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INSURANCE SPOTLIGHT

September 15, 2015

Carrier News

Harrison Medical Center No Longer In First Choice Network
First Choice Healht Effective October 1, 2015, Harrison Medical Center will no longer be in the First Choice Health Network. First Choice contracts with other hospitals on the Olympic Peninsula and throughout the Puget Sound region that will provide comprehensive access to a full range of services and specialties. Physicians under the Harrison HealthPartners network and urgent care centers are not affected and will remain in-network. Read more

Premera Blue Cross' Statement Regarding Excellus BlueCross BlueShield Cyberattack
Last week, Excellus BlueCross BlueShield based in Rochester, New York, announced that it had been the target of a sophisticated cyberattack. Excellus is a separate company from Premera Blue Cross, although both are independent licensees of the Blue Cross Blue Shield Association. A small number of Premera members who received care in Upstate New York may have been affected. Premera is working with Excellus and the Blue Cross Blue Shield Association to better understand how this incident may have affected their members. Members who signed up through Premera for free Experian credit monitoring will continue to be covered. Members who wish to sign up still have time and can do so at Premeraupdate.com.

Regence - Flu Shot Resources
Getting a flu shot is an easy way for members to protect Flu Shots themselves, their families and their workplaces this time of year. Regence has contracted with multiple vendors who employers can work with to offer on-site flu shot clinics for employees. Flu shots are a covered preventive health benefit for many Regence members.  Read more

Federal & State News

Medicare Part D Creditable Coverage Determination Needed by Oct. 15
The Medicare Modernization Act mandates that certain Reminder entities offering prescription drug coverage, including employer and union group health plan sponsors, disclose to all Medicare-eligible individuals with prescription drug coverage under the plan whether such coverage is "creditable."
 
Determining whether or not certain coverage is creditable is essential to an individual's decision whether to enroll in a Medicare Part D prescription drug plan. If you offer a prescription drug plan to Medicare-eligible individuals, understand that:
  • Annually, carriers test standard benefit designs to satisfy the actuarial value test of the creditable coverage determination.
  • Once the plans have been tested, the data becomes available to employers.
  • You then must communicate the creditable or non-creditable status to your members.
  • This determination is mandatory at least once a year and the deadline for completion is Oct. 15.
Health & Wellness
New Cholesterol Drug Approved
A new type of cholesterol-lowering drug called Praluent™ has Pill Rx recently received approval from the Food and Drug Administration (FDA). Praluent is the first of several expected PCSK9 inhibitors that are rapidly making their way through the new drug approval process. These new drugs have been shown to be highly effective at lowering LDL cholesterol, but will also be very expensive.
Key concepts:
  • PCSK9 inhibitors have a different way of working than existing treatments for high blood cholesterol such as statin drugs like Lipitor® or Crestor®. They are intended to be used in addition to statins in patients with very high LDL cholesterol levels, or to be used in patients who cannot tolerate statins.
  • Unlike existing statins, PCSK9s are specialty, or biologic drugs. Specialty drugs often require special handling or medical supervision when they are used. PCSK9s are administered via self-injection, given either every two weeks or monthly. In contrast, oral statins are taken daily.
  • Another characteristic of specialty drugs is that they are often very expensive. The average cost of a year's supply of generic statins is approximately $197. By contrast, the annual cost of the first PCSK9 inhibitor was set at $14,600 per year.

September is National Cholesterol Education Month
Too much cholesterol in the blood is one of the main risk Cholesterol factors for heart disease and stroke-two leading causes of death in the United States. One way to prevent these diseases is to detect high cholesterol and treat it when it is found.
 
What is cholesterol?
Cholesterol is a waxy, fat-like substance that your body needs. But when you have too much in your blood, it can build up on the walls of your arteries and form blockages. This can lead to heart disease, heart attack, and stroke.  There are two kinds of cholesterol: high-density lipoprotein (HDL) and low-density lipoprotein (LDL). HDL is also called "good" cholesterol. LDL is called "bad" cholesterol. When we talk about high cholesterol, we are talking about "bad" LDL cholesterol.
 
Seventy-one million American adults have high cholesterol, but only one-third of them have the condition under control. September is National Cholesterol Education Month-a good time to resolve to get your cholesterol screened.
 
Find out what role screening plays in detecting high cholesterol as well as prevention and treatment ideas here.
If you have any questions about the articles contained in this newsletter, please give us a call or e-mail us: