Text Size:   A+ A- A   •   Text Only
Find     
Public Employees' Benefit Board

April 2010
Download the Newsletter

Download the April newsletter.
 
Choose your paper size:
 
 

Using Your Formulary

 
 
Choices and costs
 
Your formulary gives you and your doctor choices in effective, affordable treatment. In PEBB plans, member cost is lowest for generic drugs; higher for brand-name formulary drugs; and highest for non-formulary brand-name drugs. Most drug classes for most common conditions include generic alternatives with a history of good outcomes.
 
New prescriptions
 
When your doctor prescribes a new medication, ask questions to make sure it’s right for you:
 
  • Why are you prescribing this drug?
  • What should I expect from it?
  • Is it on my plan’s formulary?
  • Are there other effective alternatives?
Long-term treatment
 
If you’re taking a medicine long-term, check your formulary before you get a refill. If it’s no longer on the list, talk to your doctor about effective alternatives.
 
Prior authorization
 
Some prescriptions must be authorized by the plan before they’re covered. Reasons include medical necessity, place of therapy, length of therapy, step therapy or number of doses. Your provider can submit a prior-authorization request to the plan, describing why you require the drug.
 
Specialty drugs
 
Specialty drugs need special handling. This may limit you to 30-day supplies from a specific supplier. For Providence plans, it’s Providence Specialty Pharmacy, 800-772-7053, ext. 54535.
 
 

Federal Legislation
US Capitol
 
Aspects of recently enacted federal legislation on health care will affect group health plans, including those in the PEBB program.
 
For example, the legislation requires plans to extend coverage for dependent children to age 26. PEBB plans currently offer coverage for qualified dependents to age 24.
 
Your Benefit Board is working to ensure the program complies with this and other requirements. PEBB’s Web site, newsletters and e-mails will keep you up to date on any changes to your benefits.
 
The Oregon Health Authority will provide more information on the impact of this legislation on Oregon and how the Authority is moving forward to improve health; lower costs; and improve access, quality and reliability of care.
 
 

Do you know a child who needs healthcare?

If you know parents who can’t afford health insurance for their children, tell them about Oregon’s new Healthy Kids program.
 
Depending on family income, the kids may be eligible for free or low-cost health coverage for doctor visits, dental care, vision care, prescription medicines and more.
 
Tell them to call 503-540-8463 or 800-452-2146, ext.163 or 186.

Keep on Track
 
Whether you run regular marathons or just walk the dog for exercise, your health plan has resources to help you start and stay on track with a fitness routine.
 
Members in the Statewide Plan and Providence Choice can sign up for MyLifeBalance. This online program includes a number of personalized activity tools:
  • An Activity Planner to help you plan your weekly exercise and activity regimen
  • An Activity Tracker that helps you track and calculate your results
  • A Walking Tracker & Journal for step counting, goal setting and progress monitoring 
 
The Healthy Lifestyle Program helps Kaiser Permanente members supercharge their success with a personalized online program to reach their health goals. Register for the program.

Quitting Tobacco isn't a Walk in the Park
 
When you’re ready to quit, you don’t have to do it by yourself. The Quit For Life® Program will provide the support you need to help make your next quit your last.
 
It’s free. It’s confidential. It works. 866.QUIT.4.LIFE (866.784.8454). www.quitnow.net/pebb.
 
Kaiser Members: Call the "Talk with a Health Coach" service at 503-286-6816 or 866-301-3866; select Option 2. Tell them you’re a PEBB member and want the PEBB benefit.
 

Compare Quality Care
 
Your Benefit Board wants you to have quality care that improves outcomes.
 
A new Web site lets you see quality scores for doctors’ offices and medical groups in every part of the state. 
 
The site uses quality indicators such as how many people with diabetes get the blood tests they need and how many women get appropriate screenings for breast or cervical cancer. You can see if your doctor’s office performs better than average, average or below average compared with other practices.
 
The site has data for hundreds of adult primary care providers in offices that have at least four providers. It also links to helpful guides on getting quality care:
  • What to do before, during and after your appointment
  • Tips to help you get care that works the best
  • Tips for staying healthy
  • How to find trustworthy health information on the Web
The site is a program of Partner for Quality Care: Information for a Healthy Oregon, managed by Oregon Health Care Quality Corporation.

Connect with Your Benefit Board


Resources

PEBB    
(503) 373-1102, fax (503) 373-1654      
Medical Plans Mail-order Prescriptions    Dental Plans Optional Plans Other Benefits