Throughout the nation, health care costs continue the dramatic rise which began in the late 1990s and which are predicted to continue for the foreseeable future.

Managed care plans were developed in the 1980s to address rising health costs. However, there are few additional savings to be found. The addition of new technologies, better prescription drugs to combat disease, increased use of prescription drugs, and normal inflation are now combining to drive costs higher.

The Joint Health Care Committee (JHCC), working with consultants and health plans to keep cost increases moderate for state employees, continues to seek new approaches which can reduce costs.

Such initiatives include disease management programs which will help people better manage their illnesses to avoid poor long-term effects on health. Wellness programs are being developed and emphasized in an attempt to keep healthy people healthy and to assist others in addressing their poor health and lifestyle issues. However, these and other solutions will not begin reducing costs for several years.

Medco Health Solutions, the pharmacy benefit manager for Ohio Med, tightened the prior authorization criteria for the very expensive COX-2 inhibitors Celebrex, Vioxx and Bextra, designed to provide inflammatory pain relief without upsetting the stomach.

Currently, several criteria permit an automatic approval of these drugs. However, the use of gastrointestinal medications, such as Prilosec or Zantac, will no longer automatically authorize the coverage of COX-2 drugs.

This change is due to the fact that while stomach medications are sometimes used for ongoing conditions (which might be an appropriate situation for using COX-2 drugs), sometimes stomach drugs are only used as needed for short-term problems (which probably would not be a reason for using the expensive COX-2 drugs).

If members or their physicians feel the COX-2 drugs are still medically necessary, the process does include an appeals procedure.

In addition, the non-sedating antihistamine Claritin, which was a prescription drug, is now an over-the-counter drug.

Because over-the-counter medications are not a covered benefit, requests for Claritin through the retail or mail pharmacy programs will be denied with an explanation of the need to purchase them over the counter.

Although the Ohio Med PPO does not currently have a formulary, there are several drugs that require pre-authorization.

These drugs include weight-loss drugs (Xenical, Meridia and Adipex), gastrointestinal medications (Prilosec, Prevacid, Zantac, etc.), and anti-inflammatories (Celebrex, Vioxx and Bextra). Cost-effective alternatives are available for these very expensive medications, which, for most people, are equally effective.

People taking Prilosec, Prevacid, Zantac or other gastrointestinal medications* will receive a letter explaining that coverage is limited when use of the medication exceeds recommended medical guidelines.

In order to continue these medications, your doctor must call Medco Health Solutions and provide medical information as to why you must continue taking it.

If your diagnosis and history meet the criteria, the drug will be filled. If not, you will need to contact your doctor so the two of you can determine an alternative medication.

Celebrex, Vioxx and Bextra have been proven to be no more effective than other over-the-counter anti-inflammatory drugs when it comes to relieving pain. In fact, the FDA has repeatedly warned the manufacturers to stop overstating their claims about the effectiveness of these drugs.

If your diagnosis and history meet the criteria, the drug will be filled. If not, you will need to contact your doctor so the two of you can determine an alternative medication.

Obesity and high blood pressure are the leading risk factors for heart attack and stroke. An exercise program that includes walking offers protection against these two major killers.

Studies show that brisk walking on a regular basis can improve the body’s ability to consume oxygen, strengthen bones, control weight, lower the resting heart rate, reduce blood pressure, increase heart and lung efficiency and help burn extra calories.

Walking burns approximately the same amount of calories per mile as does running. On average, every minute you walk can extend your life by 1.5 to 2 minutes and walking an extra 20 minutes each day will burn off 7 pounds of body fat a year. There are several things you can do in the course of your normal workday to add walking to your daily routine.

These include:

Try walking - it is easy, can be done almost anywhere and doesn’t cost a thing! You can walk almost anytime. If the weather is too inclement, check your local mall. Malls often have extended hours so that people can enjoy walking even during bad weather.

Health Plans Offer Heart Care Programs

Retail Frame Allowance
In the past, frame allowances have been described in terms of the wholesale price.

Wholesale prices are seldom displayed in eyewear outlets, making it difficult for members to choose a frame that falls within the allowed amount. VSP recently began communicating the retail frame allowance (the actual price of the frames on display) rather than the wholesale price.

• Member Preferred Pricing on annual supplies of some of CIBA’s and OSI’s most popularly dispensed contact lens brands.
• Direct delivery to members’ residences when coordinated through your VSP doctor.
• Additional direct-from-the-manufacturer incentives, such as eye solution discounts and coupons.

Many of us don’t think about contacting a mental health professional when we are feeling sad, depressed or anxious.

Often our first contact for help is with a primary care physician with whom we are familiar and feel comfortable with discussing the difficulties we face in our lives. Frequently these contacts result in a prescription for an antidepressant medication with little or no follow-up care.

Research has shown that brief, intermittent therapy with a mental health professional can be much more effective than antidepressant medications alone.

In fact, antidepressant medication use can be avoided altogether in many cases with targeted, professional therapy interventions.

United Behavioral Health (UBH) provides mental health and chemical dependency services for state employees and their dependents enrolled in a state-sponsored health plan.

UBH services must be pre-authorized and provided by a UBH-contracting mental health professional. This can be accomplished with a simple phone call to UBH.

Mental health services provided by non-mental health professionals, such as primary care physicians, are not a covered benefit and may be denied by your medical plan.