UST medical plan changes benefit many employees

From the Department of Human Resources

The University of St. Thomas modified certain provisions of its employee benefits plans. These changes became effective Jan. 1, 2008. This article discusses some of the new prescription drug provisions, dependent student status and a clarification to the Vision Plan.

Over-the-counter drugs

Over-the-counter drugs are as safe and effective as a prescription version. The University of St. Thomas health plans cover some over-the-counter drugs. These drugs fall into two groups: antihistamines for allergies and proton pump inhibitors, e.g., Prilosec, OTC for stomach disorders.

When you choose an over-the-counter drug instead of the prescription version, you can receive the drug at no cost.

To take advantage of this unique cost-saving benefit, you will need to secure a prescription from your doctor for the over-the-counter version of your drug. Your doctor will decide whether the over-the-counter version is right for you.

If you cannot take an over-the-counter drug, UST’s medical plans provide an over-the-counter (OTC) Drug Exception Process, which applies as follows:

If your doctor prescribes a brand name antihistamine or PPI that is not covered by the plan because it has a covered over-the-counter alternative, that noncovered antihistamine or PPI drug may be covered at the same co-pay level as a nonformulary brand name drug ($50) for up to one year if one or more of the following conditions are met and documented by your doctor:

  1. You have tried and failed at least one OTC and/or generic or formulary brand name alternative in the same therapeutic class for the same diagnosis to be treated with the nonformulary brand name drug;
  2. The OTC and generic or formulary brand name alternative are contraindicated; or
  3. You have been receiving the noncovered brand name drug and switching to an OTC drug may cause a health risk.

Eligible (OTC) drugs are covered up to a 31-day supply, as an alternative for similar prescription medications, subject to package limitations, at a participating retail pharmacy.

Specialty drugs

Doctors prescribe specialty drugs to treat serious or chronic medical conditions such as multiple sclerosis, hemophilia, hepatitis, etc. These drugs typically are injectable and self-administered by the patient or a family member. You can only receive these types of drugs from the Specialty Drug Network.

The Specialty Drug Program gives you a convenient, cost-effective way to order specialty drugs for delivery to your home. When you use a Specialty Drug Network, you only pay the plan co-pay amount with no additional costs for shipping and handling. Suppliers in the Specialty Drug Network survived a rigorous evaluation before being admitted to the network and were deemed to offer outstanding customer service and dedication to patients.

Mandatory generic

If you choose a brand name drug when a generic drug is available, you will have to pay the difference in cost between the brand name and generic drug in addition to the applicable co-pay. Generic drugs are as safe and effective as a brand-name drug. Ask your doctor if there is a generic equivalent available instead of the brand name drug. Depending on certain circumstances, your doctor may feel that a brand name drug is the most appropriate medication for you, instead of an available generic. Talk with your doctor to find out what is best for you.

90-day Rx program

If you have prescriptions that you fill regularly, you can save by getting a three-month supply at once for only two co-pays by going to your participating neighborhood pharmacy.

Ask your doctor to write a prescription for a 90-day supply. You also can ask your pharmacist to talk to your doctor.

Go to a pharmacy that is part of the 90-day supply program. Participating pharmacies include Target, Wal-Mart, Cub, Walgreen, CVS, Snyder and Kmart. To view a complete list of 90-day Rx pharmacies, go to Prime Therapeutics Web page or Blue Cross Blue Shield of Minnesota and click on "find a pharmacy."

Tell your pharmacist that you participate in the Blue Cross 90-day Rx program.

Student status

The State of Minnesota passed legislation that allows dependent children between the ages of 19 and 25 to remain on medical and dental plans without requiring dependents to be full-time students. The University of St. Thomas health and dental plans follow all federal guidelines and are not required to follow state-mandated benefit provisions. If you have dependent children between the ages of 19 and 25, they will have to be full-time students to remain eligible for the medical and dental plans.

The vision plan does follow Minnesota mandates and, therefore, your dependents would be eligible for the vision plan and would not be required to be full-time students.

Vision

A correction was made to Vision Plans A and B. The correct contact lens allowance for "all other elective contacts" is $105.

Necessary contact lenses are determined at the provider’s discretion for one or more of the following conditions: following post-cataract surgery without intraocular lens implant, to correct extreme vision problems that cannot be corrected with spectacle lenses, with certain conditions of anisometropia, and with certain conditions of keratoconus. The necessary contact lenses are covered in full (after applicable co-pay) at an in-network provider and up to $210 at an out-of-network provider.

For questions concerning the St. Thomas health plan, please contact Blue Cross Blue Shield of Minnesota, (651) 662-5004.