For those of you who are new enrollees in Ohio Med, it is important to understand how the retail and mandatory mail-order programs work together.

The program is in place because it saves both you and the state money -- the state gets a better deal by buying larger quantities, and you only pay 2 copays for 3 months of medication.

If you get a prescription from your doctor, you can go to your local pharmacy to get it filled one time, for up to 30 days. It doesn’t matter if the doctor has written the prescription with refills — your local pharmacy cannot honor those refills.

After your initial 30-day supply, you must use the mandatory mail-order program through Medco Health Solutions, Inc. (Merck-Medco has changed its name to Medco Health Solutions, Inc. Their services are not changing, only their name.)

The only exceptions to this rule are those classes of drugs listed on page 46 in your purple Health Care and Long Term Care Benefits booklet in your State of Ohio Employee Benefits Handbook box.

The easiest way for you to avoid complications (when you need a medication for more than 30 days) is to ask your doctor for two prescriptions — one for 30 days with no refills and one for 90 days with refills. Submit the 90-day prescription with refills to the mail-order program. Doctors are familiar with this practice and will understand the purpose of your request.

If you experience difficulties in obtaining prescriptions, please call Medco Health Solutions at 1-800-903-8030.

During this year’s open enrollment period, approximately 20,000 employees made a change to their health coverage. Most of these changes were the result of Aetna withdrawing its HMO coverage to state employees as part of a corporate effort to stem financial losses.

Aetna, United HealthCare (UHC) and Ohio Med were the only statewide plans available to employees last year. No other statewide plan bid in most counties of the state for the state’s employee health insurance business for this year. Therefore, for most state employees, United HealthCare and Ohio Med were the only plans available to enroll in for this fiscal year. Employees in northwest, northeast and eastern Ohio had additional options provided by regional HMOs.

If you changed health plans during this past open enrollment period, please review the following checklist to see if you have taken the steps necessary to assure you do not have difficulties with your benefit coverage throughout the year:

	Your new plan was effective July 1, so please throw away your old ID card.
	If you changed from an HMO to Ohio Med, you now have to meet an annual deductible. (See article).
	If you changed from an HMO to Ohio Med, the mail-order prescription service is mandatory for refills. This program is cost-effective for both you and the state. If you have ongoing medications, you will need to get new prescriptions from your doctor in order to get them through the mail service.
	If you changed from Ohio Med to an HMO, although mail order is not mandatory, it is convenient and can save you money. Contact your HMO for more information on their mail-order program.
	If you changed from Ohio Med or UHC to The Health Plan, Kaiser Permanente, Paramount, QualChoice or SummaCare, you will have to utilize a primary care physician (PCP) to direct all of your care. (Check your I.D. card to make sure your PCP is listed). UHC and Ohio Med members are not required to pick a PCP.

Employees from 13 agencies, two boards and the Governor’s Office as well as the governor himself competed in the second annual Governor’s Fitness Challenge, which was held in conjunction with the National Employee Health and Fitness Day activities held on the Statehouse lawn May 15.

For the first time the Governor’s Fitness Challenge featured several interagency competitions. Teams of four participated in jump rope, stationary bike race and obstacle course competitions. Out of the 50 teams participating, special congratulations goes to the teams from the Ohio Departments of Administrative Services, Health, Mental Health, Public Safety, Rehabilitation and Correction, and Youth Services, as well as the Ohio Lottery Commission.

The governor also recognized four state employees who have committed to being Healthy Ohioans. They included Carol Curry, Administrative Services; Kim Lutz, Ohio Department of Natural Resources; Bill Mayo, Ohio Veterans Home; and Calvin Jamison, Youth Services.

Generic Prescribing vs. Generic Substitution
Yes -- there is a difference -- and it is a new step you can take
to reduce your out-of-pocket costs

One of the successes of the state health plans in constraining costs has been the use of generic drugs. Generic drugs are about a third to one-half cheaper than the identical brand drug. The health plans automatically substitute a generic drug when one is available, unless a state employee objects.

For employees there is a real financial incentive not to object — your cost is three times higher when a brand drug is purchased when the same drug in a generic version is available. State employees and their dependents have responded to this approach. When a generic is available, State of Ohio employees and their dependents purchase the generic 94 percent of the time.

But there is another step you can take to reduce your prescription drug costs. Just as you see commercial after commercial touting brand name drugs, your doctor is also intensively marketed by the drug companies promoting their most expensive drugs.

Studies show that most doctors simply don’t realize the high cost of these heavily marketed brand medications. But your doctor often has a choice between prescribing an expensive brand name drug and prescribing a comparable generic drug that is available for the same medical condition. The comparable generic drug may be one-third to one-tenth the price of the brand drug that does not have an exact generic available yet — and your copay will be cut in half.

