Enhanced Prescription Drug Benefits:

All Capital Health Plan Medicare Advantage (HMO) plans will offer a 90-day retail supply and a 90-day mail order supply of most prescriptions beginning January 2012.

To take advantage of the 90-day retail supply just ask your physician’s office for a 90-day prescription and fill the prescription at your local pharmacy.

To take advantage of the 90-day mail order service:

Contact your physician’s office and ask for a 90-day prescription with three refills. 

• Fill out the Mail Service Order Form. 
  • Download the form at caremark.com under “Forms for Print.” 
  • Or, call Member Services at the numbers listed below, and we will mail you a form. 
• Mail the form to Caremark at the address printed on the form.

Drugs available through mail order are drugs you take on a regular basis, for a chronic or long term medical conditions.  The drugs that are not available through mail order service are marked with a “NM” (not available at mail order) on your Formulary (drug list).   The Formulary is available on line at capitalhealth.com/2012 Medicare. All Medicare Advantage members enrolled in plans that renew between October 1 and January 1 have also received the new 2012 Formulary by mail.  

Medicare-Covered Preventive Services:  

Most preventive services have been covered by Capital Health Plan at no cost to members in the past.  However, in 2012 members will see some additional preventive services covered at no cost.  Please refer to your Evidence of Coverage, Chapter 4, for a list of preventive services.   This is a good time to check and make sure you have completed your annual screenings for 2011.

For other 2012 changes, please refer to your Annual Notices of Changes and Evidence of Coverage.

Questions:  Contact Member Services, 850-523-7441 or 1-877-247-6512 (TTY 850-383-3534 or 1-877-870-8943) 8:00 a.m. to 8:00 p.m., seven days a week.

H5938_DP 267 File & Use 11222011

Question:How can I improve the benefits of my prescription drugs while reducing the risks?

Nancy Van Vessem, MD

Chief Medical Officer

Answer: In the last 25 years, we’ve seen a major increase in the number of drugs available to us. There are many obvious advantages to that availability, but one negative effect is that we expect there to be an effective pill for every condition. What we may not realize is not all pills are effective for everyone, many carry side effects that can outweigh their advantages, or many may simply control the adverse results of an unhealthy lifestyle rather than address underlying issues with diet and exercise.  To make informed decisions about your medical care, here are some things you should keep in mind about prescription drugs.  

Most medications are tested in young, healthy people who are not on other drugs. The effectiveness and safety of a drug is very different, for example, when taken by an elderly person with tired kidneys who is also taking six other drugs.

The problem is that over time, multiple doctors can continue to prescribe you medications without considering your total health picture. Some may be for symptoms which are bothersome but not life threatening. Those drugs may cause side effects and you may be prescribed more drugs to reduce the side effects.  You may be reluctant to stop any medication once you start it. And that can all add up to a real mess.  

Being proactive and knowledgeable about your prescriptions is very important in the event of a hospital stay. Let’s say you have an emergency and go to the hospital. Hospital

staff will try to find out what medications you are taking. If you or your family members don’t know the names and dosages of your medications, it can be hard for them to give you the best medical care. 

More complications can come when you are released from the hospital. Nurses try to reconcile medications you were taking before you went into the hospital with any new prescriptions from your hospital visit. They will develop a list and give it to you with instructions. You may be overwhelmed by all the new information. Make an appointment to follow up with your primary care physician who knows your medical history best. Be prepared to discuss new medications and any new side effects you may be experiencing. 

There are other simple things you can do to help avoid complications from prescriptions medications. Be honest with your physician about how regularly you take your medications. Let your physician know your goals. Do you want to minimize cost, maximize convenience, or minimize your medications? Working along with your physician, you can experience the advantages to the vast advances in prescription drugs, and avoid the disadvantages. 

Our Commercial Formulary (list of covered prescription drugs) is changing January 1, 2012. 

The changes will help us provide the quality, affordable care you’ve always counted on. The 2012 Commercial Formulary is available online beginning July 18, 2011.

Visit the “About Your Medications” page at capitalhealth.com to see if the 2012 changes affect your prescription drugs.

New health care regulations and decisions of your employer may have affected your group plan. 

When it’s time for your 2012 open enrollment, be sure to read your policy information thoroughly and work with your group administrator to understand any changes.

