Blood Pressure Resource Guide

2 May 2017

Blood Pressure Resource Guide A Guide for Macy’s, Inc. Associates This resource guide is designed to:

provide education and awareness around blood pressure; encourage compliance with prescribed medication and recommended age based preventive

screenings; provide an understanding of why monitoring blood pressure is important; and provide resources to help keep blood pressure in a healthy range.

Please Note: This is an informational resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This material is intended to be basic patient education. You should consult with your health care provider before making any healthcare decisions or for receiving diagnosis of, or guidance about, a specific medical condition.

Designed to enhance the lives of Macy’s, Inc. associates and their families. Live Healthy provides inspiration, incentives, and tools to create healthier lifestyles.

3 May 2017

Table of Contents Blood Pressure Definition and Categories .................................................................................................... 4

What is Blood Pressure? ................................................................................................................................ 4

Categories of Blood Pressure ........................................................................................................................ 4

Blood Pressure Screenings ............................................................................................................................ 5

Healthy Blood Pressure ................................................................................................................................. 5

Low Blood Pressure ....................................................................................................................................... 5

Causes of Low Blood Pressure ................................................................................................................... 6

High Blood Pressure ...................................................................................................................................... 7

Risk Factors for Developing High Blood Pressure ...................................................................................... 7

Monitoring and Managing Your Blood Pressure ........................................................................................... 8

American Heart Association’s Steps to Manage or Prevent the Disease ........................................................ 8

The Importance of an Accurate Blood Pressure Reading ............................................................................... 8

Lifestyle Changes to Help Lower Blood Pressure ........................................................................................... 8

Know the State of Your Blood Pressure ....................................................................................................... 10

How to Monitor and Record Your Blood Pressure ........................................................................................ 11

Resources Available through the Macy’s, Inc. Cigna Medical Plan ........................................................... 12

4 May 2017

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Blood Pressure Definition and Categories

What is Blood Pressure?

Blood pressure is one of the fundamental metrics of overall health. And, if out of range, it is relatively easy to control through lifestyle modification (exercise and diet) and/or drug therapy when required. Blood pressure is the amount of force exerted on the walls of your blood vessels, or arteries, when your heart beats. Blood pressure is typically recorded as two numbers systolic (the top number) and diastolic (the bottom number), written as a ratio like this:

Systolic, or the top number, which is the higher of the two numbers, measures the pressure in the arteries when the heart beats (when the heart muscle contracts). Diastolic, or the bottom number, which is the lower of the two numbers, measures the pressure in the arteries between heartbeats (when the heart muscle is resting between beats and refilling with blood).

When it comes to systolic and diastolic, typically more attention is given to the

top number (the systolic blood pressure) as a major risk factor for cardiovascular disease for people over 50 years old.

Categories of Blood Pressure

This chart reflects blood pressure categories defined by the American Heart Association:

Blood Pressure Category

Systolic

mm Hg (upper #)

Diastolic

mm Hg (lower #)

Normal less than 120 and less than 80

Prehypertension 120 – 139 or 80 – 89

High Blood Pressure (Hypertension) Stage 1

140 – 159 or 90 – 99

High Blood Pressure (Hypertension) Stage 2

160 or higher or 100 or higher

Hypertensive Crisis (Emergency care needed)

Higher than 180 or Higher than 110

5 May 2017

You don’t need a doctor’s appointment to get your blood pressure checked! Many grocery stores and drugstores offer public blood pressure

machines!

In a Hypertensive Crisis, this is a situation where the blood pressure is severely elevated [180 or higher for your systolic pressure (top number) or 110 or higher for your diastolic pressure (bottom number)], but there is no associated organ damage. Those experiencing a hypertensive crisis may or may not experience one or more of these symptoms:

Severe headache

Shortness of breath

Nosebleeds

Severe anxiety

Blood Pressure Screenings Starting at age 20, the American Heart Association recommends a blood pressure screening at your regular health care visit, or once every 2 years, if your blood pressure is less than 120/80 mm Hg. Your blood pressure rises with each heartbeat and falls when your heart relaxes between beats. While blood pressure can change from minute to minute with changes in posture, exercise, stress or sleep, it should normally be less than 120/80 mm Hg (less than 120 systolic AND less than 80 diastolic) for an adult age 20 or over. About one in three U.S. adults has high blood pressure. If your blood pressure reading is higher than normal, your doctor may take several readings over time and/or have you monitor your blood pressure at home before diagnosing you with high blood pressure. A single high reading does not necessarily mean that you have high blood pressure. However, if readings stay at 140/90 mm Hg or above (systolic 140 or above OR diastolic 90 or above) over time, your doctor will likely want you to begin a treatment program. Such a program almost always includes lifestyle changes and often prescription medication for those with readings of 140/90 or higher. An important thing to remember is that blood pressure changes throughout the day based on what you have been doing. Food, caffeine, tobacco, exercise, stress, lack of sleep and many other factors can influence your blood pressure. In order to get an “accurate reading,” you should check your blood pressure a number of times over several days or weeks and then average the results. Averaging the readings will give you a better overall idea of your blood pressure profile.

Healthy Blood Pressure

Traditionally, an ideal blood pressure is considered to be anything under 120/80 mm Hg. A person's ideal blood pressure may depend on several factors, such as diet and lifestyle. Blood pressure readings can vary throughout the day due to things like tension, exercise, and nicotine use. When comparing your blood pressure to the "ideal" blood pressure, make sure to take several readings over a few days. If your blood pressure reading is higher than normal, your doctor may take several readings over time and/or have you monitor your blood pressure at home before diagnosing you with high blood pressure. And, even if your blood pressure is normal or “healthy,” you should consider making lifestyle modifications to prevent the development of high blood pressure and improve your heart health.

Low Blood Pressure

Low blood pressure, also called hypotension, is blood pressure that is low enough that the flow of blood to the organs of the body is inadequate and symptoms and/or signs of low blood flow develop. Low pressure alone, without symptoms or signs, usually is not unhealthy. If you experience any dizziness, lightheadedness or any other symptoms, it's a good idea for you to consult with your health care provider. What is considered low blood pressure for one person may be normal for others. Most doctors consider

6 May 2017

chronically low blood pressure to be too low only if it causes noticeable symptoms. Some experts define low blood pressure as readings lower than 90 systolic or 60 diastolic. You only need to have one number in the low range for your blood pressure to be considered lower than normal. So, if your systolic pressure is a perfect 115, but your diastolic pressure is 50, you’re considered to have lower than normal pressure.

A change of just 20 mm Hg — a drop from 110 systolic to 90 systolic, for example — can cause dizziness and fainting when the brain fails to receive an adequate supply of blood. And big plunges, especially those caused by uncontrolled bleeding, severe infections or allergic reactions, can be life-threatening.

Causes of Low Blood Pressure

Some medical conditions and medications can cause low blood pressure:

Pregnancy. Because a woman's circulatory system expands rapidly during pregnancy, blood pressure is likely to drop. This is normal, and blood pressure usually returns to your pre-pregnancy level after you've given birth.

Heart problems. Some heart conditions that can lead to low blood pressure include extremely low heart rate (bradycardia), heart valve problems, heart attack and heart failure.

These conditions may cause low blood pressure because they prevent your body from being able to circulate enough blood.

Endocrine problems. Thyroid conditions — such as parathyroid disease — adrenal insufficiency (Addison's disease), low blood sugar (hypoglycemia) and, in some cases, diabetes can trigger low blood pressure.

Dehydration. When you become dehydrated, your body loses more water than it takes in. Even mild dehydration can cause weakness, dizziness and fatigue. Fever, vomiting, severe diarrhea, overuse of diuretics and strenuous exercise can all lead to dehydration.

Far more serious is hypovolemic shock, a life-threatening complication of dehydration. It occurs when low blood volume causes a sudden drop in blood pressure and a reduction in the amount of oxygen reaching your tissues. If untreated, severe hypovolemic shock can cause death within a few minutes or hours.

Blood loss. Losing a lot of blood from a major injury or internal bleeding reduces the amount of blood in your body, leading to a severe drop in blood pressure.

