Excellus BCBS Broker News Vol. 18 No. 11

Gag Clause Prohibition Attestation Under The Consolidated Appropriation Act

The gag clause prohibition under the Consolidate Appropriations Act (CAA) prohibits health plans from entering into contracts that restrict specific data and information that a plan can make available to another party. Plans must annually submit an attestation that they have not entered into any prohibited contractual restrictions.

Excellus BlueCross BlueShield has determined that they will be completing the attestation on behalf of their fully insured groups. A gag clause attestation certificate of completion will be available to groups upon request.

If you receive any gag clause attestation inquiries from your fully insured groups, please let them know Excellus will be completing the attestation on their behalf by December 31, 2023.

For self-funded groups, Excellus will supply a Certificate of Compliance that they can use to file directly with CMS. These groups have been informed of this process directly from their account manager.

Please share this information with your groups. If you have any questions, contact your account manager.

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Sunsetting Wellbeing Programs & How Members Can Claim Their Rewards

With the much-anticipated transition to Excellus' new digital, wellbeing engagement program, ThriveWell^SM, they will be sunsetting several of their wellbeing programs. The following programs* will be discontinued the last day of a groups’ benefit year:

• HealthyRewards
• Active&Fit ExerciseRewards

In addition, Calm® subscriptions will be discontinued on December 31, 2023 and replaced with ThriveWell.

Excellus wants to make sure, with the discontinuation of these programs, that members have the opportunity to claim any rewards they have earned. Below is a FAQ document for members to understand when their benefits will end, and the process for claiming rewards. Please download and distribute to groups as needed.

*Program participation varies by group contract

Member FAQ

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Fully Insured Large Groups To Move To Preferred Value Formulary

Please be advised that all Commercial Fully Insured Large Groups will move from the current 3 Tier Open Formulary to the Preferred Value Formulary (PVF) based on their plan year. This change excludes Minimum Premium groups, who will continue to have the option to choose between 3 Tier Open Formulary or PVF.

Why is Excellus BCBS making this change?

They believe this change will help manage rising costs and provide the best financial value for Large Group customers. It will also help mitigate impacts of the frozen formulary state mandate and any additional state/federal mandates.

Will members need new ID cards?

ID cards (view sample) will be updated to include the 4-digit formulary ID (5578) which is also posted on the excellusbcbs.com website. ID cards will be distributed based on the group’s plan year.

For example, if a group’s renewal date is March 2024, and their plan year is March 2024, Excellus will reissue new ID cards prior to their renewal date. If a group’s renewal is March 2024, but their plan year is January 2024, they will reissue new ID cards prior to January 2024.

How are they communicating this change to groups and members?

For members currently taking a medication that will no longer be covered under the PVF, they will be notified via letter at least 90 days prior to when the formulary change takes place. NOTE: Excellus will also send communications to providers.

To access the formularies on the Excellus BCBS website, go to:

• www.excellusbcbs.com > Find a Plan > Managing Prescriptions > Check Our Drug Lists > (5578) 2024 Preferred Value State Mandate Formulary

Please share this information with your fully insured large groups and contact your account manager with any questions

(5578) 2024 Preferred Value State Mandate Formulary (PDF)

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Updated Annual Group Information Form And Web Tool Available

An updated version of the Annual Group Information Form (AGIF) is available for Large and Small Groups. The only change in this version is that a question has been added to the AGIF and online AGIF Web Tool which requires groups who offer a dental plan through the Health Plan to provide the number of dental eligible employees.

The addition of this question will allow us to capture all group size data on one form, to ensure that dental groups are classified in the correct market segment. This change will apply to both the paper version of the form, as well as the electronic Web Tool version which is available online to Excellus BCBS brokers and Groups.

Visit the AGIF Resources link below to access:

• The updated printed AGIF
• Electronic AGIF web tool
• Instructions for completing the form

Contact your account manager if you have questions about the AGIF.

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Updated Brochures Now Available        

Excellus BCBS has updated the brochures below with the new Everybody Benefits logo. Please share these brochures with your groups. Questions?  Contact your account manager.
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‍Out-of-Pocket Protection Program Brochure (PDF)                  
Rx Home Delivery Brochure (PDF)  

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December Wellbeing Tip: Where to go for care

Understanding where to go for medical care before you need it can help minimize frustration, time, and cost. Your primary care provider should be your first choice for routine medical care or minor illnesses or injuries that are not an emergency. A primary care provider cares for many health needs and is a champion for your health. Primary care providers can be pediatricians (for children), family doctors, nurse practitioners, internists, or obstetrician-gynecologists. Everyone should have a primary care provider who they see regularly.

Many medical offices now offer telehealth for common illnesses and follow-up care. Telehealth is just like any other scheduled appointment with your doctor. Instead of going into the doctor’s office, you both conduct the visit through phone or video connection.

Telemedicine is an option for minor medical or behavioral health needs when your primary care provider is not available, or you are out of town. Telemedicine, provided by MDLIVE®, gives you fast and convenient access to a doctor 24/7/365 using a phone, tablet, or computer.

If your primary care provider is not available and you prefer to see a doctor in person for non-life-threatening medical issues, you can visit an urgent care center. You can find an urgent care center near you using the Find a Doctor tool on our website: ExcellusBCBS.com/Find-A-Doctor.

For life-threatening conditions, such as symptoms of heart attack (severe chest pain) or stroke (numbness, sudden loss of vision or difficulty talking), uncontrollable bleeding, poisoning or suicidal thoughts, call 911 for help or have someone drive you to the emergency room.

Share the Finding Care Toolkit (ZIP) with your groups so they can help educate their employees about the different options for finding care.

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Kicking Off A New Social Media Campaign

Excellus BCBS launched a new campaign on their social media channels that will feature some of the positive feedback they receive from their health plan members. Topics will vary monthly so be sure to bookmark the various social media sites and check back often.

This month they are featuring member testimonials about their Pharmacy Site of Care Program. See the member quote and view the social media post.

"My first nursing visit went great - I am currently pregnant and due in the next month, so I am happy that I can have my infusions at home while spending more quality time with my newborn." View "I can spend more quality time ..." Post →

"I live in a rural area, so the option of home administration eliminates a 1.5 – 2-hour drive to my facility each time I need to receive an infusion.” View "Home administration eliminates ..." Post →

“I didn’t have a ride to my appointment. Excellus BCBS made sure I didn’t miss a dose, and had a nurse sent to my home to give me my injection. As a bonus, I saved money on the cost of my medicine.” View "I save on ..." Post →

Please share these with your groups and as always, contact your account manager with any questions.

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The Right Meds At The Best Value

An Excellus BlueCross BlueShield program is focusing on medication safety while saving millions of dollars in prescription drug costs. The program, Pharmacy Concierge, is available to most midsize and large employers through the health plan.

“Improving care is the primary goal of Pharmacy Concierge,” says Mona Chitre, PharmD, chief pharmacy officer and president of pharmacy solutions at Excellus BCBS. “Slowing the growth in drug spending without compromising care is an added benefit.”

With Pharmacy Concierge, a team of clinical pharmacists from Excellus BCBS reviews an employer group’s pharmacy claims for opportunities to improve patient care and/or reduce pharmacy spending. This includes finding unnecessary or inappropriate medications, incorrect dosing, safety concerns, and savings opportunities with approved generics or biosimilars. Generics and biosimilars are as safe and effective as their brand name counterparts but can cost less.

“Pharmacy Concierge has saved our organization thousands of dollars in prescription management,” says Dan Ross, vice president of corporate compliance and risk management at Heritage Christian Services in Rochester, New York. “It is a great asset with minimal risk.” In 2022, Heritage Christian Services saved just under $100,000 in pharmacy costs. They are on track for even greater savings in 2023.

Last year, the Pharmacy Concierge team eliminated $11 million in unnecessary or inappropriate pharmacy spending. Nearly 900 employers participated, and more than 7.4 million claims were reviewed for potential clinical safety and/or savings opportunities

Here are some examples:

• Pharmacy Concierge identified a member who had been prescribed two different medications to treat their diabetes. When used at the same time, the medications have no added benefit according to American Diabetes Association guidelines. In addition, one of the medications is associated with potential safety concerns. Outreach was made to the prescribing physician, who worked with the member to adjust the prescription therapy.
• The program identified a member prescribed the incorrect dosage of an anti-depressant. The physician was notified of the dosing issue. A lower cost generic alternative was also suggested. The member is now taking the correct and safer dosage, with an annual out-of-pocket savings of $3,500.
• A consortium of upstate New York school districts reduced pharmacy spending by more than $1 million after participating in the program.

Chitre says all medication decisions are made by the member’s provider in consultation with their patient.

“Our employees at Heritage Christian Services get a knowledgeable resource that can answer their questions, and our organization sees significant savings with reduced pharmacy costs,” says Ross. “It’s truly a win-win!”

In the first six months of 2023, the clinical pharmacists have identified $10.8 million in unnecessary or inappropriate pharmacy costs.

Learn more about our Pharmacy Concierge Program.

Visit ExcellusForBusiness.com For Our Pharmacy Concierge Program Handout →

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