Talk to your doctor about a drug before you fill it

Many people stop taking drugs because they cost too much, didn’t seem to work or had ugly side effects. If you stop taking a drug, your health problem may get worse and wind up costing you more later. You can save yourself from going down this path by asking your doctor a few easy questions:

About your coverage

  • Is the drug covered?
  • Why do I need this drug?
  • Will a generic work for me?
  • Do I need to try a generic or other drug first?
  • Is there an over-the-counter option?

About the drug

  • Are there any side effects?
  • How often should I take the drug?
  • For how long will I be taking the drug?
  • Must I avoid certain foods, drinks or other things while I’m taking the drug?
  • What should I do if I forget to take a dose?
  • How will the drug interact with other drugs I’m already taking?
  • Do I need to wait for approval?

 

Talking to your doctor about the drugs he or she orders is important. You’ll feel more comfortable taking a drug that best treats your health problem and have fewer surprises at the pharmacy.

 

Find out about Blue Cross covered drugs here

Find out about Humana covered drugs here

Online doctor visits available 24/7

BlueCare is now available 24/7 to let customers have online doctor visits using a computer, laptop, tablet, smartphone or other internet-accessible device with a camera.

Telemedicine services are a benefit for all fully insured group and individual customers. The services are offered at the same cost share as a primary care physician-level office visit.

BlueCare and telemedicine offer customers expanded access to care outside of their doctors’ usual office hours, with greater convenience and at a lower cost than the emergency room. Since Blue Cross recently raised co-pays on ER visits up to $350 (previously from $150-$200, depending on plan type) across all non-grandfathered fully insured plans in 2017, BlueCare can be a good way for customers to get treatment for minor health issues and keep their out-of-pocket costs in line.

Some common conditions treated by telemedicine include cough or cold, bladder infections, mild stomach viruses, pink eye, rashes, allergies or sinusitis. Telemedicine can also be used for follow-up care and, in some cases, medication refills.

How do customers use BlueCare?
BlueCare is online at www.BlueCareLA.com. To have an online visit, customers need to use a laptop, desktop computer or other internet-accessible device with audiovisual capability so they can see and speak with the doctor. They can find out if a device is going to work for BlueCare before a visit by using the “Test Computer” link in the top-right corner of www.BlueCareLA.com.

  • To use BlueCare from a smartphone or tablet, customers can download the BlueCare app for Android and Apple devices by searching for “BlueCare” (one word) in the Apple App Store or Google Play.  Statistically, most users prefer accessing telemedicine services via mobile app.
  • On the first visit, customers will create a member account with a log-in ID and password that they will use each time they use BlueCare.  They can create the account using the web-based site (www.BlueCareLA.com) or the BlueCare mobile app, and use the same log-in information for both.
  • Once logged into the BlueCare site, customers will see a list of doctors available to treat them and can choose the one they want to see. Each BlueCare doctor has a short biography describing his/her experience, languages spoken, etc., which is posted on the site. All physicians are U.S. trained and board certified.

How much does BlueCare cost? 
All Blue Cross customers can use BlueCare by paying a flat fee, typically $39, at the time of the visit. Depending on the telemedicine benefits that are included on their plans (typically the same cost share as a PCP office visit), customers may receive a refund from Blue Cross once the claim has processed.

Who do I call if I am having trouble with BlueCare?
If you are having a technical problem with the www.BlueCareLA.com website or the BlueCare app for Android and Apple devices, call 1-855-269-3554 or email BlueCareSupport@americanwell.com.
 
How can I learn more about BlueCare?

Blue Cross 2017 Pharmacy Benefit Changes

Guide to Changes in Drug Coverage for Fully Insured Members in 2017

In 2017, Blue Cross and Blue Shield of Louisiana will implement a closed formulary for non-grandfathered individual and non-grandfathered small group (2-50) plans and make annual formulary updates to drug coverage for all other members.

New covered drug list:

Affected Members: non-grandfathered individuals and non-grandfathered small group plans

Today, the Blue Cross formulary is open for all members. This means Blue Cross cover all contract-eligible prescription drugs at different cost-share levels. Starting Jan. 1, 2017, drug lists for non-grandfathered individual and non- grandfathered small group (2-50) plans will be closed. This means Blue Cross will not cover every drug, only those on the list. Continue reading “Blue Cross 2017 Pharmacy Benefit Changes”

Changes Happening to the 2017 Humana Drug Lists

Starting January 1, 2017,* some of the medicines covered by Humana’s prescription drug plan may change. 

