Excellus BCBS Broker News Vol. 19 No. 11

Incorrect ID Card Mailing Impact

Excellus BCBS has identified that incorrect ID cards were recently mailed out to some small groups. Since ID cards are mailed in batches, not all small group members would have received an incorrect ID card. They are working promptly to reissue ID cards for those affected. A slip will be included with the new ID cards notifying members to discard the previous ID cards. The issue was the result of an internal error, and a fix was put in place on November 6, 2024. The Excellus processes have been updated to ensure this does not happen again.

If you have any questions, please reach out to your account manager.

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REMINDER: Gag Clause Prohibition Attestation Under the Consolidated Appropriation Act

As a reminder, Excellus BlueCross BlueShield (Excellus BCBS) will be completing the attestation on behalf of fully insured and minimum premium groups for the time they had Excellus BCBS coverage in 2024. If any additional information is required to submit the attestation, they will work with you and the group to obtain it.

If you receive any gag clause attestation inquiries from these groups, please let them know Excellus BCBS will be completing the attestation on their behalf by the due date of December 31, 2024.

For self-funded groups, Excellus BCBS will supply a Certificate of Compliance that they can use to file directly with CMS. Account managers of self-funded groups will provide the Certificate of Compliance via email on or around November 15, 2024.

Read More Here

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Healthy New York - New Group Application and Recertification Form

The new Healthy New York – New Group Application and Recertification Form is now available for brokers and small groups.

The New Group Application should only be used when a small group is applying for a standalone Healthy New York plan, or when applying for Healthy New York along with another commercial plan.   

The New Group Application can be found online at New Group Paperwork | Brokers | Excellus BlueCross BlueShield.

The new form will be required for all new Healthy New York business use as of April 1, 2025, instead of the DFS HNY New group application. If a group does use the DFS HNY New group application before the cutoff date, please ensure they also complete the Healthy NY Eligibility Policy form.  

The Recertification Form can be found online at Renewal Group Paperwork | Brokers | Excellus BlueCross BlueShield.

Please complete the recertification form in its entirety. It is important that the form is fully completed to be able to process recertifications in a timely manner.

If you have any questions on the Healthy New York – New Group Application or Recertification Form, please contact your account manager or dedicated underwriter.

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Health Status Questionnaire

Excellus BCBS encourages all plan members to complete a health status questionnaire upon enrollment and annually thereafter. This information is used to identify members who may need care right away and are eligible for health care services that may be beneficial to them. Case managers may reach out to these individuals to create an individualized plan to maintain or improve their health status.

The health status questionnaire can be accessed through the ThriveWell℠ platform. If a member does not have access to the digital platform, they may request a paper survey by calling case management at 877-222-1240.

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December Wellbeing Tip: Self Care & Seasonal Blues

While the holiday season can be a time of joy, it may bring added stress, anxiety, and depression for some people. According to the American Psychological Association, nearly 9 in 10 (89%) of U.S. adults say that concerns such as financial pressure, family conflict, and missing loved ones cause them stress during the holidays. That’s why, during the holiday season, it is important to practice self-care.

Self-care refers to the intentional practices and activities that individuals engage in to maintain or improve their mental, physical, and emotional wellbeing. Self-care can help manage “seasonal blues” and is essential for maintaining emotional wellbeing. It can help people adapt to changes, build strong relationships, and recover from setbacks. From a physical health perspective, self-care also reduces the risk of heart disease, strokes, and cancer.

There are several ways that you can prioritize self-care this holiday season. For example, know and respect your limits. For many, the holidays are one of the busiest times of the year. It’s okay to say no to extra obligations that fill up your schedule. Focus on activities that bring you joy and relaxation. By prioritizing self-care, you can prevent “seasonal blues” and boost mental wellbeing.

The December Resources (ZIP) includes materials that can be shared with your groups.

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Smart RxAssist is Now HelpScript!

