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Excellus BCBS Broker News Vol. 18 No. 9

September 19, 2023
Excellus BlueCross BlueShield

Leading The Industry In The Pursuit Of Biosimilars

In Excellus' ongoing efforts to ensure access to high quality, affordable health care, Excellus BlueCross BlueShield leads the insurance industry in pursuing biosimilar drugs for their members. According to the FDA*, biosimilars are safe and effective treatment options for many illnesses and can often be provided at a lower cost. Excellus BCBS began the journey of biosimilar adoption in 2018 as the first stand-alone health plan to prefer a biosimilar in the Infliximab category.

Over the years, Excellus BCBS had educated countless stakeholders throughout the country on how to implement a successful biosimilar program. They will now use their expertise to continue to provide member-centric care and maximize savings opportunities for the community by preferring two biosimilars, along with HUMIRA®, for all custom formularies.

Effective September 1, 2023, Excellus BCBS will offer:

  • Boehringer Ingelheim’s CYLTEZO®, which is available in low concentration, and
  • Organon’s HADLIMA™, available in high and low concentrations

With eight manufacturers currently making eleven options in the Humira category (and more to come), Excellus' preferred biosimilars were chosen after an extensive clinical review. They believe this strategy will maximize provider and member opportunities to convert to a biosimilar if desired.

Offering these two preferred biosimilars will increase biosimilar use and decrease costs, while maintaining safe and effective low-cost options for members.

Read the press release to learn more and share this exciting information with your groups today.

Coming Soon: Annual Notice Of Change Letters

This month, group benefit administrators with Medicare Blue Choice (HMO-POS) or Medicare Blue PPO (PPO) plans will be mailed an Annual Notice of Change (ANOC).

The ANOC provides details on 2024 benefit changes.

  • Your members will receive their 2024 ANOC, along with their Evidence of Coverage (EOC) before September 30, 2023, as required by the Centers for Medicare and Medicaid Services.
  • All benefits changed will be effective January 1, 2024.

Members who receive extra help paying for premiums will receive a separate insert to show the amount of their low-income subsidy.

Share this information with your groups and reach out to your account manager with questions.

2024  Community Rated, Small Group Medicare Advantage Rates And Plans Are Now  Available On Blue On Demand  

You can now view 2024 Community Rated, Small Group Medicare Advantage Plans on Blue on Demand.

Blue on Demand allows you to compare plans and access your group's 2023 benefit summaries and rate sheets.

Please contact your Group Medicare account manager with any questions.

Together We Can Move Towards Health Equity

Health care should meet the needs of everyone – no matter who you are, where you live or who you love. This is something Excellus takes very seriously.

Health equity is when everyone has the chance to be as healthy as possible. To improve health equity in the communities served, Excellus needs would like to learn about what gets in the way. Then they can help remove barriers.

The first step is better understanding the barriers that exist for members, including those in employer group plans. Barriers to health equity could be access to care, food, transportation – or not having a provider who speaks your language.

In the coming months, Excellus will begin asking members questions about language preferences, gender identity, race, food, housing, transportation challenges, and more. Members will have options for how they provide this information to Excellus, such as through their online account, the Excellus BCBS mobile app, and more. The answers will help them work to address unmet needs.

The information we gather will stay safe and only be used to help members; it will not be shared with the member’s employer. Excellus will use this information to measure and reduce gaps in care. Answering the questions is optional, but the answers will help offer better care and will not affect health coverage or premiums.

Businesses can also play a part in promoting greater health equity.

Excellus invites you to join in this effort. To learn more about the work Excellus BCBS is doing to remove barriers for members and for ideas on how you can help do the same for employees and their families, download the Health Equity Resources form.

October Is Breast Cancer Awareness Month

Breast cancer is the second most common cancer in the United States among people who were born female, after skin cancers. About one in eight women will have breast cancer at some point in their lifetime. While white women are more likely to develop breast cancer, Black women are 40% more likely to die from breast cancer compared to white women. Men can also get breast cancer, though it is rare: the lifetime risk is one in 833.

The U.S. Preventive Services Task Force (USPSTF) is currently updating its recommendations for breast cancer screening. The draft recommendation states that all women should get screened for breast cancer every other year starting at age 40. Previously, the recommendation was to start screening at age 50. Screening is commonly done with digital mammography, or mammogram. There is insufficient evidence to recommend supplemental screening, such as ultrasound or MRI, in women with dense breasts and a negative screening mammogram.

There are risk factors for breast cancer that people cannot change – such as being born female and getting older – but there are some things people can do to reduce the risk of getting breast cancer. Maintaining a healthy weight, being physically active, and not drinking alcohol, or drinking in moderation, are factors we can control. Breastfeeding, especially for a year or more, also reduces a woman’s risk of breast cancer.

Please share this article and this Breast Cancer Awareness Resources & Toolkit (ZIP), with your groups, so they can promote Breast Cancer Awareness Month among their employees.

Excellus BCBS Launches Innovative Program To Reduce Costs

The Medication Assurance Program is a new initiative of Excellus BlueCross BlueShield aimed at reducing self-funded employer group overall spend. This program is designed to reduce spend on medications by holding manufacturers accountable for drugs that were approved through the Food and Drug Administration’s (FDA) Accelerated Approval Program. Unlike traditional FDA-approved drugs, accelerated approval drugs have unconfirmed clinical benefit at the time of the approval.

While Excellus supports the FDA’s Accelerated Approval Program for some drugs, they are concerned about drugs that have not completed clinical benefit trials in the timely manner mandated by the FDA. Most accelerated approval drugs are “specialty drugs,” which are high-cost medications used to treat rare and complex conditions and as utilization continues to rise, this has created challenges nationally for health plans, including Excellus BCBS. The new Medication Assurance Program drives affordability by reducing spend on drugs that have no, or questionable clinical benefit.

Beginning in October 2023, manufacturers of accelerated approval drugs that agree to participate in this Medication Assurance Program will have their accelerated approval FDA progress monitored. If program requirements are not met, the manufacturer will pay a financial guarantee back to the health plan. A drug manufacturer who declines to participate in the program will not have their accelerated approval drug covered.

Learn more about the Medication Assurance Program.

Get the Medication Assurance Program Flyer →

View Details >View Details >

Questions? Call us at 855-888-8326.

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