Severe infection (septicemia). Septicemia can happen when an infection in the body enters the bloodstream. This condition can lead to a life-threatening drop in blood pressure called septic shock.

Severe allergic reaction (anaphylaxis). Anaphylaxis is a severe and potentially life-threatening allergic reaction. Common triggers of anaphylaxis include foods, certain medications, insect venoms and latex. Anaphylaxis can cause breathing problems, hives, itching, a swollen throat and a drop in blood pressure.

Lack of nutrients in your diet. A lack of the vitamins B-12 and folate can cause a condition in which your body doesn't produce enough red blood cells (anemia), causing low blood pressure.

Medications That May Cause Low Blood Pressure: Diuretics (water pills), such as furosemide (Lasix) and hydrochlorothiazide (Microzide, Oretic)

Alpha blockers, such as prazosin (Minipress) and labetalol

Beta blockers, such as atenolol (Tenormin), propranolol (Inderal, Innopran XL, others) and timolol

Drugs for Parkinson's disease, such as pramipexole (Mirapex) or those containing levodopa

Certain types of antidepressants (tricyclic antidepressants), including doxepin (Silenor), imipramine (Tofranil), protriptyline (Vivactil) and trimipramine (Surmontil)

Sildenafil (Viagra) or tadalafil (Cialis), particularly in combination with the heart medication nitroglycerin

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High Blood Pressure

High blood pressure, also called hypertension, is a disease and often does its damage without creating symptoms. High blood pressure affects your entire body by causing:

An increase in the workload of your heart, causing the heart to enlarge which can lead to heart failure, heart attack and angina.

Aneurysms to form in the brain’s blood vessels, which may burst and cause a stroke.

Blood vessels in the kidney to narrow, which may lead to kidney failure.

Arteries throughout the body to harden (atherosclerosis), especially arteries in the heart, brain, kidneys and legs. This can lead to a heart attack, stroke, kidney failure, or amputation of part of the leg (a complication of peripheral artery disease).

Blood vessels in the eyes to burst, bleed or thicken which may cause vision changes and can result in blindness.

A single high reading does not necessarily mean you have high blood pressure. However, if readings stay at 140/90 mm Hg or above (systolic 140 or above OR diastolic 90 or above) over time, your doctor will likely want you to begin a treatment program. Such a program almost always includes lifestyle changes and often prescription medication for those with readings of 140/90 mm Hg or higher. Although, the only way to tell if you have high blood pressure is to have it checked, the test can be done easily, quickly and painlessly. Upon diagnosis by a health care professional, high blood pressure can usually be managed through lifestyle changes and, when prescribed, medication.

Risk Factors for Developing High Blood Pressure

Anyone can develop high blood pressure, but you are more at risk if you:

Are over 45 years old;

Are overweight;

Are African American;

Have a family history of high blood pressure;

Eat a diet high in salt;

Are not physically active;

Consume too much alcohol;

Are pregnant;

Have diabetes, gout or kidney disease; and

Are a woman who takes birth control pills, that is overweight, had high blood pressure during pregnancy, has a history of high blood pressure or has mild kidney disease.

8 May 2017

Monitoring and Managing Your Blood Pressure High blood pressure is a major risk factor for heart attack, stroke, heart failure and kidney failure. The longer it's left untreated, the more serious its complications can become. But there is also a clear pathway to help you manage high blood pressure and enjoy the many benefits of a healthy heart.

American Heart Association’s Steps to Manage or Prevent the Disease

The American Heart Association provides a complete suite of information and tools to help you learn about high blood pressure and then manage or prevent the disease. Just follow these simple steps:

Learn about high blood pressure. Understand what happens when blood pressure is high. Chances are strong that you or someone you care about will be battling this disease.

Understand the toll high blood pressure takes on your body. High blood pressure can create serious health problems. Understand the facts so you'll be motivated to care for your circulatory system and live a heart-healthier life.

Know your risks for high blood pressure and what you can do to live your healthiest life. Find out if your lifestyle choices, family history or health factors make you a likely candidate for high blood pressure. You'll also learn how a few lifestyle changes can lower your blood pressure and your health risks.