Hospice care seeks to enable patients to live their remaining days in an alert and pain-free manner, with symptoms monitored and controled, so that those last days may be spent with dignity and quality, at home or in a home-like setting, surrounded by people who love them.

Hospice care does not use artificial life-support systems or medical/surgical procedures when there is no reasonable hope of remission of the disease. Often, hospice care is less expensive than inpatient hospital care. Ohio Med and all HMOs available to state employees provide hospice care coverage.

For employees enrolled in the Ohio Med PPO, deductibles, copayments, co-insurance and out-of-pocket maximums are important terms to know. If you changed from an HMO to the PPO this year, these terms can be particularly confusing.

A deductible is an amount of money that you must pay each year before insurance begins paying. However, some benefits are paid on your behalf even if you have not met your annual $125 single or $250 family annual deductible. The benefits listed below are paid by the plan regardless of whether you have paid your annual deductible:

• Benefits that are paid at 100 percent, such as home health care.
  
  
• Benefits that require you to pay a copayment, such as office visits.

A copayment is the amount of money you pay each time you receive certain medical services ($10 office visit, $25 emergency room visit). Even if you haven’t reached your deductible, you will still only be required to pay the copayment.

When you use non-network providers, your out-of-pocket expenses can be considerably higher. This is because the non-network provider may not accept Ohio Med’s payment as payment in full and may bill you the balance. For a list of network providers, please call (800) 822-1152.

If you are newly enrolled in United HealthCare (UHC), it’s important to remember that UHC is different than most HMOs. UHC pays many benefits at 90 percent unlike some HMOs which pay most benefits in full.

You may wish to review the Open Enrollment Comparison Chart and Guide that shows most of the benefits for which you pay 10 percent of the charges until you reach the out-of-pocket maximum. These include allergy testing and treatment, inpatient hospital care, ambulance service, skilled nursing facility and physical therapy services.

Cholesterol made the news again in July when a panel at the Institute of Medicine determined trans-fatty acids actually reduce the level of so-called “good” cholesterol while increasing the level of “bad” cholesterol. The panel decided that there is no safe amount of trans fat a person can consume.

First, what is “good” and “bad” cholesterol? Good cholesterol is called high-density lipoprotein or HDL. HDL actually removes bad cholesterol from existing plaque and slows its growth.

Having a high level of HDL can protect against heart attacks and strokes, while having a low level of HDL can put you at risk. Bad cholesterol is called low-density lipoprotein or LDL. This kind of cholesterol clogs your arteries and promotes plaque and blood clots. A high level of LDL can increase your risk of a heart attack.

Trans-fatty acids are common in foods containing shortening, including pastries and fried foods, and are found in lower levels in dairy products and meats. Therefore, you should strive to identify more healthy substitutions, and avoid or minimize consumption of such foods.

The U.S. Food and Drug Administration had proposed ordering the labeling of trans- fatty acid levels on food packages in 1999 but held off finalizing the regulation until the Institute of Medicine issued its report.

Now that the panel has released its report, the FDA is likely to go ahead with a rule ordering the labeling, according to press reports.

Corticosteroids or Antihistamines?
Are you an allergy sufferer? Do you take more than one medication to treat your allergies? You may be treating your symptoms twice or using the wrong medication. Two different classes of medication are used to treat allergies: corticosteroids and antihistamines.

Inhaled nasal corticosteroids (Flonase, Rhinocort, Vancenase pocket inhalers) are a highly effective class of medication to control nasal symptoms such as swelling, runny nose, sneezing and nasal congestion. These medications have been used for many years in treating both childhood and adult allergies.

Nasal corticosteroids are not like Afrin and other decongestants that offer fast relief but should not be used more than three days. For most people, when used on a daily basis during allergy season, these corticosteroid medications are more effective than the more common antihistamines.

Thanks for Your Response
What Your Coworkers Said about Open Enrollment

Thanks to all the employees who completed this year’s survey about the open enrollment process. The nearly 1,800 responses will help us improve and simplify the open enrollment processes for all employees.

Many of you, for the first time, used the telephone or new Web enrollment systems to change your health plan. Employees thought both systems were easy to use but the Web system was viewed as more reliable because employees could check the system to make sure that their choices “took.”

Two-thirds of the respondents indicated that if the paper enrollment form is eliminated as a method of making health benefit changes, they would favor using a Web-based system rather than a telephone system.

Where did you receive information about open enrollment? According to the survey, 75 percent of you rely on the Benefits Comparison Chart and Guide, 42 percent on Pathways and one-third of you get open enrollment information from your co-workers or agency personnel.

Employees who were enrolled in the Aetna HMO received news of the need to change plans from the DAS letter mailed to homes (100 percent), co-workers (100 percent) or from the Benefits Comparison Chart and Guide, Pathways, agency personnel or Aetna (each 60+ percent).

Thanks to the many employees responding we have identified several ways to better communicate benefit changes to you during open enrollment and throughout the year.