Your Key to the 1199SEIU Benefit Funds 330 West 42nd Street New York, NY 10036-6977 Presorted Standard U.S. POSTAGE PAID New York, NY Permit No. 3700 SPRING 2009 Do We Have Your Current Information on File? Help us make sure our members have the most current, accurate in- formation about our provider net- work. Check our online directory at www.1199SEIUFunds.org to verify your information. If we do not have your cur- rent information, complete a Provider Demographic Change Request form, available on our website under “Forms and Resources.” Personalized Medicine Program Helps Pinpoint Best Treatment Plans As you know, familiarity with a patient’s genetic make-up is helping many physicians optimize breast cancer therapies and manage anticoagulant drugs more effectively. And because we value the quality of care that you provide to our members, we’re giving you access to this tool as well. Our new Personalized Medicine Program helps our providers determine drug therapies with greater precision by giving you access to one of the latest medical approaches. Beginning April 1, through a simple cheek- swab diagnostic test, you will be able to better assess how effective warfarin and tamoxifen will be in treating an 1199SEIU patient. With this knowledge in hand, you’ll have a deeper understanding of the patient’s ability to use or metabolize the drugs, leading you to more finely tuned treatment plans and prescription doses. Before prescribing one of these medications, contact Medco and request a cheek-swab test. Medco will also reach out to you directly about testing if one of your patients submits a prescription for either warfarin or tamoxifen. Medco will send a test called MedMatch to your patient, who will complete it and return it to the lab. And when the results are ready, they’ll be sent to you. There is no cost to you or to our members for participating in the Personalized Medicine Program. The pro- gram is voluntary, but we encourage you to take advantage of the tools we provide, so that together we can uphold the high standards of care our members enjoy. To contact Medco regarding warfarin prescriptions, call: Medco Therapeutic Resource Center (800) 838-5233 9:00 am to 5:30 pm, Monday to Friday Physician fax: 1-800-837-0959 To contact Medco regarding tamoxifen prescriptions, call: Medco Therapeutic Resource Center (800) 240-8144 8:00 am to 6:30 pm, Monday to Friday Physician fax: 1-800-837-0959 And as always, to contact the Benefit Fund with questions or for information regarding our new Personalized Medicine Program, you may call our Provider Call Center at (646) 473-7160.
Transcript
Your Key to the 1199SEIU Benefit Funds
330 West 42nd StreetNew York, NY 10036-6977
Presorted StandardU.S. POSTAGE PAID
New York, NYPermit No. 3700
Spring 2009
Do We Have Your Current Information on File?
Help us make sure our members
have the most current, accurate in-
formation about our provider net-
work. Check our online directory at
www.1199SEIUFunds.org to verify your
information. If we do not have your cur-
rent information, complete a Provider
Demographic Change Request form,
available on our website under “Forms
and Resources.”
Personalized Medicine Program Helps Pinpoint Best Treatment PlansAs you know, familiarity with a patient’s genetic make-up is helping many physicians optimize breast cancer therapies and manage anticoagulant drugs more effectively. And because we value the quality of care that you provide to our members, we’re giving you access to this tool as well.
Our new Personalized Medicine Program helps our providers determine drug therapies with greater precision by giving you access to one of the latest medical approaches. Beginning April 1, through a simple cheek-swab diagnostic test, you will be able to better assess how effective warfarin and tamoxifen will be in treating an 1199SEIU patient. With this knowledge in hand, you’ll have a deeper understanding of the patient’s ability to use or metabolize the drugs, leading you to more finely tuned treatment plans and prescription doses.
Before prescribing one of these medications, contact Medco and request a cheek-swab test. Medco will also reach out to you directly about testing if one of your patients submits a prescription for either warfarin or tamoxifen. Medco will send a test called MedMatch to your patient, who will complete it and return it to the lab. And when the results are ready, they’ll be sent to you.
