Benefits and considerations for new GLP-1 weight loss drugs
Weight loss is a complex and often difficult journey for many individuals, prompting the exploration of various strategies and treatments to aid in the process. Among these options is a relatively new class of drugs - glucagon-like peptide-1 (GLP-1) – which include brand names such as Wegovy and Saxenda. Originally developed for management of Type 2 diabetes , GLP-1 drugs have gained attention for their associated weight reduction.
Understanding GLP-1 drugs:
Glucagon-like peptide-1 drugs are designed to emulate the actions of hormones in the body. Primarily used for diabetes treatment, these medications exhibit insulin secretion stimulation as well as curb hunger and slow movement of food through the GI tract which can result in weight loss.
Despite their growing popularity in mainstream culture for weight loss, GLP-1 drugs were not designed as a stand-alone solution for this purpose.
Prior authorization and coverage:
Prior authorization is required in most cases for GLP-1 prescription coverage through Blue Shield. Members and providers should confirm coverage before starting treatment. Some GLP-1 drugs are FDA approved specifically for obesity management, while other GLP-1 drugs are FDA approved only for Type 2 diabetes management. Coverage for members will depend on multiple factors such as body mass index (BMI) and co-morbid conditions, as well active engagement in comprehensive lifestyle modifications.
Prioritizing lifestyle modifications:
A holistic approach to weight loss prioritizes sustainable lifestyle changes, emphasizing healthy habits like a balanced diet and regular physical activity. Any GLP-1 drugs should be regarded as a supplement to lifestyle modifications, complementing, rather than replacing, these fundamental behavioral changes.
Individualized Approach:
Weight loss is a multi-faceted journey that demands an approach tailored to each person's unique needs, preferences, and medical history. Blue Shield of California offers a supportive solution in our innovative Wellvolution platform. Services provided through Wellvolution focus on holistic well-being, including weight management, nutrition, and overall health improvement. With Wellvolution, members can access diverse evidence-based interventions and personalized support to help individuals achieve their weight loss goals. These include seeking guidance from a healthcare professional specializing in weight management, which is crucial to determining the most appropriate action. Such professionals can evaluate an individual's specific circumstances and select the most suitable intervention.
Consideration of side effects:
As with any medication, GLP-1 drugs have potential side effects and safety concerns. Nausea, vomiting, diarrhea, and headaches are common side effects of treatment. Some studies have raised questions regarding potential long-term effects of the drugs on pancreatic and thyroid function. An informed evaluation of the risks and benefits associated with GLP-1 drugs is essential, especially when alternative options are available.
Communications:
Blue Shield conducts regular provider outreach to ensure alignment with our coverage policies and their prescriptions to patients. We also communicate with our members with diabetes or at risk of diabetes to educate them on benefits and services, including care management programs.
Price Check My Rx Tool Offers Cost Control for Commercial Members
Commercial members now have a better way to manage their medication costs online. The Price Check My Rx tool creates a personalized experience with real-time information from the member’s formulary and benefits usage.
Once logged into their Blue Shield account, members can:
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View their active prescriptions and see their current costs.
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See lower-cost alternative options and potential savings specific to the member (if available).
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Perform a price comparison between prescription costs at different network pharmacies.
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Search for any drug and the cost of its brand or generic formulation (if available).
The Price Check My Rx tool will be continually enhanced to provide the best and most efficient user experience. A recent enhancement to the tool allows members to compare medication prices by searching for a new drug and their existing prescription drug in one query. The search result will display the costs and information for both drugs in a single view.
Blue Shield launched the tool to Medicare members in January of this year. So far, more than 9,000 Blue Shield Medicare members have used the tool to confirm their current prescription drug costs and to identify lower-cost alternatives. Be sure to let your clients know about the online Price Check My Rx Tool available now.
Reduce enrollment processing time by 99% with the Employer Enrollment Tool
Shop, quote, enroll, and maintain your Blue Shield business in one system with the Employer Enrollment Tool (EET). Online enrollments use real-time integration, making it faster than ever to get your clients the coverage they need. Learn how processing times have been reduced 99% with the EET while improving processing quality, and find updated guides and tutorial videos for each release on your dedicated Employer Enrollment Tool resource page.
We will continue to stabilize and grow all areas of the Employer Enrollment Tool based on your feedback and ideas. The next code release (July 20th) will focus on fixes and a few new fields. See the full list of changes here.
To avoid disruption to your submissions, we ask that you do not access the EET from 8 p.m. July 20 to 3 a.m. July 21. Keep an eye out on Broker Connection for posted maintenance and outages as all downtimes on the portal impact access to the EET.
Coming Soon: Multi-factor authentication for online portals
This summer, we will introduce multi-factor authentication protocols to all of our Blue Shield of California online portals (including the member portal). Multi-factor authentication (MFA) provides an additional layer of security beyond just a username and password. MFA is a simple two-factor process that is unique to each user. You may have already experienced MFA when logging into your online bank or cellular accounts. Implementing MFA can significantly reduce the risk of unauthorized access and data breaches. Below are some of the benefits of two-factor authentication:
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Enhanced Security – By using multiple factors, access is denied even if one password is compromised until all factors are verified.
