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Teamsters Local 631
Security Fund
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Teamsters Local 631 Security Fund for Southern
Nevada
P.O. Box 26509
Las Vegas, Nevada 89126-0509
TO : ALL INDEMNITY PLAN
PARTICIPANTS
FROM : BOARD OF TRUSTEES
DATE :
April 2005
Important Notice
Summary of Material Modification
What's New
¨
CHANGE IN PRE-AUTHORIZATION & UTILIZATION REVIEW
¨
UPDATED FORMULARY LIST
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SUMMARY ANNUAL REPORT
Click here to access report
The following
plan changes have a direct impact on all Indemnity Plan Participants. We
urge you to read this notice carefully and familiarize yourself with the
changes and updated material.
CHANGE IN PRE-AUTHORIZATION AND ULITIZATION REVIEW ORGANIZATION
REMINDER!!!
Effective February 1, 2005, the
Pre-Authorization/Utilization Review Organization changed from Healthcare
Strategies to Beech Street
Corporation.
Beginning
February 1, 2005, you and
your physician must contact Beech
Street Corporation at
1-800-407-1228
to obtain the required medical review pre-authorization for all hospital
admissions, all outpatient surgeries and for all diagnostic tests and
laboratory work exceeding $500.
Please note: IF
Medically necessary services are provided without prior authorization, your
benefits will be reduced to 50% of covered charges.
No benefits will be provided for any days of
confinement or services or supplies determined to be not medically necessary
by the medical utilization review organization.
UPDATED FORMULARY LIST FOR PRESCRIPTION DRUGS
Enclosed is an updated Express Scripts formulary
list. Remember that you pay only 20% in co-payment for brand name drugs
that are on the Express Scripts formulary at retail pharmacies (20% instead
of 50% for brand-name drugs at retail, or $30 instead of $60 for brand-name
drugs filled by mail-order). Be sure to check the list to make sure that
any medications you are currently taking continue to be part of the
formulary. If not, talk to your doctor to find out if it is possible to
switch to a formulary drug. Always bring a copy of the formulary list with
you to your doctors’ appointments.
On January
27, 2005 the National Pharmacy and Therapeutics Committee provided decisions
on the following medications:
|
Drug Name |
National
Preferred Formulary |
Use |
|
Campral |
Non-Formulary |
Abstinence
from Alcohol |
|
Enablex tablet |
Non-Formulary |
Overactive
Bladder |
|
Fosrenol
Tablet |
Non-Formulary |
Reduction of
Serum Phosphorous in patients with End-Stage Renal Disease (ESRD) |
|
Lunesta Tablet |
Non-Formulary |
Insomnia |
|
Luveris
Injectable |
Non-Formulary |
Infertility |
|
Palladone
Capsule |
Non-Formulary |
Persistent,
Moderate to Severe Pain |
|
Sanctura
Tablet |
Non-Formulary |
Overactive
Bladder |
|
Tarceva Tablet |
Formulary |
Advanced or
Metastatic Non-Small Cell Lung Cancer (NSCLC) |
|
Vesicare
Tablet |
Non-Formulary |
Overactive
Bladder |
The
above-referenced drugs will be updated as indicated on the Express Scripts
Inc. National Formularies effective March 15, 2005.
SUMMARY ANNUAL REPORT
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