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October 30, 2008

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Member Update

by Jack W. Walker, Ph.D., Executive Administrator

October 30, 2008 - As I review the Plan's financial performance with you, I want to reassure you that your health care coverage is in full effect and all claims will continue to be paid. 

The Plan remains committed to restoring cash reserves and strengthening financial health.   Throughout this process, transparency for our members and taxpayers is an important value.  Closely monitoring our "recasted," or revised budget, against actual expenditures is a key part of this process.

Here are some highlights from the State Health Plan's September 2008 financial report:

  • For the 1st Quarter of Fiscal Year 2008-2009, our year-to-date actual plan loss is $89.8 million, vs. the recasted budget projection of $115.4 million loss and the original budget projection of a net gain of $44.1 million.

  • The ending cash balance for September was $49.9 million.

  • Please keep in mind, as previously reported: For Fiscal Year 2008-2009, the Plan confirms a projected loss between $264 and $280 million.  (A loss of $62 million was originally projected.)

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New Pharmacy Programs Beginning November 1, 2008

 

Formulary Coverage Review for New Users of Effexor XR® and Pristiq®

Effective November 1, 2008, all new users of Effexor XR® and Pristiq® will be prescription-padsubject to a formulary coverage review also known as a step therapy program.  Coverage will only be provided for Effexor XR®and Pristiq® if the provider documents that the member has experienced failure or intolerance to preferred antidepressant medications. Click here for details of the policy.
 
Please encourage your employees to talk with their doctor about possible alternatives for Effexor XR® and Pristiq®including generics.  Members can save money by using generic drugs instead of brand name drugs and generics medications are always State Health Plan-preferred medications. 
 
Prior Authorization for New Users of Certain Specialty Medications

Also beginning November 1, 2008, the State Health Plan will implement pharmacy prior authorization programs for new users of the following specialty medications:
  • Psoriasis Medications:  Amevive® and Raptiva®
  • Multiple Sclerosis Medications:  Betaseron®,Rebif®,Avonex®, Copaxone®, Tysabri®
  • Immunomodulators: Thalomid® and Revlimid®
Members currently using these medications will not be subject to the prior authorization requirements.  Program information is located on the Pharmacy Prior Authorization Policy Web page.  
 
Click here for the complete articles and frequently asked questions (FAQs).
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