Agenda - 10-03-2006-5e - Laserfiche WebLink

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Mr. John M. Link, Jr. - 3 - August 10, 2006 appears to have subsided since the early days of the transition. CIGNA and CAREMAILK continue to commit themselves and their customer service to ongoing education and training on our program. Delayed Follow-~ on Adding New Providers -Ongoing dialogue between CIGNA, the NCACC, and the County exist through emails that outline the providers who are critical to Orange County employees. Ongoing follow up has occurred on the network continuity for Orange County, and we expect to continue communicating the progress that CAPE has made on your County's behalf. In the coming weeks, our staff is meeting with CAPE to craft a communications strategy that consistently educates members when contracting successes occur. We plan to begin a monthly update in the next month of progress on provider-contracting within each of our counties, as well as addressing individual county concerns. My staff have advised me of the Women's' Health Alliance issue that surfaced in mid-July, which is seriously affecting some Orange County employees. CIGNA's provider relations department has advised the NCACC that the Women's' Health Alliance, comprised of several large OB/GYN practices, is already the highest contractuall-paid provider in the Triangle area and on the highest reimbursement schedule in the entire state for OB/GYN. They are requesting an additional &% increase, over the 5% increase they received this year in May and last year. Certainly, the provider recognizes the timing of this and they are leveraging their size as a means to higher reimbursement. CIGNA remains in negotiation with the Alliance as the proposed 9/25/06 termination date nears. In a nutshell, their demand will ultimately increase costs for our members, as well as for all companies in the area who use CIGNA as their claims administrator. We are watching this closely. Lack of Prescription Coordination of Benefits - We have verified with BOBS that Coordination of Benefits with-the BCBSNC Prescription Drug Plan was not being provided under the BCBSNC Merck program. What was actually occurring was an employee filing the Rx claim under both providers and getting paid at the appropriate level of benefit for both, as if the other had not paid. Neither BCBS nor Caremark do verify with pharmacy claims whether a participant has other coverage elsewhere and whether that other coverage has paid on these claims. The result was the ability to receive greater than 100% reimburse-ment on specific drugs by filing the claim with both secondary and primary carries. 'That is not COB, but it does appear to be a means for an employee to have dual coverage and "double dip" on prescription drug benefits between primary and secondary carriers. The way we have asked Caremark to administer prescription drug claims (as before with BCBSNC) is, if an employee presents with a prescription and if the medication is covered, it should be paid. We expect those participants with dual coverage to then decide, on the honor system, which plan they wish to use to have their prescription drugs reimbursed, their primary or secondary, but not to file the same claim twice. Under the Caremark plan with the NCACC, they are required to pay a co-pay only, regardless of the high cost of the brand name or specialty drug. By mail-order, they have the ability to receive athree-month supply for approximately two and ahalf co-pays. Coordination of Benefits on the health plan for medical care will continue to be provided. John, as you can hopefully see outlined here, the NCACC has taken numerous preventative measures to ensure a smooth transition. It was not perfect. Considering the scope of the transition, it went very well. We have heard from our member counties, and from Michael Edmonds in Orange County, that issues have significantly slowed down toward the end of July, possibly due to employees and pharmacists becoming accustomed to the "change" itself. Many of the issues described can be attributed to misunderstandings and have since been resolved. The NCACC does recognize its part in this transition, and we continue to strive to iron out the issues as we become aware of them. You still have our firm