Gray & Troy Insurance Services, Inc.

Two versions of the generic brand for Lipitor are now available, resulting in a few changes for Anthem and Blue Shield members:

When Atorvastatin, the generic brand for Lipitor became available November 30^th, Anthem Blue Cross announced it would remain on tier 2 until another version of the generic drug became available.

Since the release of the second version on December 5^th, the brand name Lipitor drug has moved to tier 3. Availability and cost of the brand-name drug varies amongst plans.

According to Blue Shield, the price of generic Lipitor is expected to remain high because only two manufacturers have exclusive rights to the generic drug. As a result, Blue Shield has implemented a program providing coverage of brand name Lipitor at a generic copayment for most commercial members from November 30^th, 2011 to May 28, 2011.

** For specific questions pertaining to your plan, please contact us.

Unless an agreement is reached between Express Scripts and Walgreens before the end of the year, Walgreens will be leaving the network on January 1, 2012. If you’re insured through a carrier using the Express Scripts network, members should take action to move their prescriptions to another in-network before December 31^st, 2011. Read more at Anthem Blue Cross.

Lucile Packard Children’s Medical Group and Lucile Packard Children’s Hospital are back in the Blue Shield of California networks. A new two-year contract was signed between the providers effective October 20, 2011. The Packard providers were not in Blue Shield of California’s networks from August 31^st through October 19^th.

The new agreement was not predated to the date of termination, and therefore, services provided August 31^st – October 19^th, 2011 are considered out-of-network.

Learn more about Blue Shield of California’s contract with Lucile Packard Pediatric Providers.

To limit net income to 2 percent of revenue, Blue Shield of California announced in mid-October that the company will return approximately $295 million to its customers and community by December 31^st.

The following is an approximation of how the reimbursements will be allocated.

• $283 million will be credited back to individuals, fully-insured group customers, and share-risk policyholders. Credit amounts will be determined based on a percentage of their August 2011 dues and/or premiums.
• $10 million in funding will be given to provider groups that applied for grants to help them participate in Accountable Care Organizations (ACOs) after the last Blue Shield pledge announcement.
• $2 million will support community grants.

Learn more about Blue Shield of California’s 2 percent pledge

Anthem has reached a multi-year agreement with Stanford University Hospital and their physicians.  The contract will be dated effective September 1, 2011, leaving no lapse in member coverage.

Stanford Hospitals had terminated their commercial hospital and professional agreements with Anthem Blue Cross, effective September 1, 2011.  Since that time, both parties had been engaged in active negotiations.

For more information visit Stanford Hospital & Clinics

As of September 1, 2011, Stanford Hospital and Clinics have terminated their contracts with Anthem Blue Cross (“Anthem”).  This termination also includes Stanford Medical Group, Lucile Salter Packard Children’s Hospital, and Menlo Medical Clinic.  The terminations of these contracts came after months of negotiations between Anthem and Stanford Hospital and Clinics.

The news of this contract termination affects many of Anthem’s members, including members on the central coast.  As your agents, we are committed to keeping you up to date on this issue and would like to clarify what benefits and options are available to Anthem members.  Stanford Hospital and Clinics are stating that Anthem member’s claims will be honored as an “in-network” benefit (Stanford Hospital – For Anthem Patients) This sounds like a great benefit to the member, but in reality, Anthem will be paying 0% towards a claim at a “non-contracted” facility.

In a nutshell, Stanford will be charging the member the negotiated rate, but Anthem will be paying nothing.  This could end up costing the member much more than originally anticipated.  Another thing that should be taken into consideration is lab work and outpatient services done at Stanford Hospital and Clinics, such as MRI’s, CT scans, lab work and x-rays.  The same type of claims payment, or lack there of, will be applied if the member goes to one of these “non-contracted” facilities.

Due to the fact that there are so many variables in play, we suggest that you contact us directly with any questions regarding the “non-contracted” Stanford Hospital and Clinics or when a member is considering using one of these facilities.

Please be aware that this does affect all Anthem Blue Cross contracts such as individual, small group, large group and government contracts, including CalPERS for example.  This does not affect Medicare supplement members.  This news may affect employees and/or their spouses, so we suggest sharing this information with your employees as well.

We will continue to update you on this issue as more information becomes available.

For a list of participating Anthem providers, please visit Anthem Provider Lookup. For more information and facts from Anthem, please see Anthem Blue Cross Stanford and Lucile Hospital and PPO Physician Post Term FAQ 09-14-211

Please contact Gray & Troy Insurance at (805) 540-7010 with any questions or concerns.