2014 Plan Year
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WHAT’S NOT CHANGING FOR 2014
Premiums will remain the SAME
First Choice providers and Generic Medications are
STILL NO COST TO YOU once your HRA is
exhausted
HRA remains the SAME
Deductible remains the SAME
Plan pays 100% for certain wellness services, with
no HRA involvement
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New in 2014
Increased Out-of-Pocket Maximums
Enhanced Drug Management Programs
Discontinued Life Insurance Benefit
Aetna ASA network www.aetna.com/asa
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New in 2014 – Out of Pocket Maximums
 Out of Pocket Maximums will be increasing by:
 $500 for Employee Only to $2000
 $750 for Employee + Spouse to $3000
 $750 for Employee + Children to $3000
 $1,000 for Employee + Family to $4000
No immediate impact!
Will only affect your 10% Co-Insurance
AFTER you reach your Deductible.
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Continuing for 2014 – Pharmacy Co-Pays
 After a Member’s Deductible is met, the Member pays a fixed Co-Pay
for a 30-day supply of Brand name and Specialty medications
 $40 Brand Name / $120 Specialty
 Limits a Member’s monthly cost for typically expensive prescription
medications
 If the cost of a prescription is less than the Co-Pay amount, Member
pays the lesser of the two amounts
 Remember that Generics are still $0 Out-of-Pocket to Members
Co-Pay System limits your financial exposure
and helps you to budget for monthly expenses!
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Continuing for 2014 – Pharmacy Co-Pays
Member Pays
Plan Pays
Remaining
Deductible
HRA
Deductible
Medical
Co-Insurance
Pharmacy
Co-Pays
10%
In Network
$40 Brand
$120 Specialty
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Enhanced for 2014 – Drug Management Programs
 Enhanced Drug Management programs will limit overspending and medication drug waste – saves YOU and
LSU First money!
 Drug Management Programs:
 Select Home Delivery (opt-out mail order)
 Step Therapy with Grandfathering
 Supplemental Prior Authorizations
 Drug Quantity Management
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Continuing for 2014 – Drug Management Programs
 Select Home Delivery – opt-out mail order
• Requires Members to contact Express Scripts regarding
their mail order preferences for maintenance medications
• Fast, accurate home delivery available directly from Express
Scripts—no more monthly trips to the pharmacy!
• Receive 3 months’ supply at a time (3 Co-Pays will apply)
• Members who take maintenance medications will begin to
receive notifications via mail and phone in November
Express Scripts’ Customer Service will work with your
retail pharmacist to set up Home Delivery for you!
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Continuing for 2014 – Drug Management Programs
 Step Therapy with Grandfathering
• Requires Members to try first-line medications before pricey
brand name drugs on NEW prescriptions
• Grandfathering allows Members currently receiving brand
name medications to continue without first trying alternatives
• Any Rx medication not filled during the previous 130 days
will be considered NEW and will be subject to the step
therapy program
In most cases, first-line medications are JUST
AS EFFECTIVE as higher-cost medications!
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Continuing in 2014 – Drug Management Programs
 Supplemental Prior Authorizations
• Program already in place with some drugs – just added a few
more to the list
• Few Members affected
• If a Member’s prescribed medication is on a Supplemental
Prior Authorization List, Express Scripts will contact the
Member’s physician to discuss alternate treatment options or
provide authorization to dispense the medication as written
Express Scripts and your Physician will work
together to find the most effective care for you.
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Continuing for 2014 – Drug Management Programs
 Drug Quantity Management
• Aligns dispensed quantity of prescription with FDA-approved
dosage guidelines
• Eliminates wasteful spending – ensures the most cost
effective product strength is dispensed
• For example, if a Member receives two monthly prescriptions
for a low dose of one medication, s/he could achieve the
same outcome with one monthly prescription at a higher dose
Drug Quantity Management can help you
eliminate multiple co-pays
for Brand name medications.
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LSU First Review of
Current Benefits
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Important Plan Features
 Remember, once your Health Reimbursement Account (HRA) dollars are
exhausted:
 LSU First pays 100% for covered services from First Choice Providers
 LSU First pays 100% for generic drugs
 Remember, LSU First pays $5,000 for Critical Illness Benefits
 Stroke
 Major Organ Transplants
 Heart Attack
 Renal Failure
 Invasive Cancer
 Coronary Artery Bypass Surgery
 Remember, LSU First reimburses your Transplant-related travel expenses
for you and one dependent up to $10,000
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Important Plan Features
 Remember, Free Preventive Care with First Choice and In-Network
Providers without using HRA dollars
 Routine Preventive Care
 Well-Baby Care and Well-Child Care
 Annual Wellness exam for adults
 One routine vision exam per Plan Year
 Immunizations
 Based on age and gender
 Routine Mammogram, PSA, Pap Smear
 Based on age and gender
Visit LSU First at www.lsufirst.org for more Wellness information
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LSU First Website
 www.lsufirst.org
 See your medical and
pharmacy claims and
account information
 Search for First Choice and
Verity network providers
 View Summary of Benefits
and Coverage
 View complete Summary
Plan Description
 Download claim and
reimbursement forms
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Assistance and More Information
 LSU First Website:
 www.lsufirst.org
 E-mail
 LSUFirstinfo@lsu.edu
 Call an experienced Member Advocate
 1-866-607-5325 or 225-906-1275
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Questions
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