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Public Employees' Benefit Board

December 2009
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Choose Wisely in 2010
 
While the plan design for 2010 remains the same, you may have new prescription choices based on changes to plan formularies.
Prescription-Drug Plan Design
 
Tier
Description
Cost to Member
Cost to PEBB
1
Generic
Lowest
Lowest
2
Formulary Brand
Higher
Higher
3
Non-formulary Brand
Highest
Highest
 
A formulary is a plan’s unique list of covered drugs that are approved by the Food and Drug Administration (FDA). Formulary determines a drug’s placement on Tier 1, 2 or 3. Formularies may differ among plans and may change over time.
 
Generic Drugs. Formularies include most generic drugs. These drugs are off patent and have a history of positive outcomes. When a generic becomes available, the plan may stop covering the brand. Example: Protonix (generic pantoprozole).
 
Brand Drugs. Plans may differ on which brand drugs they include in their formulary. One may cover Brand X while another covers Brand Z. Covered brands change with changes in the markets. Example: Lipitor and Crestor.
 
Non-prescription Drugs. Plans don’t cover drugs that may be sold without a prescription over the counter (OTC). Example: Prilosec OTC (generic omeprozole).
 
Non-approved Drugs. Formularies don’t include drugs not approved by the FDA, even if they’re prescribed. Example: Levbid.
 
Value Based Drugs. The formulary for PEBB’s Statewide Plan includes a list of value based drugs that have zero co-payment. This removes any cost barrier to care that’s proven to have good outcomes.
 
 
 

Ask About Your Choices
 
You have choices among drugs for most common conditions. Ask your provider if your plan’s formulary covers a specific brand or if there’s a generic version that would work as well for you. Ask if the class of drugs has a value-based choice you can access at low or no cost.

Statewide Plan Transition
Rx
 
If you’re in the Statewide Plan for 2010 and are taking a drug not on the formulary, a plan pharmacist will mail you information and advice on your choices. If you have questions, call the plan’s customer service at (800) 423-9470.
 
NOTE: Members whose providers obtained an exception for them for a non-formulary brand drug will continue to be able to purchase the drug at the Tier-2 member cost.

New ID Cards
 
Members who enrolled in PEBB’s Statewide Plan will receive a new member ID card from the plan. So will others who enrolled in new plans for 2010. The plans will mail the cards in mid-to-late December.
 
Providence Health Plan, the administrator for the Statewide Plan, is working with in-network pharmacies to roll over member records to their new ID number to ensure a smooth transition.
 
Remember to have your ID card with you on your first prescription fill or provider visit in the New Year.

Self-insurance and PEBB
 
FAST FACTS
 
In 2010, PEBB will self-insure about 80 percent of members. This means PEBB pays member claims instead of paying premiums to an insurer.
  • If claims are higher than contributions, PEBB reserves pay the difference.
  • If claims are lower than contributions, the difference goes into PEBB reserves.
  • The reserves are held in the State Treasury.
The Board contracts with administrators for self-insured plans.
  • Providence Health Plans administers medical.
  • ODS administers dental.
  • They process claims and contract for provider networks.
Forty-two states self-insure employee health plans. About 90 percent of workers in firms with 5,000-plus employees are in self-insured plans.

Weight Watchers Success
 
Weight Watchers continues at no cost for principal subscribers in 2010.
 
PEBB members in Weight Watchers at Work have lost a combined total of more than 56,000 pounds in 2009. Many report they not only feel better, but also know they’re healthier. Some have even been able to stop taking medications for long-term, chronic conditions.
 
Read their inspiring success stories.
 
To join or extend participation in December, contact your current plan and ask for your access code. Beginning Dec. 15, go to http://www.mypowwr.com/downloads/PEBB.pdf to register.
 

Connect to Your Benefit Board
 
Connect with Your Benefit Board
Voting members
Suzanne Hoffman, Chair
Rich Peppers, Vice Chair
Peter Callero
Rocky King
Diane Lovell
Paul McKenna
Jeanene Smith
Bret West
Advisory Members
Rep. Tina Kotek
Sen.William Morrisette

Survey Reminder
Survey
PEBB’s annual member survey closes on Dec. 15. This quick, anonymous survey is your opportunity to give important feedback on your benefits.
 
 
If you don’t have Internet access at work, ask your agency for a paper copy of PEBB’s annual member survey.

Resources
 
PEBB oregon.gov/das/pebb    
Benefit Questions: inquiries.pebb@state.or.us
Comments for the Board: pebb.connect@state.or.us   
(503) 373-1102, fax (503) 373-1654      
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