| September 2018 | Volume 1 |
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What's Inside:
Join us for Capital BlueCross’ 2019 Group Product Portfolio Training | Addressing the Opioid Epidemic: Changes to Our Formularies in 2019 | We’re Expanding Pain Management Options to Include Manipulation Therapy and Acupuncture | Online Billing Available for Employer Groups | Group Termination Request Form Update: Mark What Should Stay Active | Fitness Your Way September Promotion: Waive the Enrollment Fee | Onsite Flu Clinics Available | Save Money on Lab Services—Member Flyer Available | 360° for Business, September 2018 |
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| Join us for Capital BlueCross’ 2019 Group Product Portfolio Training |
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| Our team will introduce what’s new and review changes for our nonlarge group product portfolio in 2019. |
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September 24
Capital Blue
2845 Center Valley Pkwy #404
Center Valley, PA 18034 | |
September 27
Capital Blue
4500 Marketplace Way
Enola, PA 17025 | |
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8:00 a.m.
8:30 a.m.
9:45 a.m.
10:00 a.m. |
Registration and Continental Breakfast
Group Products Presentation
New Group Onboarding Process
Closing Remarks |
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| Addressing the Opioid Epidemic: Changes to Our Formularies in 2019 |
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As the opioid crisis continues and remains a public health priority, updates will be made to our formularies to reflect guidelines from the Centers for Disease Control and Prevention (CDC), per the recommendation of the
Commonwealth of Pennsylvania. Effective January 1, 2019, Capital BlueCross will update our selectively closed formulary (those with Individual or CHIP plans). Effective February 1, 2019, our open/closed formulary (most commercial accounts) will be updated as well. (Medicare and FEP are not in scope.) These updates are another positive step Capital BlueCross is taking to reduce opioid use in our network.
Capital BlueCross will make the following changes and updates to the formularies with respect to opioids:
- Reduce morphine milligram equivalents (MME) to less than or equal to 50 MME on all extended-release and immediate-release opioids (previously 90 MME)
- Add sickle cell crisis and terminal illness as acceptable exceptions to the quantity and MME restrictions
- Limit quantities of immediate-release products to five days for adults (18 years of age or older) and three days for children (under 18 years of age)
- As a reminder, in 2017/2018 we implemented utilization management for opioids; the changes for 2019 supersede the changes made in 2017/2018
- Quantities beyond initial limits will only be covered for chronic pain in the event of tapering the opioid dose; Capital BlueCross will allow longer time for dose reductions with a medical necessity prior authorization, which must be requested by the prescribing provider
- Additional quantities for acute pain will not be covered
- MAT Therapy is a covered benefit
Because this is a recommendation from the state, there is no option to opt out of the formulary change. These changes apply to fully insured and self-funded groups, Individual accounts, and CHIP.
See the next article for another way Capital BlueCross is helping to curb the opioid epidemic: expanding pain management services to include acupuncture and manipulation therapy. |
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| We’re Expanding Pain Management Options to Include Manipulation Therapy and Acupuncture |
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Effective January 1, 2019, pain management alternative services will include acupuncture. They will also include manipulation therapy (chiropractic care) for certain chronic conditions (e.g. migraines, tension headaches, and neck and back pain) beyond the acute care treatment already covered.
These expanded pain management services will provide our members with alternatives to opioid medications. They will be automatically added to our standard commercial group and Individual products and will be an option for our custom large groups.
Members will find details about these services in their benefit plan documents (Certificate of Coverage and Summary of Benefits and Coverage) on or after January 1, 2019. They will be able to view them on their secure account at capbluecross.com. |
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| Online Billing Available for Employer Groups |
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On September 11, most commercial employer groups were emailed an announcement of the upcoming access to online invoices and payment histories. They will receive emailed instructions on September 17, when access goes live.
In October, a link for producers with employer group access will be available on Producer Tools. We’ll publish it here as soon as we have it. |
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| Group Termination Request Form Update: Mark What Should Stay Active |
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| To minimize confusion and allow for more accurate processing of a group’s termination request, a new section has been added to the group termination form. The new section makes clear what lines of coverage should remain active. Please begin using this new form immediately. |
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| Fitness Your Way September Promotion: Waive the Enrollment Fee |
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| Time is running out! Encourage your employer groups to spread the word: members who join Fitness Your Way by the end of September can waive the $29 enrollment fee. And when they go to Blue365 and sign up, tell them to use the promo code SeptSave29 at checkout. |
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| Onsite Flu Clinics Available |
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| If a group customer would like to provide its employees with the convenience of onsite flu shots, let the group know that a few of
Capital BlueCross’ participating pharmacies are available to help them out. Onsite flu clinics are now available to our fully insured and self-insured group customers who have coverage for preventive seasonal vaccines under their Capital BlueCross Rx benefits. |
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Requesting an Onsite Flu Clinic
A group customer should do the following:
- Contact any of the four participating pharmacies listed below
- Provide a date and time to the pharmacy to hold the onsite flu clinic
- Give the expected number of participants or employees (the minimum is 30 employees, but some of the pharmacies may be willing to negotiate/accept fewer)
- Determine if it will need or want an online scheduling tool (currently, CVS and Rite Aid have this capability available); the group customer would work directly with the pharmacy to set up this tool option
- Have employees present their Capital BlueCross member ID card to the onsite pharmacy
For group employees who have Capital BlueCross preventive Rx benefit coverage, the claims will process under the pharmacy preventive benefit at $0.00 cost share to the member.
For employees who have other pharmacy coverage and the pharmacy providing the onsite clinic is a participating pharmacy with that coverage, the same process may apply; their claims may be submitted to their current Rx plan administrator.
For group employees who do not have this coverage or are insured by another plan that excludes the coverage of flu vaccines on the pharmacy benefit, they could provide the flu vaccine to their employees at a fee-for-service rate.
Participating Pharmacies Offering Onsite Flu Clinics |
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| Save Money on Lab Services—Member Flyer Available |
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| It's easy to let members know they have a choice when it comes to where their lab work is done. This flyer provides them with tips to help find an in-network independent clinical laboratory and pay less out-of-pocket cost. |
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| 360° for Business, September 2018 |
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Employer groups recently received the latest edition, featuring:
- Help Your Employees Get Care Anytime, Anywhere with the Virtual Care Toolkit
- Mental Health in the Workplace
- Help Your Employees Fall Into Healthy Savings This Season
- And more!
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| | | If you have any questions, please contact your account executive. |
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All Rights Reserved
Capital BlueCross is an independent licensee of the BlueCross BlueShield Association. Communications issued by Capital BlueCross in its capacity as administrator of programs and provider relations for all companies serving 21 counties in Central Pennsylvania and the Lehigh Valley.
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