LSU First & WebTPA: Working Together

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LSU First & WebTPA: Working Together

2016 LSU First Health Plan Changes

2016 LSU First Health Plan Changes New ID Card Specialty drug copay $150 90 day timely filing period (medical and pharmacy) Home Health Care Services limited to 60 visits. Skilled nursing facility limited to 90 days. 2016 Plan Changes What You Need to Know

2016 LSU First Health Plan Changes Precertification Current Services New Services Genetic Testing Home Healthcare Skilled Nursing Physical Therapy Occupational Therapy Speech Therapy ABA Therapy Inpatient Hospital Admissions Durable Medical Equipment (over $1,000) PET Scans Cardiac Rehabilitation CT Scans MRI / MRA Outpatient Pain Rehabilitation / Pain Control Programs Residential Treatment Centers Mental Health Inpatient and Outpatient Substance Abuse Inpatient and Outpatient Outpatient Surgery Orthotic Devices (over $1,000) Prosthetics (over $1,000) Injectables (over $1,000) Hyperbaric Oxygen Therapy Blood Clotting Factors Transplant

Mobile App Now available for Android, iphone, ipad WebTPA On-the-go functionality to view ID cards, check eligibility, review claims, and more!

Care Coordination How Our Program Can Help You

What is Care Coordination eqhealth s Care Coordination program is a high-touch approach that ensures each member receives the care, services and community support leading to improved health. We engage the member s primary physician and care team as part of overall patient plan of care. Under the direction of the primary physician, our Care Coordinator manages and monitors the needs of the members. Confidential Proprietary to eqhealth Solutions

Who are Care Coordinators Care Coordinators are Nurses who can assist with questions or concerns related to the member s health. Services they provide: Disease Education Medication Education Self Care Education Provide Community Resources Coordination with their Doctors Assistance in Navigating the HealthCare System Care Coordinators establish a relationship and an understanding of the member s needs.

What are the Goals of Care Coordination Whole Person Management - Managing all conditions of the member Sustainability - Achieving long-term behavior modification Results - Improved quality of care Confidential Proprietary to eqhealth Solutions

What are the Benefits of Care Coordination Improve your quality of health by accessing a nurse in your community via phone or face-to-face interactions Education and resources about your health condition(s) to help you become better equipped to control your health conditions Learning about how you can better access your doctor, medications and other medical services you may need. Maximize use of your benefit plan in meeting your health goals/outcomes

Why do we do this? Assessment During face to face sessions, member expressed new diagnosis of prediabetes and a desire to learn about a low carbohydrate diet; expressed financial issues as well Patient with history of Peripheral Vascular Disease, Coronary Atherosclerosis, Anxiety, Hypertension, and Obesity Care Coordination Educated on diet and exercise Coordinated follow up with MD for clear instructions on diet and exercise Educated on normal blood pressure ranges Educated on switching blood pressure medication to a generic to help with cost Patient Outcome Started exercise program with a friend Successfully following her diet plan Has lost a total of 8 pounds so far Blood pressure medication decreased to half a tablet per day Blood pressure within normal limits I feel so much better and everything that has been provided to me has been very helpful. Confidential Proprietary to eqhealth Solutions

Care Coordination Programs Available Catastrophic Case Management Care Transitions Asthma Chronic Kidney Disease COPD Depression Diabetes Heart Failure HIV/AIDS Hypertension Maternity (High Risk Pregnancy/Post Partum) Oncology Smoking Cessation Special Needs Children Transplants

Open Enrollment 2016

Citizens Rx Citizens Rx will be managing your pharmacy benefits beginning January 1, 2016. You will receive prescription drug services for retail, home delivery, and specialty pharmacy services from Citizens Rx. Citizens Rx is an innovative leader in the Pharmacy Benefit Management arena, which is dedicated to excellent customer service by helping people receive safe and effective prescription medications at the lowest possible cost.

Frequently Asked Questions Will I be provided a new member ID card? Yes, LSU First will mail you a new ID card prior to January 1st, 2016. You will need to present your new ID card to your pharmacy for prescriptions filled beginning January 1st, 2016. Please make sure to tell the pharmacy associate that you have a new pharmacy benefit provider. What happens if the pharmacy experience any difficulties when filling prescriptions (if the associate at the pharmacy tells you your insurance is not covering your prescription)? This may be due to their failure to enter the new RxBin number. Ask them to be certain they entered the new information completely. If you experience any additional difficulty, contact the number on the back of your card (855) 346-LSU1. What if I still have questions about my pharmacy benefit? You may contact Citizens Rx at any time using the number on the back of your card (855) 346-LSU1.

Drug Management Programs Prior Authorization Some medications require pre-authorization in order to be covered by the Plan. In such cases, Citizens Rx will alert the retail pharmacist or your physician that a prior authorization process must be completed. You will NOT have to obtain a new Prior Authorization, if you already have an existing, active Prior Authorization. Drug Quantity Management This program helps ensure that Prescription Drugs are dispensed in accordance with FDAapproved dosage guidelines. For example, if you receive two monthly prescriptions for a low dose of one medication, you could instead receive one monthly prescription at a higher dose for treatment for an equivalent clinical effect. If you are identified through this program, the pharmacist will be alerted and may discuss other possible dosage options with you and your physician. Step Therapy In some cases, Generic and/or lower-cost Brand Name Drugs may provide the same safe, clinically effective treatment as a more expensive Brand Name Drug. In cases such as this, the Plan will not cover the more expensive Brand Name Drug unless your doctor has demonstrated a clinical need for the more expensive Brand Name Drug. Members currently taking prescriptions that require Step Therapy will NOT be required to change their existing medication.

Citizens Rx Retail Pharmacy Networks Members have access to one of the nation s largest retail pharmacy networks - 67,000 pharmacies Independent Pharmacies Regional Chains National Chains 17

Home Delivery PraxisRx Pharmacy Home Delivery is your new mail order pharmacy delivery service. For NEW home delivery: PraxisRx Pharmacy can contact your physician for you for your new home delivery prescriptions; OR You can obtain a prescription from your physician and send it to PraxisRx Pharmacy by mail; OR Your Physician can send a prescription to PraxisRx Pharmacy by fax or through electronic prescribing Be sure to ask your physician to write the prescription for a 90-day supply with three refills and authorize a one-year supply (when appropriate) 18

Mail Order Transition If you are currently enrolled in Mail Order Citizens Rx will transfer all scripts with remaining refills from your current Mail Order Pharmacy Citizens WILL NOT automatically ship prescriptions. You must register with your new mail order vendor PraxisRx in order to activate your mail order account. Registration forms are available at the Citizens Rx table today. You can also register online at CitizensRx.com and proceed to the member portal. 19

Specialty Pharmacy 19 different conditions served High touch therapy management Patient Care Coordinator First call resolution Free delivery of medications and supplies Verified refill reminders (adherence counseling, side effect management) Injection training Therapy specific and disease specific education Side effect management and support 24/7 Access clinical pharmacist 20

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