Health plan update [Vol. 3, no. 2 (Nov. 8, 2002)]

Health Plan Update
A Publication of the Board of Regents of the University System of Georgia
November 8, 2002 Volume 3, No. 2

MedCall Offers Free Open Enrollment Ends Nov. 14 Act Now to Change Your Health Benefits! Medical Advice 24/7

Are you using the cost-effective generic drugs available from your pharmacist?
Are you concerned about the cost of prescription drugs? Would you want to get the same benefits for less money? Then consider the following facts.
Generic medications are accepted by physicians, pharmacists and health-plan providers as safe and effective. In fact, they are so widely accepted that generic drugs account for more than 40 percent of all medications dispensed annually in the United States. The availability of these drugs is constantly expanding as the U.S. Food and Drug Administration (FDA) approves more and more generic equivalents of brand-name medications.
The FDA ensures that generic medications are as safe, effective and high in quality as brand-name drugs. To meet FDA approval, generic medications must contain the same active ingredients in the same dosage forms and strengths as their brand-name equivalents .
Co-payments are lower for generic drugs -- $10 as opposed to $20, in most cases, whether you participate in the University System of Georgia's indemnity, preferred-provider organization (PPO) or health-maintenance organizations (HMOs). Consumers who choose generic drugs when filling their prescriptions at retail pharmacies collectively realize annual savings in the billions.
Drug manufacturers spend large sums of money on the research, development, marketing and advertising of brand-name drugs. These costs are reflected in the price of the drug. The manufacturers of generic equivalents have much lower costs -- See "Generic Drugs," Page 2

Have you ever spent a sleepless night wondering whether your child's fever warranted a doctor's attention? Ever been in enough pain from a cut, a badly sprained ankle or an insect bite to wonder if you need immediate medical attention?
With a quick call to MedCall (dial 1-800-756-0006), participants in the University System of Georgia's preferred provider organization (PPO) and indemnity health plans can get expert advice from specially trained registered nurses at any hour of the day or night. Medcall's Health Information Line is more than just a handy resource -- using it saves University System employees money if they are referred to a hospital emergency room for treatment.
MedCall nurses also are equipped to refer callers to doctors, self-help groups and
See "MedCall," Page 2

How Often Can I Get My Prescriptions Refilled?

If your current supply of drugs then your health plan will cover a

is for...

prescribed refill on the...

30 days 60 days 90 days

...21st day after buying the current supply
...41st day after buying the current supply
...61st day after buying the current supply

Helping you navigate your health-plan options

Generic Drugs
continued from Page 1
think of the money saved on marketing and advertising -- and those savings are passed on to the consumer.
Pay Attention When a Prescription is Written
Physicians sometimes don't think to write a prescription for a generic drug when an appropriate one exists, but that doesn't mean necessarily that they are opposed to the patient using a generic. It pays to ask your physician if a generic drug would do. If he or she wants you to use only the brand-name medication, make sure this is noted on the prescription.
The Express Scripts pharmacy program used by participants in the indemnity and PPO plans has a $10 co-payment for generic drugs, a $20 co-payment for preferred brand-name drugs and a co-payment of 20 percent of the cost of a non-preferred brandname drug ($35 minimum, $75 maximum). If your physician specifies "brand necessary" on the prescription, you will only be responsible for the preferred brand or non-preferred brand copayment. However, if your physician doesn't specify "brand necessary" and your pharmacist doesn't ask you for your preference -- or if you choose the brand-name drug over its generic equivalent -- then you will be required to pay $10 plus the difference between the brand-name drug and its generic equivalent. This "pay the difference" fee is commonly referred to as an "ancillary charge."

MedCall
continued from Page 1
community agencies, and can answer questions about medical procedures, illnesses and the potential side effects of medications In addition, they can advise callers of any pre-certification requirements that may govern the treatment options being discussed and will transfer a caller to the utilization-review team when appropriate.
Anyone suffering from one of the illnesses covered by the Disease State Management Program (asthma, congestive heart failure, diabetes, and breast, lung and colorectal cancers) will be advised of this benefit and how it works.
If MedCall nurses don't have the health information you request immediately at hand, they will do some research and try to call back with an answer within an hour.

They also can mail or fax information packets customized to a caller's individual concerns, including print versions of the tapes in the audio library.
This service is intended to offer information and support, not to diagnose illnesses. While nurses will help callers to assess their symptoms and suggest the options available, the final decision on whether to seek treatment or administer self-care rests with the caller.
MedCall also offers an audio library of tapes on more than 200 health-related topics (everything from "Aspirin and Arthritis" to "Varicose Veins").
Among the hundreds of 3-5-minute audio tapes available to callers are several on wellness issues -- summaries on good nutrition, mammography, immunizations and tips for quitting smoking.

What Your Co-Workers Like Best About Their Health Plans
"What I like best is the concept of the annual wellness check-up being a part of the health benefits package."
Wynell Wilson Personnel Specialist PPO participant Albany State University
"I like the flexibility (of not being restricted to certain physicians)."
Phil Norrell Director of Plant Operations Indemnity plan participant North Georgia College & State University
"It makes me glad to know that each year, the indemnity plan's benefits are increased and/or improved. This is one way of making the plan cost effective."
Cassandra Alexander Interim Director, Human Resources Management Indemnity plan participant Albany State University
"I like the $10 co-pay (for most doctor's visits, wellness and other services) and not having to deal with balance billing. HMOs provide great coverage at a reduced price and are not as hard to use as you would think."
Donna McKenzie Payroll Assistant HMO participant Columbus State University

-- 2 --