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AUGUST 2015
IN THIS ISSUECustomer service2 Formulary Update 2 New physicians 3 Fall thriller: The Flu 4 Talk with your doc
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Member Update
Thank you for being a Geisinger Choice member. Please call us with any questions at 800-504-0443.
You can also find helpful information on TheHealthPlan.com. Register for an account using your member ID number to access
benefit documents and personalized health alerts.
or click away
Jeffrey, Kayla and Joni answer your commonly asked questions in the videos below.
“How can I save money on prescriptions?”
“Is this a bill?”
“Should I go to the emergency room?”
we’re just a call
How does it work? Open the QR code scanner application on your smartphone or tablet. You must have a cellphone equipped with a camera and a QR code reader application. Most newer smartphones already have an app pre-installed. Don’t have one installed? Visit your phone’s app store and download a free app.
Scan these blocks with your smartphone!
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Kaitlyn, an enrollment specialist in Danville, says members should “always have an above-and-beyond experience.” Colleagues nominated her for a Service Excellence award this year. Way to go!
The Member Update is published
quarterly by Geisinger Health Plan and
serves as an informational resource for
members. Comments are welcomed.
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This issue and previous issues of the
Member Update can be viewed at
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Plan and Geisinger Choice are referred
collectively as “Geisinger Health Plan”
or “GHP,” unless otherwise noted.
GEISINGER HEALTH PLAN | MEMBER UPDATE
Brand Name Marketplace Tier
Triple Tier
Formulary
4th Tier Application
Traditional Formulary
Prior Authorization
Quantity Limit
Detailed Limit Formulary Alternatives
Arnuity Ellipta
NF NF No NF Yes No − Advair Diskus/HFA, Dulera, Flovent Diskus/HFA, Pulmicort Flexhaler, Qvar, Asmanex HFA
Belsomra NF NF No NF Yes Yes 1 tablet per day eszopiclone, zaleplon, zolpidem, amitriptyline, mirtazapine, tra-zodone, estazolam, flurazepam, quazepam, temazepam, triazolam, zolpidem ER
Evotaz Formulary 2 No 2 No No − Aptivus, Crixivan, Invirase, Kaletra, Lexiva, Prezista, Reyataz, Viracept
Farydak Formulary 3 Yes 2 Yes Yes 6 capsules per 21 day cycle
Thalomid, Pomalyst*, Revlimid*
Hysingla Er NF NF No NF Yes Yes 1 tablet per day fentanyl, morphine sulfate ER, oxy-codone ER*, tramadol ER, Avinza, Butrans*, Nucynta ER*, Oxycontin*
Lenvima Formulary 3 Yes 2 Yes Yes 3 capsules per day, 30 day supply per fill
Caprelsa*, Cometriq*, Nexavar*
Mircera NF NF No NF Yes No − Aranesp*, Epogen*, Procrit*
Naloxone Prefilled Syringes
Formulary 1 No 1 No No −
Prezcobix Formulary 2 No 2 No No − Aptivus, Crixivan, Invirase, Kaletra, Lexiva, Prezista, Reyataz, Viracept
Savaysa NF NF No NF Yes Yes 1 tablet per day warfarin, Eliquis, Xarelto
Zohydro Er NF NF No NF Yes Yes 2 tablets per day fentanyl, morphine sulfate ER, oxy-codone ER*, tramadol ER, Avinza, Butrans*, Nucynta ER*, Oxycontin*
Formulary update The table below represents recent updates to our formulary. If you have any questions, please contact the pharmacy customer service team at 800-988-4861 Monday through Friday, 8 a.m. to 5 p.m. Obtain a hard copy of the formulary by calling customer service or logging on to TheHealthPlan.com. Non Formulary = NF
New physiciansThis list includes new primary care physicians (PCPs) who have joined our network since Sept. 15, 2015. For more information on these and other participating providers, please visit TheHealthPlan.com, or call the customer service team at the number on the back of your member ID card. (Key: FP, Family Practice; IM, Internal Medicine; and P, Pediatrics)
Non-Marketplace plans
*Indicates prior authorization (PA) or step therapy (ST)
AdamsKhalilah C. Dann MD - FPJoseph M. Devlin MD - FP
BedfordJeanne C. Pfeilsticker MD - FP
BlairElias Mounif Rifkah MD - FP
CarbonLindsay Goffredo Hughes DO - FP
ChesterJustine Ann Bello MD - FP Catherine Mary Bergan DO - FP Levelle D. Bigatel MD - FP Beth Ann Bingaman DO- FP Christian J. Duplass DO- FP Sherry Sushil Garg MD- FP Carol Ann Glessner MD - FP Virginia Eva MacCabe Keeler DO - FP William Edward Lehner MD - FP
Jeffrey R. Melrose DO - FP Pamela Ann Tedesco DO - FPPallavi Arabolu MD - P John Michael Babinecz MD - P Anne Damayanthi - PCristin Samantha Hagelstein MD - PMichael Joseph Harkness MD - P Tracie Michelle Safier MD- P Stephen Coughlin Townend MD - P
CumberlandMeena Goil Charan MD- FPHoward R. Cohen MD - FPGerri Lynn Steele DO - IM
DauphinDivya Vodikad Jaiprakash MD- IM
HuntingdonNoah G. Schmuckler MD - FP
LackawannaBojana Milekic MD - IM
Christopher Michael Minello DO - IM Jennifer Marie Zangardi MD - IM
LancasterD. Thais Magill MD - FP Nancy Joy Rist MD- IM
LehighMeagan L. Grega MD - FP Lindsay Goffredo Hughes DO - FP Sireesha Vemuri-Vijaya MD - FP Sara Doyle DO - IM Courtney E. Bennett DO - IM
LuzerneLindsay Goffredo Hughes DO - FP
LycomingNigelle S. Pinto MD - FP
MonroeMeagan L. Grega MD - FP Lindsay Goffredo Hughes DO- FP
NorthamptonMeagan L. Grega MD - FP Lindsay Goffredo Hughes DO - FP Sabriya Carolyn Scott-Caffrey MD - FP Rahul Bhagat MD - IM Hui Chung Chung Lee MD - P Courtney E. Bennett DO - IM
PikeShalini Chethan Byadgi MD - IM
WayneHortense Patricia Russell MD- FP
TiogaStephen Daniel Sasser MD- FP
YorkJoseph M. Devlin MD - FPChalak Najat Muhammad MD- FP
GEISINGER HEALTH PLAN | MEMBER UPDATE
It’s no secret that mammograms and other breast cancer screening methods save lives. They are the tools doctors use to detect breast cancer early, when it’s easiest to treat. However, breast cancer becomes more difficult to detect in women with dense breast tissue.
