Updated: Product Portfolio and Benefit Design Updates, Effective October 1, 2009

In the June issues of Important Administrative Information and BlueLinks eNews, we included a chart detailing the standard plan design changes that will become effective on October 1, 2009. An updated Standard Plan Design Changes chart is now available to you online, which replace the chart that you received last month.

The following is a list of updates that have been made to the Standard Plan Design Changes chart:

• The ER copayment for HMO Blue Value^SM with BasicRx is $150, NOT $100
• The ER copayment for HMO Blue Value Plus^SM is $100, NOT $150
• The ER copayment for Network Blue^® $10 Copayment is $100, NOT $150
• The following plans have been removed from the chart:
  • Network Blue Options $500 Deductible
  • Network Blue Options $1,000 Deductible
  • Network Blue New England Options^SM $500 Deductible
  • Network Blue New England Options $1,000 Deductible
  • Blue Care Elect^SM $4,500 Deductible
  • There is no high-tech radiology benefit change to the Preferred BlueSM 80 with Copayment plan
• There is a high-tech radiology benefit change to the Advantage Blue^® plan

Please review the Product Portfolio and Benefit Design Update brochure and the updated Standard Plan Design Changes for a detailed overview of the benefit design updates. We apologize for any inconvenience. If you have any questions about the plan changes, please contact your account executive.

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Regulatory Updates

Health care reform is on the minds of legislators from Beacon Hill to Capitol Hill. As a valued business partner, we feel it is essential to help you stay current on the progress of both Massachusetts and national health care reform. In keeping with this effort, we are posting weekly summaries of the news and events in national health care reform to BlueLinks for Brokers. To read these updates and learn more about Massachusetts and national health care reform, visit the Regulatory Updates section of BlueLinks for Brokers.

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Mini-COBRA Subsidy Amendment

As you may know, the American Recovery and Reinvestment Act (ARRA) includes a mini-COBRA subsidy provision for employees involuntarily terminated between September 1, 2008 and December 31, 2008. On July 2, 2009 an amendment to the Massachusetts mini-COBRA statute was signed into law, providing an additional election period for Massachusetts mini-COBRA to individuals that may be eligible for the subsidy under ARRA. A letter is being mailed to all accounts that may be subject to Massachusetts mini-COBRA, informing them of an important employee notification requirement. Accounts are being instructed to immediately notify affected employees of this continuation of coverage election provision and forward the requested information to Blue Cross Blue Shield of Massachusetts in order for us to apply the subsidy to their bills.

The account letter is expected to be mailed during the week of July 27, to insured groups that may be subject to mini-COBRA. Generally, insured groups with 2 to 19 employees (that are not otherwise subject to federal COBRA) are subject to Massachusetts mini-COBRA, but we are including groups of 1 in the mailing in the event that they are subject to mini-COBRA.

You can view the mini-COBRA account letter and forms right now at www.bluecrossma.com/broker and www.bluecrossma.com/employer.

Please contact your account executive or account service representative if you have any questions.

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September 1, 2009 Pharmacy Updates

In our continuing effort to provide high-quality, affordable prescription medication benefits to all of our members, we have made some changes to our pharmacy program. These changes are based on clinical guidelines and recommendations from our Pharmacy and Therapeutics Committee, which is made up of independently practicing physicians and pharmacists who are not employed by Blue Cross Blue Shield of Massachusetts. The following changes are effective September 1, 2009:

1. Institution of Step Therapy for Certain Medications
Step therapy is a key part of our prior-authorization program, which allows us to assist physicians with appropriate and affordable drug treatments. Before Blue Cross Blue Shield of Massachusetts will pay for certain costly Step 2 medications, the member must first try an effective, but less expensive Step 1 medication. Certain medications may require multiple steps before authorization is granted.

We are adding a step-therapy policy for certain drugs used in the treatment of Parkinson's disease. The following is a list of the medications that will be included in step-therapy program, effective September 1, 2009:

Drugs Used in the Treatment of Parkinson's Disease

• Step 1: Ropinirole
• Step 2: Requip, Requip XL, Mirapex

2. New Prior-Authorization Requirements
For certain medications, prior authorization is required. It is generally required in cases where the patient must meet certain medical-necessity criteria in order to receive coverage.

The following is a list of medications that will have a prior-authorization requirement, effective September 1, 2009:

• Actiq
• Amitiza
• Banzel
• Fentanyl
• Fentora

3. Pharmacy Medical-Policy Updates
The following medical policies will become effective on September 1, 2009:

For more information on any of the programs mentioned above, please visit our website at www.bluecrossma.com/pharmacy.

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New Prior-Authorization Requirement for Select Medications

Effective October 1, 2009, certain drugs that are provided under the medical benefit will now require prior authorization for HMO/POS plans. This change is to ensure that drug utilization is consistent with current medical policy guidelines for safety and effectiveness.

Providers will be asked to submit requests for authorization, including demographic and relevant clinical information, prior to administering these medications. Providers will submit the necessary information for review using an Express Scripts^®'', Inc. web-based tool. Requests meeting Blue Cross Blue Shield of Massachusetts criteria will be approved immediately via the web, while requests requiring further clinical review will be forwarded to Blue Cross Blue Shield of Massachusetts. In addition, providers can also submit requests for other drugs that require prior authorization that are provided under the pharmacy benefit using this web-based tool.

