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September 2009 |
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H1N1 and Other Flu Viruses Influenza, commonly referred to as the flu, is currently a highly covered topic in the media. According to the Word Health Organization (WHO), this attention is well deserved. As of September 11, regional flu activity in the U.S. was on the rise, with the greatest increases reported in the south eastern part of the country. Worldwide, the 2009 H1N1 (or “swine flu”) virus continues to be the most predominant influenza strain. Keeping your benefit plan members healthy is an important part of working through this flu season. While basic sanitation, such as frequent hand washing and regularly disinfecting high-touch surfaces like doorknobs can help prevent flu viruses from spreading, the U.S. Centers for Disease Control and Prevention (CDC) says vaccines are “the most powerful public health tool for control of influenza.” Most plans cover vaccines under the medical benefit, and with concerns about both “regular” flu and H1N1 this season, two vaccinations offer the best all around defense:
Getting vaccinated is the first line of defense, but for those who do get sick, antiviral medications can be used to reduce flu symptoms, such as sore throat, cough, runny nose and fever, and shorten the illness’ duration. The most recent CDC recommendations are to use antivirals only for treating patients who already have the flu and not as a preventative measure except in extremely rare cases. Overuse of antivirals can lead to resistance, making dangerous viruses even more difficult to treat and control. The CDC’s guidance is intended to ensure antiviral medications can quickly reach those in greatest need, such as severely ill patients and those at high risk for influenza related complications. Antivirals are typically covered under the pharmacy benefit; however, most patients, including those with 2009 H1N1, recover without treatment by antiviral medications. Although few patients who get the flu will need antiviral therapy, we recently changed quantity limit restrictions on two of these products – Tamiflu and Relenza – to allow for more than one treatment per year. Innoviant is leveraging our resources as part of UnitedHealth Group to track and respond to flu-related developments and will keep you up-to-date as events unfold. In the meantime, the WHO website is a great resource for current, global influenza information; the CDC website is also a trusted source and contains patient-facing information you can share with your membership. Generic Utilization Part 3 When you joined Innoviant, you chose either a voluntary, restricted or mandatory generic program as part of your plan design. Today, that choice continues to help your unique plan strike its balance between member medication access and managing overall benefit plan costs. All three generic coverage options allow use of brands and generics, but they have very different affects on how much members contribute when they choose a branded product over its available generic equivalent. The cost difference between your plan’s generic and brand copayments (or deductible) can guide members toward choosing generic medications. The greater the difference, the more likely they are to use generics. For plans with a voluntary generic program, the difference between brand and generic copays is the only incentive for members to use generic versions of brand medications. Mandatory and restricted generic programs include more financial incentive – in the form of a penalty – for members to use generic equivalents. When the product selection penalty applies, members are responsible for paying the plan’s brand copayment plus the difference in cost between the brand and its generic equivalent. Because brands can cost a lot more than generics, this penalty can significantly increase how much members pay out-of-pocket. In a restricted program, when doctors indicate “dispense as written” (DAW) on prescriptions for brand name products, members do not have to pay the generic product selection penalty and are only responsible for the plan’s defined brand copayment. However, in a mandatory program, members are assessed the penalty even when DAW is indicated. The following graphic summarizes the differences between
On a very basic level for controlling plan costs relating to brands with available generic versions, voluntary programs afford the least control, while mandatory programs offer the most and restricted programs fall in between. However, the full economic picture of total plan costs has many, many parts, including overall structure, rebates and the generic pipeline. No single generic coverage option is right for all plans. Your voluntary, restricted or mandatory generic program is a foundational building block within your plan design, and when your entire foundation is aligned with your plan’s unique goals, you can successfully balance member access to medications with managing plan costs. Because pharmacy benefit plans are dynamic in nature, knowing more about these building blocks empowers you to continue striking this balance in the future. For more information about generic program options, contact your Innoviant Account Manager at 1.866.800.4321. In the next and final installment in this series on generics, we’ll feature a special member education section filled with information you can use to promote generic utilization to your membership.
Through Client Connection and Innoviant.com, you have access to educational content specifically written for members that you can adapt to meet your unique member communication needs. In October, several national health observances are aimed at helping manage medications. As the number and variety of medications available to consumers constantly increases, so does the challenge your members face in making sure they use their therapies as prescribed and avoid duplicate therapies and unwanted medication interactions. Sharing information about managing medications with your members can help them live healthier lives – and can even help manage your plan’s overall benefit costs. Managing Your Prescriptions October is Talk About Prescriptions Month, which recognizes that communication between you and your health care providers plays an important role in helping you achieve better health. When you use your medications safely and as directed, you increase your chances of reaching the outcomes you and your doctor expect. Several tools are available to help you manage your medications:
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LOOKING AHEAD |
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October Health Observances Health observances are days, weeks or months devoted to promoting particular health concerns. You may choose to use these special times The following observances are recognized by the U.S. Department of Health and Human Services for the month of October. For more information about the observance or to obtain support materials, please contact the sponsoring organization directly via the websites provided.
Source: 2009 National Health Observances, National Health Information Center, Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, Washington, DC. |
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A Customer-Directed Monthly |
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