Beginning January 1, 2010, Horizon Blue Cross Blue Shield of New Jersey will implement a new formulary for prescription benefits for members of your employer-sponsored health plan.

WHAT THIS MEANS TO YOU AS AN EMPLOYEE?
The new Advantage Formulary is an update to the prescription benefits that are a part of your employer-sponsored health plan. This incorporates Utilization Management (UM) programs and prior authorization processes which require you, a member of an employer-sponsored health plan, to try a first tier medication. Many of the first tier prescription drugs are generic drugs. Select brand name drugs will be covered after a first-tier medication has been tried.

The types of therapies included under the Advantage Formulary that would trigger prior authorization include, but are not limited to:

• Proton pump inhibitors (Aciphex, Kapidex, Nexium)
• Antihistamines/Combinations (Xyzal, Allegra D)
• Nasal steroids (Veramyst, Nasacort AQ)

If a physician determines that a non-preferred drug is medically necessary due to the
ineffectiveness or documented intolerance to a generic, the physician can request approval for the non-preferred drug to be covered.

WHAT SHOULD I DO NEXT?
If you or a family member have questions about this notice or your prescription benefits, please feel free to reach out to your BenefitsVIP team for assistance. As your employer’s broker, Corporate Synergies will continue to closely monitor this issue and will keep participants informed of any additional changes as they occur.

Corporate Synergies is pleased to provide regular updates on issues affecting group benefits insurance. As an insurance broker and consultant, Corporate Synergies monitors federal and state legislative and regulatory activity to ensure that you stay informed.