Get your blood pressure tested: diagnose and monitor. A diagnosis can be done quickly, easily and painlessly in a variety of places including a doctor's or dentist's office, hospital, clinic, school, nurse's office, company clinic or at a health fair. And ask your healthcare provider to work with you on a home monitoring plan.

Prevent and treat: Even though high blood pressure is serious, your choices will make a big difference in your quality of life. Take charge today.

The Importance of an Accurate Blood Pressure Reading

An important thing to remember is that blood pressure changes throughout the day based on what you have been doing. Food, caffeine, tobacco, exercise, stress, lack of sleep and many other factors can influence your blood pressure. In order to get an “accurate reading,” you should check your blood pressure a number of times over several days or weeks and then average the results. Averaging the readings will give you a better overall idea of your blood pressure profile. Heredity can also be a factor in determining your blood pressure profile. If you are concerned at all about your results, you should consult a health professional.

Lifestyle Changes to Help Lower Blood Pressure

Lifestyle changes to reduce blood pressure or decrease the risk of developing hypertension include:

Reduce sodium intake. Eat more natural foods and less processed foods. Salt naturally raises your blood pressure; eating less salt will reduce the effect.

Instead of adding salt to food when cooking or eating, try cooking with fresh herbs, lemon juice or other spices.

Choose fresh or frozen vegetables instead of canned vegetables. If you do use canned vegetables, rinse them before eating or cooking with them to remove extra salt.

Shop for items that say “reduced-sodium” or “low-sodium.”

Avoid processed foods like frozen dinners and lunch meats.

Limit fast food and salty snacks, like chips, pretzels and salted nuts.

9 May 2017

Limit your fat intake.

Choose lean meats or fish. Remove the skin and trim the fat off your meats before it is cooked.

Bake, grill or broil foods instead of frying them.

Shop for fat-free and low-fat dairy products, salad dressing and mayonnaise.

Try olive oil or canola oil instead of vegetable oil.

Choose egg whites or egg substitute rather than whole eggs.

Losing weight if overweight or obese. Work with your doctor to create a long term, sustainable weight loss program to reach a BMI level of 25 or less, which is considered a healthy range. Losing as little as 5 -10 percent of one’s body weight can reduce insulin levels and blood pressure and decrease the risk of diabetes. For a 200lb person, this means losing 10-20 pounds in a year, which is about a half a pound a week! Avoid tobacco use (smoking or chewing). Tobacco use puts individuals more at risk for high blood pressure, heart disease, kidney disease and many other health problems. If you use tobacco, quitting can help lower your chances of getting kidney disease or help slow the disease’s progression. Checking your blood pressure regularly. High blood pressure can damage your kidneys. By monitoring your blood pressure regularly and keeping your blood pressure in a healthy range, you can help protect your kidneys and prevent or slow kidney disease. Many local pharmacies and stores have in-store monitors that can be used for free. Medication. When changes in lifestyle alone do not control the condition, your doctor may need to prescribe medications to control high blood pressure. Adherence to these medications is important in preventing the long term effects of high blood pressure. Preventive Screenings. Preventive Screenings are covered at 100% under all Company-sponsored health plans. Preventive physicals and lab work are essential to detect high blood pressure and it’s a good idea for you to check in with your primary care physician each year to receive these screenings. You should keep the lines of communication open and make sure to tell your provider about everything that’s affected your health since your last visit. Take medicines as directed. To help protect your kidneys, you should take medicines as directed. Some medicines may help you manage conditions that can damage your kidneys, like diabetes or high blood pressure. You should ask your doctor how to take any medicines he or she prescribes. You should be sure to take the medicines exactly as your doctor prescribes. This may mean taking some medicines, like blood pressure medicines, even when you feel fine.

