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Sutter, Health Net agree on new contract; Blue Shield contract expires, negotiations continue

As the clock ticked down the last hours of 2016, Health Net and Sutter Health were able to come to agreement on an extension of their current contract, extending Sutter Health’s in-network status for most Health Net plans.

With the turn of the calendar to 2017, the contract between Sutter and Blue Shield of CA has expired, although the two health giants continue to negotiate. Full text of notifications from the carriers are posted below.

From Health Net senior account executive (12/30/2016):

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Blue Shield of CA Switching to CVS for Pharmacy Management

Blue Shield recently notified policyholders of the upcoming change to their pharmacy network benefits. The details in full are outlined below. Please review, and contact Allpointe if you have questions about how this may affect your pharmacy coverage. The change will take effect January 1, 2017 regardless of when your plan renews.

 

Blue Shield has entered into an agreement with CVS Health to support manufacturer rebate and pharmacy network contracting for the outpatient pharmacy benefit, which has been approved by the Department of Managed Health Care.

CVS Health will manage Blue Shield’s national retail pharmacy network, and become our exclusive mail order pharmacy for Commercial and Medicare plans and our specialty pharmacy for Commercial plans, starting January 1, 2017.

This new agreement will enable us to leverage CVS Health’s purchasing power and reduce pharmacy costs. It will allow us to offer more competitive pharmacy products while continuing in our commitment to provide access and convenience for our members.

Who is affected?
The new pharmacy network changes will apply to all Blue Shield lines of business:

  • Commercial
    Premier, Core, Small Business, Individual and Family Plans (IFP) and Self-Funded/Administrative Services Only (ASO)
  • Medicare
    Individual and Group Medicare Advantage and Prescription Drug plans

Pharmacy network changes that will affect how our members access their benefits at the retail, mail order and specialty pharmacy will become effective January 1, 2017. Impacted members will be notified 60 days in advance of these changes by mail and telephone.

What are the pharmacy network changes?
There are three areas that will be affected by these changes. The member impact for most of these changes are relatively minimal and are as follows:

  • Retail pharmacy
    CVS Health will support Blue Shield’s retail network contracts. The Blue Shield network retail pharmacies will be nearly unchanged and will continue to include all key chains such as CVS, Walgreens, Rite-Aid, Costco and many others. The vast majority of our members will continue to have the same convenient access to network pharmacies near where they live and work. In fact, the network pharmacies with preferred cost-sharing will expand to include additional national retail pharmacies. Please refer to the 2017 Medicare Pharmacy Directories for more information.
  • Mail order pharmacy
    Blue Shield will transition from current mail order pharmacy, PrimeMail, to CVS Health mail order pharmacy.
  • Specialty pharmacy
    Currently, Blue Shield’s commercial specialty network includes two vendors, CVS/Caremark and Walgreens Specialty, with the majority of specialty prescriptions filled by CVS/Caremark. With the agreement, CVS/Caremark will become our exclusive specialty pharmacy for Commercial plans. Members shall continue to have the convenient access to pick up their specialty medications at a local retail CVS pharmacy. Medicare plans will continue to have an open specialty pharmacy network, which includes Walgreens Specialty and CVS/Caremark.

Transition plan
Blue Shield Pharmacy Services has been working with CVS Health to develop an implementation plan that ensures a smooth transition. As part of the plan, members who may be affected by these changes will be notified 60 days in advance of the January 1effective date.

  • For retail
    Letters will be sent to impacted members, which will provide information on up to four network pharmacies (two based on the member’s address on file and two based on the terming pharmacies address).
  • For specialty and mail order
    Letters will be sent to impacted members. Members will also receive CVS Health Welcome Kits.
  • Active specialty and mail order prescriptions
    For prescriptions that have active, remaining refills, Blue Shield will work with PrimeMail (mail order) and Walgreens Specialty (for specialty drugs) to transfer members’ remaining refill prescriptions to CVS/Caremark. Member payment information, such as credit card details, will not be transferred. Members will need to register with CVS/Caremark to provide this information. CVS will conduct a call campaign to these members to assist with registration.
  • Non-transferable drugs
    Some selected drugs are not eligible for transfer, such as Schedule 2 prescriptions. Since Federal law doesn’t allow refills for Schedule 2 prescription drugs, members using such drugs will have to visit their provider to get new prescriptions for each fill, even when using mail order.

Reach for the stars: how to use online review sites to your advantage

The monetary impact of review sites like Yelp, Angie’s List, Google, Facebook and others can be a boon (or devastating) to both new and established businesses.

Seventy-two percent of users are willing to try a business with a 3-star rating, but only 27% of users would look at a business with a 2-star rating. Every increase in overall stars leads to a 5-9% jump in revenues.

How is this an HR issue? Reviewers share their opinions based on your product…and even more importantly, on their interaction with your team. Hiring, training, and retaining engaged employees is the key starting point to better reviews. Resolving a conflict with a customer is an opportunity to convert them into a fan for life.

To learn more, please join us for a free webinar with our partners at HR Answerlink on Wednesday, September 15th. Space is limited – click below to register today.

Allpointe-Yelp-Reviews

Register Now

 

What we love/hate in 2016 – individual and family health insurance

I wanted to put together a compiled resource to help clients distinguish between their insurance carrier choices in 2016. This seemed like a quick, fun way to summarize a lot of the highlights (and lowlights) that we see with the different carriers. The opinions here come from our personal experience, feedback from clients, news articles and other independent sources, and analyzing the information that comes directly from the carriers. We will hit all of the major carriers as well as some ancillary products and topics. Check back here frequently as the links below will go live as new posts are added for each carrier/topic.

Let us know if you agree/disagree in the comments!

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Risk Management 2016: Low cost, minimal risk, health insurance. With tax benefits.

This strategy isn’t for everyone, but for many of our clients, this will be the best financial solution for their family’s health care. Not sure? Please check independently with your financial adviser, accountant, or whomever else you rely on for sound financial advice. But let’s be up front and identify the type of person this might not work for:

  • Has frequent, ongoing medical/Rx needs, but with moderate annual costs in the $5,000 range if paid out of pocket
  • Expected taxable income for 2016 will qualify for an Enhanced Silver 87 or 94 plan
  • Just can’t handle the added complexity of a non-traditional health plan strategy (hey, this is a legit reason)
  • Expects to be in the individual health market for less than a year

That’s it. Everyone else, keep reading.

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How to make sure your doctor is in-network for 2016

10/30/2015 update: Prescription drug formulary search links added below for all PPO carriers.

The problems patients have had with inaccurate provider data, especially in the last two years, got noticed. Just a few days ago, Governor Jerry Brown signed a bill into law requiring insurers to update their online directories on a weekly basis. Read more details on the new law from the Los Angeles Daily News and the Sacramento Business Journal. The law will not go into effect until July, 2016.

Allpointe provides the information below as a convenience to consumers who are choosing from among health plans. We make every effort to update this with accurate data as we get it, but provider networks do change. We strongly recommend you check directly with your preferred doctors, hospitals, medical groups and other facilities to find out if they intend to participate in-network in 2016.

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