients will have to wait for coverage by including a creditable coverage certificate with BlueCross65 applications.
Read More »

Special HSA messages from
Wells Fargo & First Horizon

Wells Fargo: Building a Better HSA – with Help from You

Earlier this year, Wells Fargo hosted our annual Health Savings Account (HSA) customer and broker advisory councils. The goal was to bring together healthcare professionals to discuss HSA trends and provide feedback on the Wells Fargo HSA. Read More »

First Horizon Expects HSA Demand to Increase

If early indicators hold true, more of your clients will ask you to tell them about high-deductible health plans and HSAs. Not only are employers increasingly concerned about how to control healthcare costs, this current health reform debate has drawn greater public attention to these plans and their advantages to employers and their employees. Read More »