What do these changes mean? Some medicines will have new requirements. (Specific state regulations may apply.) These requirements include:

  • Prior Authorization: The member’s doctor must contact Humana to get approval before he or she fills or refills a prescription for any medicine that requires prior authorization. His or her plan benefits won’t cover this medicine without prior authorization, and he or she will pay the entire cost of the medicine if he or she decides to buy it.
  • Step Therapy: Sometimes there’s more than one medicine that works to treat a health condition. Some medicines may cost less but work just as well. Before a prescription is filled for a medicine that costs more, the member may be asked to try at least one other medicine first.

If the member’s doctor thinks the other medicine isn’t right for him or her, he or she will need to request approval from Humana to use the medicine that costs more. His or her plan benefits won’t cover this medicine without approval, and he or she will pay the entire cost of the medicine if he or she decides to buy it.

  • Quantity Limits: A member has a limit on the amount of some medicines he or she can fill during a period of time. These limits can be placed on some drugs because of safety concerns and help prevent misuse of these drugs. If the member’s prescription is over the limit, there are two choices:He or she can get the amount of medicine that’s covered by his or her plan benefits and then pay out of pocket for any medicine that’s over the limit.

OR If his or her doctor thinks more medicine is needed, he or she can ask for approval from Humana for the amount of medicine that goes over the limit.

  • Tier Changes: The member’s medicine(s) is grouped into different tiers. For each tier, he or she will pay a different amount. If a member fills or refills a prescription for a medicine that’s moving to a different tier, he or she may have to pay more or less.
  • Not Covered: Starting January 1, 2017,* some medicine(s) will no longer be on the member’s Drug List. If a member fills or refills a prescription for any medicine that isn’t covered under his or her benefit plan, he or she will have to pay the full cost of the prescription.

The member’s doctor can ask Humana to make an exception to cover his or her drug if it’s not on our Drug List. Generally, Humana will only approve a request for an exception if the alternative covered drugs wouldn’t be as effective in treating his or her health condition and/or would cause adverse medical effects. To ask for an exception, the doctor can contact HCPR at 1-800-555-2546 between 8 a.m. – 6 p.m., Monday – Friday.

Why is Humana making these changes? 
Humana reviews and updates the Drug List to help ensure safety and offer cost-effective choices for drug benefits. Updates to the drug list can happen when medicines have changes in dosing and prescribing guidelines. The selection of available medicines may also change. This can happen when a drug is removed from the market by the Food and Drug Administration (FDA) or a drug’s manufacturer, or a new drug becomes available and is added to the drug list.

Next steps
Visit Humana.com/Druglist after October 15, 2016 to review the latest Drug Lists and changes in 2017. If you have questions, please contact your Humana Sales Representative.

Humana clients and their employees will receive notification from us explaining these changes.

*For Texas, Louisiana, and Puerto Rico Fully Insured groups, these changes start on each group’s renewal date in 2017

An Aspirin a day?

According to Blue Cross, the Food and Drug Administration (FDA) says that studies show aspirin lowers the risk of heart attacks and other health problems in some patients. But taking aspirin doesn’t fix everything, and it isn’t for everyone.

What to ask your doctor about taking Aspirin:
  1. Is taking aspirin a good idea for me?
  2. What are the risks?
  3. How much should I take?
  4. Will it cause problems with the other drugs and vitamins I take?

 

Learn more about how drugs are covered with Blue Cross

You can learn more about how your drugs are covered by reading lists called formularies. These lists have tiers that will help you see if there are drugs you can take that will cost you less. Tier 3 drugs cost more than Tier 2 and Tier 1 drugs.

These drug lists also show what rules may apply to your drugs. Some of these rules may include having your doctor call Blue Cross first before ordering a drug; getting a certain amount of a drug at one time; or trying other drugs first before your plan will cover a drug.

First, check your plan booklet to see how many drug tiers your plan has then go to:

  1. bcbsla.com/pharmacy
  2. Click Prescription Drug Lists
  3. Choose the 2016 Drug Formulary for your plan
  4. Look up your drug in the index to find what page it is on in the formulary

If you have questions, call the Pharmacy number on your member ID card.

Continue reading “Learn more about how drugs are covered with Blue Cross”

5 tips for your first doctor visit

If you’re new to insurance or haven’t been to the doctor in a long time, here are some tips to help your visit go smoothly from check-in to claim:

  1. Get there early. Plan to get there early to fill out any forms. Tell the doctor’s office that this is your first visit.
  2. Bring your ID card. Show the front desk your new member ID card and use it to fill out any forms.
  3. Ask questions. Bring any questions you have so you won’t forget to ask them. Write down the answers and tips your doctor says to try, too.
  4. Know what you have to pay at the visit. Check your plan to see if you have a deductible, copay or coinsurance. If so, you will need to be ready to pay the doctor’s office.
  5. Check your EOB. After your visit, you will get an Explanation of Benefits (EOB) form that will tell you what your plan paid for your visit and what you may owe for any other care like tests or lab work your doctor asked you to have.

Continue reading “5 tips for your first doctor visit”