Premera Blue Cross Medicare Advantage 2018 Plan Changes

We're ending our Medicare Advantage partnership with Providence Health Plan this year and will begin a new partnership with Visiant for 2018 open enrollment. Visiant is a subsidiary of Blue Cross Blue Shield of Michigan. They'll take over the same operational responsibilities currently performed by Providence Health Plan.

We selected Visiant because of their expertise and success with Medicare Advantage. The Centers for Medicare and Medicaid Services (CMS) considers Visiant to be a leader in Medicare Advantage plan management and a model for other Medicare Advantage plans.

What do I need to know?

• Providence Health Plan will administer our plans for our 2017 customers through the end of the year.
• Most processes and phone numbers will remain the same. We'll let you know about any changes later this fall.

Western Washington customers will have the same three Medicare Advantage plan options for 2018. Spokane customers will have two plan options for 2018. The options will be Premera Blue Cross Medicare Advantage (HMO) and Premera Blue Cross Medicare Advantage Total Health (HMO), a new plan.

Also starting January 1, 2018, CVS Caremark will be our new pharmacy benefit manager for our Medicare Part D customers enrolled in our Medicare Advantage plans. CVS Caremark will manage administrative services for our Part D pharmacy benefit. This includes prior authorization review and appeals for Part D medications, medication therapy management, service administration, and other clinical support programs.

This change doesn't affect other Premera plans. Express Scripts will continue to manage pharmacy benefits for our commercial lines of business. We made the decision to partner with CVS Caremark for Part D because of the unique needs of our Medicare Advantage plans.

What do I need to know?

• Contact phone and fax numbers for Premera Part D prior authorization and appeal requests will change. We'll update you later this year with this new information.
• Your office may see communication from CVS Caremark sent on behalf of Premera Blue Cross Medicare Advantage plans.
• The Part D drug list and pharmacy network will change. This includes changes to the mail order and preferred specialty pharmacy options for our Part D customers.

What do my patients need to know?

• Formulary changes: Starting December 1, 2017, customers affected by formulary changes can request 2018 prior authorization and formulary exception reviews to determine if they meet coverage requirements. Their providers can also request these reviews. If approved, authorizations will be entered for 2018 coverage of the drug. Some customers may need to get new prescriptions if their medications are no longer covered under their plan.
• Pharmacy network changes: We'll work proactively with our customers to transfer prescriptions to our new mail order pharmacy to ensure no interruption in drug therapy.
• New ID cards for 2018 will include fill information for 2018 prescriptions for our Medicare Advantage plan. Remind your patients to bring their new ID card to the pharmacy when they fill prescriptions for the first time in 2018.
• We are confident this will be a smooth transition for customers and providers with little disruption in care. If there are disruptions, notifications will be sent directly to customers affected by the change.

We'll have a new Medicare Advantage secure landing page and new provider tools. As before, you'll have a separate website to access information for Medicare Advantage customers. The look and navigation will change, but you'll still have access to the same types of tools.

• You'll be able to access 2017 customer information on the previous website until June 2018.
• Once the new Medicare Advantage home page is available, we'll have online guides to help you navigate the site and tools.

How can I learn more about these changes?

We'll continue to provide updates and details regarding Medicare Advantage plan changes through Provider News, email alerts, and through our Medicare Advantage website. To make sure you receive the latest information, be sure you are signed up to receive Medicare Advantage email communication from us. Sign up now!