“Breast density is a way to describe breast composition – it’s a measure that compares the area of fat to the area of breast and connective tissue on a mammogram,” said Jacqueline Guerriero, MD, a general surgeon at Geisinger Health System. “Having dense breasts means there is a greater amount of breast and connective tissue compared to fat.”
On a mammogram, non-dense breast tissue, which is fatty tissue, appears dark and transparent, Dr. Guerriero said. Dense breast tissue appears as a solid white area, which makes it difficult to see through. Cancer also appears white. Dense breast tissue can make tumors more difficult to identify.
Research has linked dense breast tissue with an increased risk of breast cancer compared to women with less dense breast tissue.
How to find out if you have dense breasts“When you have a routine mammogram, a radiologist analyzes it to determine your ratio of non-dense tissue to dense tissue and assigns a level of breast density to you,” Dr. Guerriero said.
Pennsylvania is one of 19 states with state density reporting laws, which requires your healthcare provider to let you know your level of breast density. Knowing that information gives you the opportunity to have informed conversations with your doctor about alternative breast cancer screening methods. If your mammogram report doesn’t include the radiologist’s analysis of your breast density, ask your doctor.
What causes dense breasts?For the most part, researchers aren’t sure why some women have dense breast tissues. Younger women, typically in their 40s and 50s, who are premenopausal or taking hormone therapy for menopause are more likely to have dense breasts. However, some women may have dense breast tissue at any age.
What should you do?Continue having routine mammograms – most breast cancers can still be seen even if you have dense breasts.
Can you lower your risk of breast cancer?Maintain a healthy weight, exercise regularly, limit your consumption of alcohol, eat a nutritious, healthy diet and quit smoking, Dr. Guerriero said.
What breast cancer screenings mean for dense breasts
Your primary care physician’s office number is located on your member ID card.
Can’t find your card? Request a copy on TheHealthPlan.com or call the customer service
number on this newsletter.
Member tip
Sample
Coming this fall: Flu season
The flu spreads every year. So does the timing, severity and length of the season. No drama: Get your flu shot for $0.
Flu viruses are constantly changing, so the vaccine is updated each year based on which influenza viruses are making people sick, how those viruses are spreading, and how well the previous season’s vaccine protects against those viruses, according to the Centers for Disease Control and Prevention.
You’re covered. Flu shots are expected to be widely available by October. You can get a flu shot at no cost! Geisinger Choice makes it easy to protect yourself against the seasonal flu, in two convenient ways: administered by your physician or at an in-network pharmacy. Visit TheHealthPlan.com to search for participating pharmacies in your area.
Who should get vaccinated? Everyone 6 months of age and older, with rare exceptions. Talk with your physician if you have any questions.
100 N. Academy Ave.Danville, PA 17822-3240
ask 1. What do I need to know?2. What do I need to do?3. Why is it important to me?
As your health insurance provider, we want to help you receive the care and services you need and deserve. Clear communication, with us and with your physician, is a necessary first step. When you visit your physician, ask these three basic but very important questions.
Getting the answers from your physician in person will improve your relationship and provide the specific information you need to manage your health. We encourage you to ask additional questions, as well, until you feel that you fully understand your doctor’s orders.
remember to takeyour medication >
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Your physician may prescribe medication to treat or prevent illness. It’s important to fill the prescription, read the directions and take it on time. Poor medication adherence can interfere with your treatment, leading to greater complications. 3
Inside: Have a smartphone? Watch videos answering your most common questions.
■■ Need a reminder? Use a pillbox, a cellphone alarm and your pharmacy’s refill reminder program. Set a routine by mixing it in with a daily activity, such as brushing your teeth.
■■ Talk with your physician. Tell your physician immediately if you feel any discomfort from your medication. Do not stop medication without discussing it with your physician first.
■■ Need financial assistance? Ask your physician to choose a generic version. Call the pharmaceutical company to see if an assistance program is available. Using mail order may also save you money.
Have you had a well visit this year?
Does your hectic schedule make it difficult to schedule a well visit with your doctor? The summer is one of the best times to schedule your visit and beat the before-school rush! Physicians often have a wide range of time frames open to fit your needs.
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