Your Key to the 1199SEIU Benefit Funds
New Prescription Drug Changes
Message from the Executive Director To help you provide our 1199SEIU Benefit Fund members with the highest quality care, we strive to keep you â€œin the loopâ€? by reporting on the information and program changes you need to know about. In this edition of Provider Connections, we give you a brief update on how we expect the Patient Protection and Reconciliation Act of 2010 to affect the Benefit Funds. You will learn about important updates to our prescription drug program, and about the best ways to expedite your claims payments. If you have any questions about the information in this newsletter, please contact your personal Provider Representative or our Provider Services Call Center at (646) 473-7160. Mitra Behroozi
As of July 1, the Benefit Funds will add five new drug classes for commonly prescribed medications to our Preferred Drug List. These include ulcerative colitis agents (new users), nitroglycerin transdermal patches (all users), epileptic anticonvulsants (new users) and Factor VIII blood factor products for hemophilia (new users). The fifth new drug class is antiplatelet agents such as Aggrenox, Effient, Plavix, cilostazol and ticlopidine. Although these drugs are used to reduce secondary cardiovascular events, they are prescribed less often for female patients. Just like the nitroglycerin transdermal patches mentioned above, these drugs are available to be prescribed to all 1199SEIU patients. Our current Preferred Drug List, as well as details on our prescription program, can be found on our website at www.1199SEIUFunds.org.
Studying the Effects of Healthcare Reform Like many in the world of healthcare, we are in the process of assessing the impact of the Patient Protection and Reconciliation Act of 2010. We are working to determine how it will affect the benefits and coverage we provide to our members. The main standards of the healthcare reform law mirror the standards of the Benefit Funds. It will make healthcare coverage affordable and comprehensive, and will prevent insurance companies from dropping coverage for pre-existing conditions. Also important is its focus on primary care and managing chronic disease. As an 1199SEIU provider, you know that these initiatives are our top priorities as well. Reform will most likely improve the primary care and disease management systems we now use, which in the long run, will benefit providers and patients â€“ you and our members. While the 1199SEIU National Benefit Fund already meets many of the main provisions of the law, we will be required to make some changes. The most significant changes will include extending dependent coverage until age 26 and eliminating annual and lifetime benefit limits. Although the law seemed to provide an exemption for collectively bargained plans until the expiration of their contract, it now appears from draft regulations just recently released that the exemption will not be applied to any collectively bargained plans. We will have to implement these provisions by January 1, 2011. The National Benefit Fund actuaries have been analyzing the cost of implementation. The Fund, along with the Trusteesâ€™ Cost Containment Committee, will continue to monitor the situation.
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1199SEIU Benefit and Pension Funds 330 West 42nd Street New York NY 10036-6977
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Other Useful Information â€“ New Third-Level External Appeal Agent On May 1, the Funds changed our external appeal agent from Empire State Medical, Scientific and Education Foundation, Inc. to Island Peer Review Organization (IPRO). To initiate a third- level review, please contact IPRO at (516) 326-7767, ext. 411, email TGiorgio@ipro.org or fax (516) 326-1034.
New York NY Permit No. 3700