January, 2006 - Health Insurance Update
Worker’s Compensation
- If you have an open worker’s compensation claim with
the city, you MUST see a work comp physician every 12 months to keep this
claim active. If you do not meet this requirement, the city will close
your claim! Your health insurance may not cover you if you do not comply
with the yearly visits.
Prescription Drug List
Changes - Effective
January 1, 2006
United Healthcare is committed to providing our plan with an
affordable pharmacy benefit and our members with choice and affordable
access to medicines that improve health and well being. Part of their
efforts in this area is the careful management of our Prescription Drug
List (PDL). They continually evaluate clinical evidence and physician
feedback to identify opportunities to take costs out of the system – not
just shift costs to consumers.
They consider a medication’s total health care value when
making tier placement decisions. This means they do not automatically
differentiate between generic and brand name medications; instead, they
evaluate a particular medication’s clinical efficacy, cost, and
pharmacoeconomic (outcomes and health care cost offset) factors.
This letter is to inform you of PDL changes effective
January 1, 2006.
UHC will be making the following up-tiering and down-tiering
classification changes:
|
|
|
|
|
§
Butorphanol
§
Fentanyl patches
§
Nabumetone
§
Orphenadrine
§
Orphenadrine cmpd
§
Tolmetin
Cardiovascular
§
Cartia XT
§
Fosinopril
§
Fosinopril + HCTZ
§
Quinapril
§
Quinapril + HCTZ
§
Taztia XT
Acne Treatment
§
Isotretinoin
§
Minocycline
|
§
Ortho Cyclen
§
Ortho Evra (patch)
§
Ortho Micronor
§
Ortho-Cept
§
Ortho Novum
§
Ortho TriCyclen
§
Ortho TriCyclen Lo
§
Modicon
Overactive Bladder
§
Ditropan XL
Fertility
§
Novarel
Erectile Dysfunction
§
Viagra
Acne Treatment
§
Tazorac
|
Asthma
§
Asmanex*
Overactive Bladder
§
Enablex*
§
Vesicare*
Kidney/Renal Failure
§
Fosrenol*
Osteoporosis
§
Boniva
|
Next Steps
UHC will communicate with physicians, pharmacies, brokers and
members regarding the changes from Tier 1 to Tier 2 and Tier 2 to Tier 3.
Members will receive personal letters about the changes if they have taken
any of the maintenance medications that are moving to a higher tier in the
past 120 days. UHC will also notify members impacted by the benefit
exclusion. Member notification will occur beginning
December 1, 2005.
Consistent with established policy,
notification letters will not be sent to members who are taking a
maintenance medication that is moving to a lower tier as these are all
positive PDL changes for the member.
New
HALF TABLET PROGRAM – starts January 1,
2006
The Half Tablet Program is designed to
support members who want to save money by “splitting” tablets for select
prescription medications. For example, the Lipitor 40 mg tablet is priced
similarly to the Lipitor 80 mg tablet. A member using Lipitor mg who
participates in the program can purchase the 80 mg tablet and then split
that tablet to achieve a 40 mg dose. This results in a financial savings
for both the member and plan sponsor. In most cases, the member pays
half a co-payment at retail or mail order, and the cost to the plan
sponsor is reduced by up to half.
Medications Available for Tablet Splitting
The list of medications available for
tablet splitting has been expanded. The medications included are:
|
Category |
Medications |
|
ACE inhibitors |
Aceon, Mavik, Univasc |
|
Angiotensin Receptor Blockers (ARBs) |
Atacand, Avapro, Benicar,Cozaar,
Diovan |
|
Anti-depressants |
Lexapro, Pexeva, Zoloft |
|
Lipid-lowering medications |
Crestor, Lipitor,Zocor, Pravachol |
|
Antivirals |
Valtrex |
Note: The program does NOT include ALL
medications within a specific therapeutic class; only those medications
determined to be appropriate for splitting are included.
Some of the tablets included in this
program are not scored or designed specifically to be split. Members,
along with their physicians, will need to determine if the Haft Tablet
program is right for them. Medications in the program will be reviewed
periodically; additional medications may be included as appropriate.
Health Trust Board Apprentice Program
With the departure of a retiring board
member, the Health Trust board is recruiting new apprentices (alternates)
to join the board in January, 2006. The board is responsible for all of
the decisions concerning the health and dental insurance programs for the
FOP members. Please contact Mary Negrey, Randy Pelham, Charlie Studders
or Joe Mogavero if you are interested in joining the Health Trust Board.
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Please remember, our medical plan is self-insured.
Contributions from the city and you pay our claims! United
Healthcare has a claim system to pay the providers and gives us access to
provider network discounts, thus acting as Third Party Administrator or
TPA. Accessing network providers and utilizing proper care will help
contain plan costs and your contributions! Keep up the great job of
being informed consumers of our plan!
Questions: Health Trust Office: 954-527-9218
Questions: Health
Trust Office 954-527-9218