10 May 2017

Know the State of Your Blood Pressure

Many people have high blood pressure for years without knowing it. Most of the time, there are no symptoms, but when high blood pressure goes untreated, it damages arteries and vital organs throughout the body. That's why high blood pressure is often called the "silent killer.” It’s up to you to successfully manage and control your blood pressure. But it doesn’t have to be a daunting task. You can take small, manageable steps to make blood pressure control your goal. When it comes to managing and control – there are two key steps:

1. Engage in a conversation with your health care providers. Blood pressure control is a team effort. Engage all of your health care providers — not just your primary care physician or cardiologist. Your pharmacist, nurses and other health care specialists can help you control your high blood pressure. Next time you go in for a visit, make a list of questions you want to ask your health care provider. For example: What is my blood pressure goal? What are the best ways to reach my goal? Mention what you’re already doing to work toward control, including exercising, changing your diet or taking medications as prescribed. Be honest and realistic with yourself and your health care providers about what lifestyle changes you’re ready to make and the ones you’re not quite ready for. Pick one goal to start working toward. As you achieve success and build confidence, choose another goal to tackle.

2. Take your medications regularly.

If your physician has put together a specific medication schedule to help control your blood pressure, it is necessary to remember that your medication is important to control and maintain your blood pressure. Here are some tips to help you stick with your medication plan:

Talk to your doctor about any side effects you experience with your medications. If necessary, discuss other treatment options. Never stop treatment on your own.

Make a schedule and set up a system to remind you to take your medications regularly—use a pillbox for every pill, every day, or use smartphone app reminders. If your insurance provides mail order delivery, set it up and request a 90-day supply of medications. If this service is not available, schedule all your refills at the same pharmacy at the same time each month so you can pick them up all at once.

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How to Monitor and Record Your Blood Pressure

The American Heart Association recommends home monitoring for all people with high blood pressure to help the health care provider determine whether treatments are working. Home monitoring is not a substitute for regular visits to your physician. If you have been prescribed medication to lower your blood pressure, do not stop taking your medication without consulting your doctor, even if your blood pressure readings are in the normal range during home monitoring.

Because blood pressure can fluctuate, home monitoring and recording of blood pressure readings can provide your physician with valuable information to determine whether you really have high blood pressure and, if you do, whether your treatment plan is working. Learn and follow these simple steps for taking accurate home measurements:

Make sure the cuff fits. Measure around your upper arm and choose a monitor that comes with the correct size cuff.

Be still. Do not smoke, drink caffeinated beverages or exercise within the 30 minutes before measuring your blood pressure.

Sit correctly. Sit with your back straight and supported (on a dining chair, for example, rather than a sofa). Your feet should be flat on the floor; don't cross your legs. Your arm should be supported on a flat surface (such as a table) with the upper arm at heart level. Make sure the middle of the cuff is placed directly above the eye of the elbow. Check your monitor's instructions for an illustration or have your health care provider show you how.

Take multiple readings. Each time you measure, take two or three readings one minute apart and record all the results.

Measure at the same time daily. It's important to take the readings at the same time each day, such as morning and evening, or as your health care provider recommends.

Accurately record all your results. Record all of your readings, including the date and time taken. Share your blood pressure records with your health care team. Some monitors have built-in memory to store your readings; if yours does, take it with you to your appointments. Some monitors may also allow you to upload your readings to a secure Web site after you register your profile.

Understand the readings. The ideal blood pressure is less than 120/80 mm Hg (systolic pressure is 120 AND diastolic pressure is less than 80).

Consult your physician if you get several high readings. A single high reading of blood pressure is not an immediate cause for alarm. However, if you get a high reading after taking your blood pressure several more times and consult your health care provider to make sure you (or your monitor) don't have a problem. When blood pressure reaches a systolic (the top number) of 180 or higher OR diastolic (the bottom number) of 110 or higher, emergency medical treatment is required for hypertensive crisis.

