Special Edition

Chemotherapy Drug Coverage Update

After listening to your concerns, we have expanded the benefit options for members who take oral chemotherapy medications. New letters (samples: letter A, letter B) will be mailed to affected members to update the information in the previous mailing. (Letter A will go to members with pharmacy plans subject to a medical deductible, such as HRA or HSA; Letter B will be sent to members on other types of plans.) Members receiving one of these letters filled a prescription for oral chemotherapy within the last 120 days. This information will also be included in member benefit handbooks that will go to all groups as they renew.

In the January 25 Agent Bulletin, we notified you about changes to our oral chemotherapy drug coverage and linked to the member notice. The changes were in response to Oregon Senate Bill 8, which requires health benefit plans that provide coverage for cancer chemotherapy treatment to also provide coverage for prescribed, orally-administered anticancer medication as favorably as IV-administered or injected cancer medications, which are covered under the medical benefit. While SB 8 allows us to implement this as groups renew, we elected to make it effective for all groups January 1, 2008. Prior to this, members who did not have a pharmacy plan had no coverage for oral chemotherapy medications.

Based on the feedback from both agents and members, we took a second look at our initial changes with careful consideration of the potential unintended impact on some members. We are revising our oral chemotherapy drug coverage to ensure that all our members have the best possible benefit. To accomplish this, while still complying with the new law, we will revise the benefits as follows:

• Our pharmacy benefit will continue to cover oral chemotherapy drugs as before. If a member’s plan includes a pharmacy benefit, they only need to show their PacificSource ID card at a Caremark^® participating retail pharmacy and pay the appropriate copay. Mail order prescription service is also available for most of these oral chemotherapy prescription drugs through Walgreens or Wellpartner. Caremark^® Specialty Pharmacy Services will continue to cover certain medications as before. Claims submitted electronically by participating pharmacies will be processed under the pharmacy benefit; all other claims will be processed under the medical benefit (see below). Pharmacy copayments do not accrue to medical out-of-pocket maximum limits, in most cases.
   
• If a member prefers, they may use their medical plan’s chemotherapy benefit instead of their pharmacy benefit for covered oral chemotherapy medication. If using the medical benefit, these drugs would be subject to any deductibles, coinsurance, out-of-pocket limits, or pre-existing conditions that apply to the medical plan. By electing this option, their oral chemotherapy medications will be covered in full for the rest of the calendar year once they have met their out-of-pocket maximum.

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Eugene
(541) 687-7047 or toll-free (877) 657-9797
fax (541) 485-0915
Troy Kirk, Vice President Sales and Marketing
Doug Sheffer, Eugene Regional Manager

Bend
(541) 330-8896 or toll-free (888) 877-7996
fax (541) 330-8948
John Wright, Bend Regional Manager

Boise
(208) 342-3709 or toll-free (888) 492-2875
fax (208) 342-4508
Dave Ewers, Boise Regional Manager

Medford
(541) 858-0381 or toll-free (800) 899-5866
fax (541) 858-0486
Fred Cornett, Medford Regional Manager

Portland
(503) 699-6561 or toll-free (866) 540-1191
fax (503) 697-1075
Dennis Reed, Portland Regional Manager
Kristin Kennedy, Marketing Sales Representative

Manley Services
(541) 485-7488 or toll-free (800) 422-7038
fax (541) 681-8792
or toll-free (800) 575-1109
Stan Manley, President

Select Benefit Administrators
(503) 598-8908 or (800) 473-0509
fax (503) 598-0197
Nancy Louris, President