Karen Frost, RN, BSA, MBA

Director of Member Services

Capital Health Plan strives to provide our members with outstanding customer service. This section of the HealthLINE answers general coverage or procedural questions that we receive on a regular basis.

Question: How can I find the cost of my prescription drugs?

Answer: Prescription drugs are separated into different levels of costs called tiers - the lower the tier, the lower the cost to you. Depending on your plan, your prescriptions may be divided into 3 or 4 tiers. To find the copayments or coinsurance you will pay for each tier, and the tier for each prescription drug, follow these steps:

Non-Medicare Members:

1.) First find the tiers and associated copayments for your plan on the front of your member ID card.

2.) Then find the tier for each of your prescriptions. Visit capitalhealth.com:

• On the CHP homepage, under “Popular Links and Documents,” click “Prescription Drug Benefit.”
• Download a copy of the Complete Formulary (for 3 Tier plans only) as well as the Preferred Medication List and locate your prescriptions. Match the tier listed for each drug to the appropriate copayment for your plan to find what you will pay.

Medicare Members:

1.) First find the copayment or coinsurance for each prescription drug tier for your plan. Visit capitalhealth.com:

• Click on the tab labeled “Medicare.”
• Then, choose the colored box with the plan you are enrolled in.
• For CHP Advantage Plus (HMO) and CHP Preferred Advantage (HMO) members, the chart in the middle of the page will tell you the copayments or coinsurance for each drug tier. CHP Retiree Advantage (HMO) members should consult the copayment schedule included with your 2011 Annual Notice of Changes and Evidence of Coverage.

2.) Next find the tier for each of your prescription drugs. Stay on the plan-specific web page at capitalhealth.com:

• In the left column, click “Prescription Drug Coverage”.
• Then click “Formulary (Drug List).” On this page you can download a copy of the CHP Medicare Advantage Formulary for your plan. CHP Advantage Plus and CHP Preferred Advantage members can also use the “Formulary Search Tool.” These tools tell you the tier for each prescription drug. Match the tier listed to the copayment or coinsurance for that tier to find what you will pay.

3.) CHP Advantage Plus and CHP Preferred Advantage are subject to the gap in coverage. The copayments or coinsurance for CHP Advantage Plus do not apply if you reach the gap in coverage ($2840 each year). The copayments for CHP Preferred Advantage only apply to Tier 1 generic drugs if you reach the gap in coverage.

Another important resource for Capital Health Plan members is caremark.com.

Capital Health Plan works with CVS Caremark to administer your pharmacy benefits. The Caremark website (www.caremark.com) provides specific information about your medications including refill history and cost, general information on medications (side effects, storage concerns, and drug interactions), and the benefit of using generics over brand name medications. Visit caremark.com and register for a free account today.

If you have trouble logging in to Caremark’s website, or you do not have access to a computer, contact their customer service department at 1-800-966-5772.

If you have trouble with these resources or do not have access to the internet, contact your local Member Services Representatives.

Member Services

Five days a week 8 a.m. – 5 p.m.

850.383.3311 or 800.390.1434

Medicare Member Services:

Seven days a week 8 a.m.– 8 p.m.

850.523.7441 or 877.247.6512

TTY/ TTD: 850.383.3534 or 800.955.8771

Have you been taking certain medications over a long period of time?

Your doctor may want you to have specific tests from time to time depending on the type of medication you take. These simple blood tests will tell your doctor if you are experiencing any unwanted side effects and confirm that you have the correct amount of the medication in your bloodstream. Regular monitoring may be recommended if you are taking any of the follow drugs:

As you get older, the way your body processes medication changes. As a part of the normal aging process, your body will most likely have a higher proportion of fat to muscle and a natural decline in kidney function. This makes it harder to clear drugs from your system. You may also be more sensitive to certain drugs.

These changes could put you at risk for serious side effects such as confusion, depression, falling, or other health consequences. A group of medical experts developed a list of drugs that are potentially inappropriate for patients aged 65 or older. This list is called the Beer’s Criteria, and some of the drugs are shown below, along with concerns and possible alternatives to these drugs.

Since the risks associated with these medications may outweigh the benefits, talk with your doctor if you are taking any of the drugs listed in the first column and ask if any of the alternatives would be appropriate for you. However, do not stop taking any prescribed medications without first consulting your doctor.