RichDayHealthPlans Blog

Impacted Members Will Be Notified in Early February

Date: 01/26/2012

Blue Cross and Blue Shield of North Carolina (BCBSNC) is expanding its utilization management programs for members with pharmacy benefits with us effective March 1, 2012. These programs include prior review and restricted access programs. (Restricted access means members must try our preferred drugs before they can receive coverage for our non-preferred drugs.)

Changes Affecting ALL users of certain drugs:

• Prior review will be required for:

• Growth hormones, which will continue to require prior review, will now also be added to the restricted access list:

Changes Affecting NEW users of certain drugs:

• Renin inhibitors will be added to the restricted access list for new users only. Members must first try a preferred drug before the non-preferred drugs will be approved:
  • Preferred renin inhibitors: losartan or losartan/HCTZ (Cozaar® or Hyzaar®), (valsartan/amlodipine or valsartan/amlodipine/HCTZ (Exforge® or Exforge HCT®), telmisartan or telmisartan/HCTZ.(Micardis ® or Micardis HCT®), valsartan or valsartan/HCTZ (Diovan® or Diovan HCT®).
  • Non-preferred renin inhibitors: Tekturna®, Tekturna HCT®, Valturna®, Tekamlo™ and Amturnide™.

• Multiple Sclerosis drugs, which will continue to require prior review, will now also be added to the restricted access list for new users only:
  • Betaseron® or Rebif® are the preferred drugs and must be tried before any other drug is approved. The following drugs are non-preferred: Extavia® and Avonex®.

New Company to Provide Administrative Services

Date: 01/10/2012

Blue Cross and Blue Shield of North Carolina (BCBSNC) and Blue Cross and Blue Shield of Kansas City (BCBSKC) announced today that they will collaborate in an initiative that will position the companies to meet the new market demands required by a fast-changing health insurance landscape.

This joint effort will be undertaken by Topaz Shared Services, LLC (Topaz); BCBSNC and BCBSKC will be its initial members. Topaz will provide services such as claims processing, enrollment and billing for the individual and small-group markets.

Please see the press release below for more information.

If you have questions, please call the Agent Contact Center.

Topaz_release.pdf

Innovative Practice Welcomes BCBSNC Eligible Patients

Date: 12/07/2011

Carolina Advanced Health, the new primary care physician practice from BCBSNC and UNC Health Care, is open for business. The new medical practice is a collaborative approach that will enhance efficiency and quality of care by coordinating a patient’s health care under one roof. By doing this, the practice will improve health and quality standards and reduce complications among patients – both of which are expected to reduce medical costs.

Please see the press release below and this short video for more information. Visit http://www.carolinaadvancedhealth.org for more detailed information about the practice.

Eligible Member Mailings Begin in January

Carolina Advanced Health treats eligible BCBSNC customers who are over 18, are covered by a participating BCBSNC health plan and living with any of the following chronic illnesses: coronary artery disease, hypertension, hyperlipidemia (high cholesterol), diabetes, chronic obstructive pulmonary disease (COPD), chronic heart failure and asthma.

Beginning in January, BCBSNC will send letters to identified members to invite them to become a patient of the practice. These members will be identified by living near the practice and having one or more of the above conditions. Individual and fully-insured group members will be included in the mailings. At this time, self-funded groups will not be included.

The member mailings will continue on a monthly basis to ensure the number of new incoming patients aligns with the practice’s capacity to manage the care appropriately. We will provide more information about the member mailings before they begin.

If a BCBSNC member is interested in using Carolina Advanced Health before receiving a letter, they may call the customer service number on the back of their ID card to see if they are eligible.

Prime Therapeutics Offers Lower Costs, More Flexibility

Date: 12/01/2011

As part of our effort to reduce costs for our company and our customers, BCBSNC has contracted with a new pharmacy benefits management vendor. Pending regulatory approval, Prime Therapeutics will administer pharmacy benefits for our commercial customers whose pharmacy benefits are handled by BCBSNC. This change is effective April 1, 2012. This change will result in lower pharmacy costs for our customers and will provide more flexibility regarding services and programs.

Please see this morning’s press release below for more information. Also, below are frequently asked questions for you and employers to answer the immediate questions you and your clients may have.

If you have additional questions, please call the Agent Contact Center.

Prime_Press_Release_FINAL.pdf