Sbsbhealth.com

SPRING ■ 2011
N E W S F O R T H E M A R K E T P L A C E IMPORTANT:
Please share the information in this document with all benfit-eligible employees.
Promoting Health Literacy
As insurance plans become increasingly complex, it’s important Health literacy is defined as the degree to which that our members understand how their plans work, how benefits individuals have the capacity to obtain, process, are paid, and how they can take a more active role in their own and understand basic health information needed health care. To help our members understand how their health to make appropriate health decisions about plan works, we’ve created the Advantage Resource Center—an services needed to prevent or treat illness.
online resource for members who need information about their Advantage plan.
Members with low health literacy may have difficulty: The Advantage Resource Center includes information specific to our Advantage plans, including our HSA compatible plans. In addition, we’ve created new videos, articles, and presentations ■ Understanding how their health insurance designed specifically to educate our members about Deductible ■ Sharing their medical history with providers ■ Seeking preventive health care Rebecca Levanduski, Director of Marketing at Tufts Health Plan, explains: “Some members have trouble understanding how deductible plans work—particularly if they are coming from a plan that does not have a deductible or significant cost-sharing feature. Tufts Health Plan understands how important And because they have trouble understanding the plans, they are it is that our members understand everything not seeing the value that consumer-directed health plans offer. about their health care so that they can make We want to educate members about consumer-directed health informed decisions. We support health literacy care in general, as well as offer them information specific to their Advantage plan, including plan overviews, and member tools like materials, in a variety of written and visual the Treatment Cost Estimator and How to Read Your EOB. The Advantage Resource Center will help fill the knowledge gap that individuals take in information. You will begin to exists for members who are new to deductible plans.” see new materials in the weeks and months to come, all created with the intention of helping There are future plans to expand the Resource Center to include our members get the most out of their health information specific as to how pharmacy benefits are paid, as well as information about referrals and how coinsurance works. Visit the Advantage Resource Center at tuftshealthplan.com/advantage.
Pharmacy Generic Incentive Program
Beginning in April, 2011, members who are on fully insured
Generic alternative drugs are not exact generic
plans that include the Tufts Health Plan pharmacy benefit equivalents, however, they are within the same class of and use certain brand name drugs (outlined in the table drugs. This means they are not chemically equivalent to the below) will be notified of an incentive program. These brand, but have similar therapeutic effects.
members will receive a letter encouraging them to switch to a lower-cost generic equivalent or generic alternative. Program Details
For members who switch to either a generic equivalent
Please note that members of plans that include a health or a generic alternative, Tufts Health Plan will pay for the savings account (HSA) will not be included in this program. entire cost of the prescription for up to three monthly Members of plans that have a front-end pharmacy fills. After this period, members who have made the switch deductible will be advised that they must satisfy their will resume paying the lower tier copayment. Members deductible before they can participate in the program. will have six months to redeem the offer from the date of the letter. Members should speak with their doctor or Generic equivalent drugs are chemically equivalent to
prescriber to discuss switching to a generic and receiving a brand-name drugs. When the patent of a brand-name medicine expires, other drug makers can make and sell the same medicine. This medicine is sold under its “generic” or This program focuses on a select number of brand name drugs that have available generic equivalents or generic alternatives. Brand Names
Generic Alternatives/Equivalents
Retail Pharmacy
Mail Order
Zomig ZMT MaxaltMaxalt MLTFrovaAxertLexapro fluoxetine (Prozac) (generic alternative)paroxetine (Paxil) (generic alternative)sertraline (Zoloft) (generic alternative) ,Imitrex, Relpax, Zomig, Zomig ZMT, Maxalt, Maxalt MLT, Frova, and Axert are used in the treatment of migraine headaches.
Lexapro is used in the treatment of depression. If you have questions, please contact your Intermediary.
Change to CVS Caremark’s Mail Service Pharmacy Effective May 1, 2011, members who order prescription medications from the CVS Caremark Mail Service Pharmacy will be required to make payments at the time the order is placed. Additionally, in order to get refills or new prescriptions, any past due balances must be paid. Orders without payment or without a method of payment specified will not be filled.
Members were notified of these changes via a letter. If you have any questions, please contact your Intermediary.
In August, 2010, Massachusetts passed a mandate related to What is New: The mandate requires coverage for Applied
Autism Spectrum Disorders. The law requires coverage for Behavioral Analysis (ABA) and other Autism habilitative certain services related to diagnosis and treatment, effective services. These services will now be covered by Tufts Health January 1, 2011. The mandate applies to all fully insured Plan. Coverage will require prior authorization, and services must be performed by a Board Certified Behavior Analyst (BCBA) or a paraprofessional who is supervised by a BCBA. Coverage Requirements
Because Tufts Health Plan already covers many of the
Please Note: Services related to Autism Spectrum Disorders
required services, the mandate doesn’t make a significant that are provided by school personnel as part of an change to the coverage our policy holders have. Services we individualized education program are not covered.
Members and providers can ask benefit questions and ■ Outpatient psychiatric and psychological care make authorization requests by calling the Mental Health ■ Physical, occupational, and speech therapy You can find more information about the mandate at mass.
gov. The full text of the bill is available at
mass.gov/legis/bills/house/186/ht04pdf/ht04935.pdf.
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Source: http://sbsbhealth.com/Documentation/EmployerUpdate_Spring2011_INT_SBSB.pdf