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

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