Transcript Slide 1

2008 Georgia Product Portfolio
Maintenance and Review (PPMR)
October 2008
Blue Cross and Blue Shield of Georgia, Inc., is an independent licensee of the Blue Cross and Blue Shield Association. The Blue
Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
Agenda
 Annual Product Portfolio Maintenance and
Review (PPMR)
 Urgent Care
 Pharmacy Changes
 Intermediate Level Mental Health
 Preventive Care
 PPO mammography benefits
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Background
 Annual process; 1st time for Georgia
 Starting with 01/01/09 new sales and upon each group’s
renewal
 Flyers highlighting changes will be included in each
group’s renewal package
 Will apply to all existing local fully insured plans, ASO,
MPA and groups with non-standard benefits EXCEPT:
managed indemnity plans 1-41 and legacy HDHP plans
9005SX-9809SX
 Will not apply to new Blue Essential and Lumenos plans
 Due to BCBSA ID Card Mandates, member ID cards will
have a different look after 11/08/08
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Urgent Care
 In-network: $60 co pay
 Out-of-network: $60 co pay, subject to deductible
and coinsurance
 Provider must bill with Place of Service 20
 Co-pay displayed on ID card
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Urgent Care Centers Online
Go to www.bcbsga.com
Click on “Members” then “Find a Doctor”
Click on the “Locate Georgia Providers” link
Choose the network
Select a Plan from the drop down box
Select Provider Type “Hospitals, Facilities, Services
and Equipment”
Select a Specialty Category “Clinics, Urgent Care
Centers”
Complete the search criteria and click “View Results”
Click “Printer Friendly” for hardcopy
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Pharmacy
 Language changes include:
• Generic is generally on Tier 1 but may also be on Tier
2 or Tier 3
• Brand is generally on Tier 2 but may also be on Tier 1,
Tier 2 or Tier 3
• Non-Preferred = Tier 3
• Mail Order Generic = Mail Order Tier 1
• Mail Order Brand = Mail Order Tier 2
 Limit day supply 30 days vs. 34 days*
 Mandatory Generic (PTD)*
*Only existing groups with these current pharmacy benefits will be
impacted at the group’s renewal
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Anthem Tiered Drug List Online
Go to www.bcbsga.com
Under Learn More, click “Pharmacy”
Click on “HMO/POS members” or “PPO
members” (you will be re-directed to the
NextRx website)
Select “Print Drug List” in the upper left corner for
a PDF of the Anthem Tiered Drug List
Or, use the search tools to search for a specific
drug on the list
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Specialty RX
 Pharmacies within the specialty pharmacy
network must be utilized
 PrecisionRx Specialty Solutions is a BCBSGa
affiliated specialty pharmacy within the network
 Prior to renewal, members will need to
transition their current specialty prescription(s)
 Letters will be sent to members currently using
specialty medications 30 days prior to the
change
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Specialty RX Network Services
One-on-one service and support from a personal
care coordinator.
Proactive phone calls to schedule timely refills.
24/7 access to a registered nurse or pharmacist for
urgent drug questions.
Coordination between them and their providers.
Educational support on what to expect from
treatment, drug interactions and side effect
management.
Drugs delivered in temperature-moderating
packaging directly to any location specified.
Members may be responsible for a greater cost
share if a participating specialty pharmacy provider is
not used
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Specialty RX List Online
Go to www.bcbsga.com
Click on “Members”
Under Learn More, click “Pharmacy”
On the Pharmacy Program page, click on the
“Specialty Pharmacy Program – Drug List” link
Scroll down the disclaimer and click on the
“Specialty Pharmacy Program – Drug List” link
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The Half Tablet Program
 Limited to Lipitor, Cozarr, Diovan
 Appropriate customers have physician write new
prescription for double the dose and half the
amount
 Using tablet splitter member takes ½ a tablet per
day
 Not for individuals with limited vision, poor manual
dexterity or those who become confused easily
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New Member ID Card
Effective 11/8/08
ID card will now read RX and co pay amounts
New Urgent Care co-pay will display
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Mental Health Partial Hospitalization
Program and Intensive Outpatient Program
 Benefit is expanded to 10 visits for both
intermediate level Mental Health programs
• Partial Hospitalization Program (PHP)
• Intensive Outpatient Program (IOP)
 Applies to all plans
 Already available in the new PPO plans that
launched 11/15/07
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Other PPMR Changes
 Adopting Enterprise Preventive Care list
 PPO mammography benefit mirrors HMO
benefits by allowing annual screening for any
age:
 “Benefits will be provided for one
mammogram and one pap smear tissue
examination per year, or more often when
ordered by a Physician”
 See the Agent/Broker site for side by side grids
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Groups Without PPMR Changes
 If a Large Group renewal was released prior to
10/15/08 PPMR benefit changes AND Specialty
Pharmacy network changes will NOT be applied
01/01/09 unless specifically requested
 PPMR benefit changes AND Specialty Pharmacy network
changes WILL be applied at 2010 renewal
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Summary
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Urgent Care
Pharmacy Changes
Intermediate Level Mental Health
Preventive Care
PPO mammography benefits
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