Providers Connections Newsletter - Spring 2009

Presorted Standard U.S. POSTAGE PAID New York, NY Permit No. 3700 330 West 42nd Street New York, NY 10036-6977

Spring 2009

Your Key to the 1199SEIU Benefit Funds

Personalized Medicine Program Helps Pinpoint Best Treatment Plans As you know, familiarity with a patient’s genetic make-up is helping many physicians optimize breast cancer therapies and manage anticoagulant drugs more effectively. And because we value the quality of care that you provide to our members, we’re giving you access to this tool as well.

Our new Personalized Medicine Program helps our providers determine drug therapies with greater precision by giving you access to one of the latest medical approaches. Beginning April 1, through a simple cheekswab diagnostic test, you will be able to better assess how effective warfarin and tamoxifen will be in treating an 1199SEIU patient. With this knowledge in hand, you’ll have a deeper understanding of the patient’s ability to use or metabolize the drugs, leading you to more finely tuned treatment plans and prescription doses.

Do We Have Your Current Information on File?

Help us make sure our members have the most current, accurate information about our provider network. Check our online directory at www.1199SEIUFunds.org to verify your information. If we do not have your current information, complete a Provider Demographic Change Request form, available on our website under “Forms

Before prescribing one of these medications, contact Medco and request a cheek-swab test. Medco will also reach out to you directly about testing if one of your patients submits a prescription for either warfarin or tamoxifen. Medco will send a test called MedMatch to your patient, who will complete it and return it to the lab. And when the results are ready, they’ll be sent to you.

There is no cost to you or to our members for participating in the Personalized Medicine Program. The program is voluntary, but we encourage you to take advantage of the tools we provide, so that together we can uphold the high standards of care our members enjoy.

To contact Medco regarding warfarin prescriptions, call: Medco Therapeutic Resource Center (800) 838-5233 9:00 am to 5:30 pm, Monday to Friday Physician fax: 1-800-837-0959 To contact Medco regarding tamoxifen prescriptions, call: Medco Therapeutic Resource Center (800) 240-8144 8:00 am to 6:30 pm, Monday to Friday Physician fax: 1-800-837-0959 And as always, to contact the Benefit Fund with questions or for information regarding our new Personalized Medicine Program, you may call our Provider Call Center at (646) 473-7160.

and Resources.”

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Pharmacy Options for Our 90-Day Maintenance Mail Order Prescriptions

Message from the Executive Director

When our members have medications they must use every month for chronic conditions such as diabetes, high blood pressure or high cholesterol, they should use our convenient 90-Day Maintenance Mail Order Pharmacy through Medco.

This “90-Day Rx Solution” helps to protect our members’ benefits while giving them the convenience of either having their three-month prescription delivered right to their door or picking up their prescription at a participating pharmacy.

As a participating provider, you help us ensure that our members have access to quality care and services. And part of making sure you can provide the best care means providing you with helpful tools like this newsletter, Provider Connections, to keep you up to date on Benefit Funds news and programs.

In this edition of Provider Connections, you’ll learn about important Preferred Drug List updates and a change in our pharmacy option for our maintenance drug program, The 90-Day Rx Solution. You’ll also read about the new Provider Manual you’ll be receiving shortly, improvements in our Provider Services Call Center and our upcoming Provider Education Program.

Although Pathmark pharmacies no longer wish to be a participating pharmacy, 1199SEIU members can continue to use Pathmark to fill short-term prescriptions up to a 30-day supply. Any threemonth supply of medication can still be ordered through Medco

As always, we hope you find this newsletter helpful. We value you as a provider and look forward to a continued successful relationship. Should you have any questions, please speak to your Provider Representative, or contact our Provider Relations Department at (646) 473-7160.

by Mail or ordered and picked up at a Rite Aid pharmacy in New York or New Jersey. More than 1,300 former Eckerd pharmacies in New York and New Jersey are now Rite Aid pharmacies, giving members more convenient locations to choose from.

Mitra Behroozi

Help Your 1199SEIU Patients Stay Healthy – Screen for Kidney Disease

Call Provider Services for Quick Answers

New Provider Relations Manual Gives You the Answers You Need

Our Provider Call Center staff is always here

Keep an eye on your mail for the 1199SEIU Benefit

to answer your questions. In fact, last year

Funds new Provider Manual, your one-stop resource for

A recent report found that cases of kidney disease are on the rise, especially among African-Americans. And while many of our members are AfricanAmerican, our claims data reveals that less than 1% of our adult population has been diagnosed with kidney disease.

we answered more than 600,000 calls and

everything you need to know as a participating provider.

resolved most of your issues right

In it you’ll find the Funds’ policies and guidelines on such

away. If you have questions or

topics as covered and non-covered services, member

need assistance, you can reach

eligibility, care management, wellness programs and

our representatives by calling

claims submission.

That’s why we want you to help us proactively offer regular screenings and tests – such as testing urine for albumin levels – to our members that can detect kidney disease early. These tests are covered by the Funds, and we want to work with you to ensure at-risk members are tested regularly. So, please be sure to recommend these life-saving tests to your 1199SEIU patients.

Provider News-Spring 2009.indd 2

(646) 473-7160. Or you can check claims and eligibility information

24

hours

You’ll notice that we’ve “gone green” with this manual, providing you with an electronic copy on CD, rather than

a day through our

a printed book. You can also download a copy of the

automated system at

manual at our website, www.1199SEIUFunds.org, under

(888) 819-1199.

“Forms and Resources.”

4/21/09 12:20:54 PM