There is no cost to you or to our members for participating in the Personalized Medicine Program. The pro-gram is voluntary, but we encourage you to take advantage of the tools we provide, so that together we can uphold the high standards of care our members enjoy.
To contact Medco regarding warfarin prescriptions, call:
Medco Therapeutic Resource Center (800) 838-5233 9:00 am to 5:30 pm, Monday to Friday Physician fax: 1-800-837-0959
To contact Medco regarding tamoxifen prescriptions, call:
Medco Therapeutic Resource Center (800) 240-8144 8:00 am to 6:30 pm, Monday to Friday Physician fax: 1-800-837-0959
And as always, to contact the Benefit Fund with questions or for information regarding our new Personalized Medicine Program, you may call our Provider Call Center at (646) 473-7160.
New Provider Relations Manual Gives You the Answers You Need
Message
from the Executive DirectorAs a participating provider, you help us ensure that our members have access to quality care and services. And part of making sure you can provide the best care means providing you with helpful tools like this newsletter, Provider Connections, to keep you up to date on Benefit Funds news and programs.
In this edition of Provider Connections, you’ll learn about important Preferred Drug List updates and a change in our pharmacy option for our maintenance drug program, The 90-Day Rx Solution. You’ll also read about the new Provider Manual you’ll be receiving shortly, improvements in our Provider Services Call Center and our upcoming Provider Education Program.
As always, we hope you find this newsletter helpful. We value you as a provider and look forward to a continued successful relationship. Should you have any questions, please speak to your Provider Representative, or contact our Provider Relations Department at (646) 473-7160.
Mitra Behroozi
Call Provider Services for Quick Answers
Our Provider Call Center staff is always here
to answer your questions. In fact, last year
we answered more than 600,000 calls and
resolved most of your issues right
away. If you have questions or
need assistance, you can reach
our representatives by calling
(646) 473-7160. Or you can
check claims and eligibility
information 24 hours
a day through our
automated system at
(888) 819-1199.
Pharmacy Options for Our 90-Day Maintenance Mail Order Prescriptions
Help Your 1199SEIU Patients Stay Healthy – Screen for Kidney Disease
A recent report found that cases of kidney disease
are on the rise, especially among African-Ameri-
cans. And while many of our members are African-
American, our claims data reveals that less than
1% of our adult population has been diagnosed
with kidney disease.
That’s why we want you to help us proactively of-
fer regular screenings and tests – such as testing
urine for albumin levels – to our members that can
detect kidney disease early. These tests are cov-
ered by the Funds, and we want to work with you
to ensure at-risk members are tested regularly. So,
please be sure to recommend these life-saving
tests to your 1199SEIU patients.
When our members have medications they must use every
month for chronic conditions such as diabetes, high blood
pressure or high cholesterol, they should use our convenient
90-Day Maintenance Mail Order Pharmacy through Medco.
This “90-Day Rx Solution” helps to protect our members’ ben-
efits while giving them the convenience of either having their
three-month prescription delivered right to their door or picking
up their prescription at a participating pharmacy.
Although Pathmark pharmacies no longer wish to be a participat-
ing pharmacy, 1199SEIU members can continue to use Pathmark
to fill short-term prescriptions up to a 30-day supply. Any three-
month supply of medication can still be ordered through Medco
by Mail or ordered and picked up at a Rite Aid pharmacy in New
York or New Jersey. More than 1,300 former Eckerd pharmacies
in New York and New Jersey are now Rite Aid pharmacies, giving
members more convenient locations to choose from.
Keep an eye on your mail for the 1199SEIU Benefit
Funds new Provider Manual, your one-stop resource for
everything you need to know as a participating provider.
In it you’ll find the Funds’ policies and guidelines on such
topics as covered and non-covered services, member
eligibility, care management, wellness programs and
claims submission.
You’ll notice that we’ve “gone green” with this manual,
providing you with an electronic copy on CD, rather than
a printed book. You can also download a copy of the
manual at our website, www.1199SEIUFunds.org, under
