Orange County NC Website
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
Attachment 1 <br />Page 2 of 3 <br />I "7 <br />• Appeals Process -NCACC will allow CIGNA to handle medical claims appeals. The <br />NCACC will manage drug-related appeals for quantity limitation issues. Since we had no <br />control over what was allowed or disallowed by Medco, the NCACC decided to take this on. <br />The County would have to support and initiate the appeal in order for it to be reviewed by the <br />NCACC. So, the County is in control of what its own employees get to have reviewed or not <br />on the drug program and medical once it has gone through CIGNA appeals. <br />• ID card -One plastic ID card for each covered member and family member. The ability to <br />create and send temporary ID cards for members waiting on the "real thing." <br />Below are the most prevalent items that are not the same as our previous plan: <br />• Disease Management - In general, Disease Management programs that were offered before <br />may not be the same programs offered now and are managed differently (opt out, different <br />programs for different diseases or conditions and different free stuff, different suppliers). <br />Disease Management programs are different with CIGNA and Weight Management, <br />Migraine are not included. <br />Weight Loss Medications - Xenical and Meridia weight loss drugs. will not be covered under <br />the new program. Weight loss medications were excluded from the BCBS program, however <br />with the BCBS Disease Management program, you were able to get either Xenical or <br />Meridia covered only if you were in that DM program and had been determined to be obese. <br />The NCACC does not cover any weight loss category drugs, and we do not have an Obesity- <br />based Disease Management program. Last year, of the over 40,000 members on the plan <br />only 21 members were on weight loss medications, Xenical or Meridia, so disruption over <br />this program should be min;,i,al. <br />• Specialty Drugs -Specialty medications are available only through the specialty mail order <br />program at Caremark. A member can no longer go to a retail pharmacy and fill a specialty <br />medication prescription. <br />• Drug Formulary -The NCACC Primary Preferred Drug Formulary may have drugs listed in <br />different tiers than MedcoBCBSNC, some on higher tiers and other on lower tiers. <br />• Quantity Drug Limitations and Prior Authorization -Caremark did not replicate the same <br />limits on the same drugs nor the drugs that require prior authorization. However, the list is <br />much smaller than BCBS as to what is limited and what needs prior authorization. <br />• Mail order through Edgepark -The County Health Plan does not contract with Edgepark mail <br />order service for DME or testing supplies. This is a contractual arrangement BCBS has with <br />Edgepark. CIGNA has its own list of providers for DME. <br />• Generic Co-pay -The generic co-pay holiday does not currently exist with the County Health <br />Plan, which means members must pay for their generic drugs at the generic co-pay. While <br />