Below is a list of the medications that are affected by this change:

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Early Intervention State-Mandated Change, Effective July 1, 2009

Effective July 1, 2009, the annual and lifetime dollar benefit maximums for medically necessary early intervention services for an enrolled child from birth through age two furnished by an early intervention provider will be removed. This state-mandated change is being applied to all insured group and non-group plans and administrative services contract (ASC) 32B accounts, excluding Medicare Advantage, Medex^®', Medicare Supplement plans, and Managed Blue for Seniors^SM effective on a one-day change as of July 1, 2009.

For ASC accounts, with the exception of ASC 32B accounts, we will begin to apply this benefit change beginning with October 1, 2009 renewals, unless the account declines the benefit. Benefit descriptions will include language about the mandated early intervention benefit change as of the employer's account renewal date, beginning on or after October 1, 2009.

If you have any questions about the early intervention mandate, please contact your account executive.

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Blue Care Connection^® Program Update

At Blue Cross Blue Shield of Massachusetts, we continuously evaluate our disease management programs to identify strong value-based opportunities designed to generate clinical quality improvements and a positive impact on medical expense savings. With this in mind, we are writing to inform you of the following changes to our Blue Care Connection programs, effective August 1, 2009.

The Blue Care Connection programs that support members with seizure disorder and hemophilia will be discontinued. Members with these conditions will be supported as appropriate by our internal case management and medication adherence programs as well as our pharmacy programs.

For certain disease management programs, Blue Cross Blue Shield of Massachusetts has determined that telephonic coaching is a more effective approach to engage our members in understanding their individual health issues. Therefore, we will no longer offer the "mail only" option to members who are receiving support for any of the following conditions:

• Rheumatoid arthritis
• Multiple sclerosis
• Parkinson's Disease
• Systemic lupus erythematosus (SLE)
• Myasthenia gravis
• Sickle cell disease
• Cystic fibrosis
• Scleroderma
• Polymyositis
• Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
• Amyotrophic lateral sclerosis (ALS)
• Dermatomyositis
• Gaucher's disease

If a member elects to receive telephonic support from a nurse coach, he or she will continue to receive educational materials by mail for support in the coaching process. Impacted accounts and members will receive a letter notifying them of these changes.

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New Retail Pharmacy Network Options Now Available for Fully Insured Health Plans

In January 2009, Blue Cross Blue Shield of Massachusetts introduced two additional cost-saving national pharmacy network options for self-funded employers. These options are now available for fully insured groups with more than 50 employees.

These pharmacy networks, which are administered by our pharmacy benefits manager, Express Scripts, Inc. (ESI), are known as The Select Network and The Select Choice Network.

The Select Network reduces pharmacy costs through a smaller network of retail pharmacies. Members are required to utilize a retail pharmacy in this smaller network which delivers improved unit cost pricing compared to Blue Cross Blue Shield of Massachusetts' traditional retail pharmacy network.

The Select Choice Network provides members with choice while reducing overall pharmacy costs through incentives for members to use lower cost designated pharmacies within Blue Cross Blue Shield of Massachusetts' traditional broad network of retail pharmacies. The designated pharmacies have improved unit cost pricing that allows members to pay a lower cost share when they choose to purchase a prescription at one of these pharmacies. Members also have the choice of purchasing their prescription at any of the other network pharmacies that participate in our traditional broad retail network, but they will pay a higher cost share for their prescriptions.

To view the national pharmacy directory for each of the network options please visit our Pharmacy Networks section. Contact your account executive for more information.

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BlueLinks for Employers Redesign

As part of our ongoing commitment to provide employers with quick and easy online access to applications and tools, important health care news, and product updates, we will launch the enhanced BlueLinks for Employers website on August 1, 2009. In addition to a new user-friendly design, your clients will enjoy:

• Streamlined navigation that puts key information and transactions at their fingertips, such as enrollment manager, ebills, and account reporting
• Centralized access to administrative forms, applications, and tools
• News & Updates to help employers stay informed
• Member Tools & Resources, which outlines the programs, benefits, and engagement tools available to members

We encourage you and your clients to check it out. Contact your account executive to learn more.

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Enhancements to the Blue IQ^SM Communications Center

The Blue IQ Communications Center offers a range of tools to help employers engage their employees in their health and health coverage. With the Blue IQ Communications Center, you and your clients can promote a healthy corporate culture, download and distribute custom employer-branded communications to employees, and guide employers and employees through every facet of their Blue Cross Blue Shield of Massachusetts coverage. Recent enhancements to Blue IQ include:

• New health articles for custom newsletters
• A Dental section featuring downloadable articles and product materials
• New worksite wellness program kits that give you a complete and simple solution to helping employees get healthier
• Downloadable Quick Start guides for a range of products
• A comprehensive Health Fair Planning Guide
• Tips for organizing wellness programs, including employee surveys and more

Discover the value that the Blue IQ Communications Center can offer your clients today.

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If the above links are not functioning in your email, copy and paste the URLs listed below into a browser window:

BlueLinks for Brokers
http://www.bluecrossma.com/bluelinks-for-brokers/

Standard Plan Design Changes chart
http://www.bluecrossma.com/bluelinks-for-brokers/pdf/enews/07-2009/92805.pdf

Product Portfolio and Benefit Design Update brochure
http://www.bluecrossma.com/bluelinks-for-brokers/pdf/enews/07-2009/90678.pdf

Regulatory Updates on BlueLinks for Brokers
http://www.bluecrossma.com/bluelinks-for-brokers/news-updates/regulatory-updates/index.html

Blue Cross Blue Shield of Massachusetts Pharmacy website
http://www.bluecrossma.com/pharmacy

Pharmacy Networks on BlueLinks for Brokers
http://www.bluecrossma.com/bluelinks-for-brokers/products/pharmacy-networks.html

Blue IQ
http://www.bluecrossma.com/blueiq