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Mitigation of Password-Based Attacks – MFA reduces reliance on passwords alone, making it significantly harder to breach accounts.
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Protection Against Phishing & Social Engineering – An added layer of protection makes it harder for phishing and social engineering attempts to reach you.
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Compliance with Security Regulations – Protecting user health data is extremely important. Two-factor authentication meets HIPPA and PHI requirements.
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User Empowerment – MFA gives you more control over your accounts and personal data while giving you quick access to your account.
We will share more details as we get closer to our launch date and keep you informed of any action needed by you and your clients.
PLEASE NOTE: MFA is unique to the individual. Each person within your organization, agency, or company who needs access will be required to register for an account on Broker Connection.
Article: UC Berkely study finds Blue Shield’s innovative plan design improves patient experiencesA Health Services Research study featuring Blue Shield of California showed that a health benefits plan that leverages a smaller network of engaged providers and a comprehensive patient navigation system improved patient satisfaction, increased access to specialty care, and reduced healthcare costs.
Researchers at the University of California at Berkeley (UC Berkeley) compared financial and qualitative data between a small-network health maintenance organization (HMO) benefits plan with a more traditional, large-network HMO offering. Both plans, offered by Blue Shield to San Francisco Health Service System (SFHSS) members, showed positive results including reduced expenditures.
The full article is available on our News Center here.
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Cycle Launch Q4 2023 recap!
We are pleased to announce the Q4 2023 rate book is now available on the dedicated Rates page of Broker Connection. Our fourth-quarter 2023 rate action is a statewide average of 1.4%. Closed rate books and more information about our rates can also be found on Broker Connection Small Business rates.
Don’t forget, the Employer Enrollment Tool lets you easily find quotes and provides a streamlined, digital experience for all your Q4 enrollments.
October, November, and December 2023 renewals
Groups renewing in October and November became available to brokers through Shield Renewals on Monday, July 10,* while group-level changes can be made using Small Group Online Renewal (SGOR). December groups will be available on Monday, August 28,* while group-level changes can be made using Small Group Online Renewal (SGOR) beginning Thursday, August 31.* To review exact renewal and enrollment dates for Q4, plus enrollment materials and updated rates books, visit our Renewal Center page on Broker Connection.
You can also access this new Broker Renewal Guide as a checklist to support your group renewals.
Group renewal information is available as a microsite for each group, and these can be accessed through Shield Renewals. No download is required; you can open the site, find the information you need, and send the link or selected components to your clients. You can also access the medical choice chart option (which provides information about your clients’ current and new plan rate) to buy up or buy down and check if Trio or Tandem are available. The choice chart will include the rate differential if you choose to move your client.
* Dates subject to change
Reminder: Help your clients save 10% with bundled specialty & relaxed participation extended
Talk to your sales executive or account executive about adding vision coverage to your clients’ medical benefits. Small Business groups can receive a 10% specialty discount when added to a medical plan though the Bundled Savings program. The discount will be applied to each line of coverage (either dental, vision, or both) when added to any new small business medical groups.
We’re relaxing underwriting participation requirements for groups with five or more enrolled employees to just 25% for our medical, dental, vision, and life insurance plans through December 31, 2023. Check out the 2023 relaxed participation flyer here for additional criteria and information.
Tools for the trusted advisor
Being a subject matter expert for your clients is fundamental to your work and, when the subject is Blue Shield of California, we want to ensure you are always prepared.
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The new Small Business Contact Sales & Support page on Broker Connection allows you to easily find the dedicated Account Executive and Sales Executive in each region.
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Small business plan documents (SOB, SBC, EOC) for medical plans, pharmacy plans, dental plans, and life insurance plans are available in one location for each line of business.
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Your Blue Shield support team is available to support you throughout the year. Producer Services: (800) 559-5905.
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The Blue Shield News Center is your go-to source for the latest news and services from Blue Shield of California. Stay up to date by following us on LinkedIn and subscribe here to have News Center alerts delivered directly to your inbox.
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Reminder: New Prescription Savings Program
At the beginning of this year, Blue Shield of California began offering a Prescription Savings Program to commercial plan members with outpatient prescription drug benefits through Blue Shield. The SMS text-based program provides discounts on member out-of-pocket costs for select medications. The program is designed to improve prescription drug affordability and medication adherence, and is a collaboration with Sempre Health, a digital health technology company.
The program works as follows:
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Members taking select preferred medications will receive email/direct mail invitations to enroll
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Once enrolled, members will receive a discount ID to use when picking up their medication at any retail pharmacy
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Participating members receive text messages with refill reminders and what they will pay for each on-time refill
Enrollment in the program is at no extra cost to the member. The amount members save depends on their benefit design and prescription refill frequency, but the more they fill on time, the more they can save.
Being a subject matter expert for your clients is fundamental to your work and, when the subject is Blue Shield of California, we want to ensure you are always prepared.
Review the annual Large Group cycle launch newsletter here.
Large group plan documents (SOB, SBC, EOC) for medical plans, pharmacy plans, dental plans, and life insurance plans are available in one location.
The Blue Shield News Center is your go-to source for the latest news and services from Blue Shield of California. Stay up to date by following us on LinkedIn and subscribe here to have News Center alerts delivered directly to your inbox. |