In July, Excellus BCBS announced a partnership with Smart RxAssist to help maximize savings available from drug manufacturer assistance programs. This program provides financial relief to self-funded employer groups and decreases out-of-pocket costs for medical specialty drugs.  

This program will now be called HelpScript. The new name represents the ongoing commitment to helping members save on prescriptions covered under their medical benefit.

Through HelpScript, members will continue to experience the same simplicity, support, and savings as they have known through Smart RxAssist.  The new name reflects a fresh look and renewed focus. This change will not impact program functionality and will only impact the program name.

Members who were enrolled in Smart RxAssist will receive a letter from HelpScript that includes answers to frequently asked questions.

The updated brochure and a copy of the member letter are now available.

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Improving the Affordability of Pharmacy Care Webinar Now Available

Most of us know the upward trend of health care costs is expected to continue, impacting both employers and individuals. High prescription drug prices, increases in outpatient procedures, and more members needing high-cost hospital care are challenging health plans, employers, patients, and the entire health care system.   

With that in mind, Excellus BCBS wants to make sure groups and members are getting the most from their pharmacy benefits and are aware of everything that is offered through Excellus BCBS.  

If you missed the recent Beyond the Buzz: Improving the Affordability of Pharmacy Care webinar you can log in to the Sales Hub to watch! They also have a new blog available that can be shared with groups: “How You Can Support Your Team with the Rise of Health Care Costs: Pharmacy Programs”.

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Excellus BlueCross BlueShield Humira and Biosimilar Formulary Updates for 2025

Biosimilars represent one of the biggest opportunities to improve access and affordability for our community. Excellus BlueCross BlueShield (Excellus BCBS) has advocated for the use of biosimilars since 2018 when they were the first standalone health plan to prefer a biosimilar in a major drug category. Today they include biosimilars in all 10 drug categories in which biosimilars are available.

Humira™ (adalimumab) is the top-selling pharmaceutical in the world, indicated for many autoimmune, rheumatologic, and gastrointestinal diseases. The first Humira biosimilar launched in 2023. Now, 18 Humira biosimilar versions are approved in the US.

Excellus BCBS offers multiple formulary options for large employer groups, dependent on the funding agreement. In 2024 Excellus BCBS commercial formularies preferred biosimilars Cyltezo® and Hadlima along with the reference drug Humira.

For 2025:

• The low wholesale acquisition cost (WAC) biosimilar Simlandi® has been added as a preferred biosimilar. Simlandi is an interchangeable biosimilar which means pharmacies can dispense Simlandi instead of Humira without prior physician approval.
• Hadlima will remain preferred; it is available in both high and low concentrations and has a low wholesale acquisition cost.
• Humira will remain preferred.
• Cyltezo will no longer be preferred.

Due to natural conversion over to the interchangeable biosimilar, Simlandi, and the competitive contracting on Humira, Excellus BCBS believes that retaining Humira on the formularies maintains member stability.

This strategy applies to 3 Tier Open, Preferred Value Formulary and Exchanged Closed Formulary. All three drugs Humira, Hadlima, and Simlandi will be Tier 2 in 2025.

Through the partnership with Express Scripts (ESI), Excellus BCBS also offers the National Preferred Formulary (NPF) to self-funded employer groups:

• Effective January 1, 2025, Humira will be excluded for new members.
• Effective July 1, 2025, Humira will be excluded for all members.
• The NPF has both high and low WAC biosimilars as preferred. They include Adalimumab-adaz by Sandoz, Adalimumab-adbm by Quallent, Adalimumab-ryvk by Quallent, Cyltezo, and Simlandi.

Clients will continue to see savings from the increase in competition the biosimilars have brought for whichever formulary is chosen.

Biosimilars are safe, effective, Food and Drug Administration (FDA) approved medications. Adding biosimilars to the list of medications covered by health plan gives members who need these types of medications a choice, increasing the communities’ access to the affordable medications.

To learn more about biosimilars see Preparing for the Biosimilar Landscape  - Excellus for Business.

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