GROUP BROKER UPDATE

What to know about GLP-1 weight loss drugs

A drug class known as glucagon-like peptide 1 (GLP-1) has soared in popularity due to social media and celebrity endorsements. As use of brand name drugs like Ozempic, Wegovy, and Mounjaro increases, your clients are likely inquiring about how GLP-1 drugs work and how these drugs are covered.

How they work:

• Originally developed for management of Type 2 diabetes, the GLP-1 class of drugs emulate the actions of hormones in the body, increase insulin levels, curb hunger, and slow movement of food through the GI tract, resulting in weight loss.

Prioritizing lifestyle modifications:

• These drugs are not designed for rapid weight loss and are not a stand-alone solution for losing weight. GLP-1 drugs should be regarded as supplementary to lifestyle modifications like diet and regular exercise.

Coverage and prior authorization:

• The FDA has approved different GLP-1 drugs for specific uses.
  • Drugs like Wegovy and Zepbound are specifically approved for use in chronic weight management only.
  • Drugs like Ozempic and Mounjaro are only approved for use in treatment of Type 2 diabetes.
• GLP1s that are FDA approved for treatment of obesity require prior authorization. Members must meet specific lifestyle modification requirements, BMI thresholds and/or have certain co-morbid conditions may qualify for GLP-1s.
• The most up to date formulary information can be found on our Drug Formularies page here. Drug formularies | Blue Shield of CA (blueshieldca.com)

Key considerations:

• As with any medication, GLP-1 drugs have potential side effects and safety concerns. Nausea, vomiting, diarrhea, and headaches are common side effects.
• Long-term effects of these drugs are still being examined. Members should be aware of the potentially life-long use of GLP-1 drugs in order to maintain weight loss. One study showed that, after one year, patients who stopped their GLP-1 drugs and lifestyle changes regained two-thirds of weight lost.
• An informed evaluation of the risks and benefits associated with GLP-1 drugs is essential, especially when alternative options are available.

Individualized approach and Blue Shield services:

• 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 supports establishing and maintaining a healthy weight and has consistently promoted weight loss programs through our award-winning Wellvolution platform.

Our pharmacy team is closely monitoring the development and evolution of GLP-1 drugs to assess our policies for coverage.

Annual Medical Loss Ratio (MLR) employer survey due March 2024

In early January, employer groups with <150 employees received a survey requesting the following Medical Loss Ratio (MLR) information:

1. The average number of employees for their business in calendar year 2022 (used for statistical sampling purposes).
2. Whether their business is wholly owned by one individual and his/her spouse.
3. Whether they are a non-governmental or non-ERISA plan.

Read January’s Broker Alert for full MLR details.

Employer groups will be given the option of submitting their group information via an online survey or by faxing their completed form to (855) 895-3497. Employer groups must submit their information by March 31, 2024.

To support your clients, we ask you to encourage them to submit their information by March 31, 2024 via our online survey or by faxing back the print survey form. To access the online survey, please use the Group ID and following web key: #44n50c

If you have any questions regarding the MLR Employer Survey, please contact us at MLRAssist@blueshieldca.com or call us at (800) 325-5166.

Prescription drug cost data collection for employer groups

Blue Shield of California is collecting D1 Premium Contribution data as part of the Consolidated Appropriations Act, Section 204 (2021)– Prescription Drug Cost Reporting regulation, on behalf of our employer groups.

To ensure group data is included in Blue Shield’s aggregate filing, groups will need to fill out the Blue Shield D1 intake form by Friday, April 5, 2024, at 6:00PM (PST). Note:

• Active groups will need to fill out the intake form available on Employer Connection upon logging in.
• Terminated groups will need to fill out this intake form, using their Blue Shield group ID and following web key: #24yr23.

Full details can be found in the recent Broker Alert. Please view the D1 Intake FAQs for more information. If you have any additional questions, please contact your Blue Shield representative.

Holistic health and Q1 2024 rate pass for dental and vision

Help your clients promote holistic health for employees and their families by integrating dental and vision coverage into their benefits package. Plus! Blue Shield issued a rate pass for Q1 2024 – part of our continued effort to make health care affordable and making it easier for you to sell Blue Shield. Visit Plan & Network Comparison Tools page to see our wide array of available plans.

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.

• Live Agent Chat is available now! You can solve your client’s challenges, upload supporting documentation, and get help navigating our self-service capabilities with our secure chat platform. The chat feature is available on all pages once you log in and check out this chat demonstration video for additional information. Our team is available 8:00 a.m. to 6:00 p.m. PST Monday to Friday.
• Broker bonus programs: visit the Rewards and Commissions page on Broker Connection for full details!
• Small Business Incentive Program: Sell more, earn more. We’re making it easier for you to earn more when you enroll in membership.
• Direct Elite Rewards: Boost your earnings with this program that benefits direct-selling small business brokers.
• Employer email campaign: Starting mid-December, new employer groups will receive several focused emails to make the transition to Blue Shield and its group management/administrative tools seamless and convenient. The emails will contain information and links to existing features, capabilities, and benefits available to Blue Shield members.
• Doing business with Blue Shield of California: resources for our Small Business brokers.
• Visit the Small Business Contact Sales & Support page on Broker Connection to easily find the dedicated Account Executive and Sales Executive in each region.
• Small business plan documents (SOB, SBC, EOC) for medical plans, pharmacy plans, dental plans, and life insurance plans all in one place.
• 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.

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.

• New hours of operations
  Our Broker and Employer Services teams have adjusted their hours of operation and are now open 8:00 a.m. to 6:00 p.m. PST.
• Live Agent Chat is available now! You can solve your client’s challenges, upload supporting documentation, and get help navigating our self-service capabilities with our secure chat platform. The chat feature is available on all pages once you log in and check out this chat demonstration video for additional information. Our team is available 8:00 a.m. to 6:00 p.m. PST Monday to Friday.
• 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.