12 May 2017

Resources Available through the Macy’s, Inc. Cigna Medical Plan

Know Your Numbers

When you know your numbers – such as height, weight, blood pressure, cholesterol, body mass index, waist circumference and glucose (blood sugar) levels, you are taking a big step toward understanding and improving your overall health. Plus, you may identify health issues, such as high blood pressure, early. You and your covered spouse are eligible to participate if you enrolled in a Company-sponsored Cigna medical option. Complete both a wellness screening and on online health assessment by the program deadlines and you will earn a $300 incentive deposited into your Cigna Choice Fund HSA. For more information visit the Know Your Numbers page under Live Healthy page of My Benefits on My IN-SITE. Preventive Screenings Preventive screenings are a key factor to early detection of any cancer or illness. When visiting your doctor to receive your preventive screenings, you are taking steps that could lead to prevention and early detection of health issues. Associates and spouses enrolled in a My Choice Plan medical option can each earn a $50 preventive care incentive for completing an approved preventive screening. Additionally, these annual preventive screenings are covered at 100% if you are enrolled in a Company-sponsored medical option and visit an in-network doctor. For more information on the preventive services that are covered at 100%, please contact Cigna at the number listed on your ID card. For more information on preventive care and available screenings, visit the Helpful Tools page of My Benefits on My IN-SITE. Omada Omada is an innovative, 16-week program based on clinically-proven science and designed to help individuals lose weight. The program focuses on guiding participants toward reaching modest weight loss and activity goals through nutrition and behavioral changes, which has been shown to help reduce behavioral risk factors for developing Type 2 diabetes and cardiovascular disease. Program eligibility requires a self-reported BMI over 24 and one of the following cardiovascular risk factors:

Elevated blood glucose

Blood pressure

Abdominal obesity

Trigylcerides

HDL

Tobacco use For successfully completing the Omada program, eligible associates and spouses enrolled in a My Choice Plan medical option can each earn a $300 incentive that will be deposited into your Cigna Choice Fund Health Savings Account (HSA) (or in your Health Reimbursement Account (HRA) for associates who are not eligible for an HSA).

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Nurse Advisor Program The Nurse Advisor program is available to all Cigna participants and offers personalized support for complex or chronic conditions. The Nurse Advisor team includes trained nurses, coaches, nutritionists, clinicians and counselors who will listen and understand your needs and help you find solutions even when you are not sure. If you suffer from certain uncontrolled conditions such as diabetes, cardiovascular disease, metabolic syndrome, or you have health risks identified through Know Your Numbers and/or pharmacy and medical claims, a Cigna Nurse Advisor can help; nurses may reach out to you directly about the Disease Management Program. Associates and covered spouses, enrolled in a Macy’s, Inc. Cigna medical option can actively engage in disease management coaching sessions that address specific health risks and goals to be eligible for a $100 incentive.* In order to receive the incentive, participants must complete program goals, including a preventive screening. *Only one incentive per enrolled participant per plan year

Cigna: 1-800-558-8361; www.mycigna.com 24-Hour Health Information Line Cigna participants can access support 24/7 when you need answers to your health care questions or help understanding treatment options. The 24-Hour Health Information Line number is listed on the back of your medical ID card; your call is always confidential and no-cost to you. Quit TodayTobacco Cessation Tobacco use puts individuals more at risk for high blood pressure, heart disease, kidney disease and many other health problems. If you use tobacco, quitting can help lower your chances of getting kidney disease or help slow the disease’s progression (if already diagnosed). The Tobacco Cessation program helps you develop a personal quit plan to become and remain tobacco free. If you are enrolled in a Macy’s, Inc. medical option and would like to learn more about the confidential and no-cost to you Tobacco Cessation program and how to develop a quit plan that is right for you, contact:

Cigna Participants: 1-800-558-8361; and say ‘lifestyle coaching’ or visit www.mycigna.com and enter your user ID and password

For all other plan participants contact Cigna at 1-866-417-7848 or visit www.cignabehavioral.com (password: macys)

Employee Assistance Program (EAP) The Cigna Employee Assistance Program (EAP) provides confidential 24/7 support for those everyday challenges, more serious problems and everything in between at no-cost to you. This program is available to associates (and their household members) who average a 20 hour work week. And, you don’t have to be enrolled in a Cigna medical option. Through the EAP, you can access help and resources for situations such as: chronic condition support; securing credit and financial counseling; managing marital issues; depression; parenting and/or work-related stress; and coping with the loss of a loved one. You may receive this assistance over the telephone, or make arrangements to meet face-to-face with a licensed clinician in your area, and receive up to five counseling sessions at no-cost to you. To access the EAP: 1-800-558-8361 or visit www.cignabehavioral.com. Under the ‘I want to’ section, click ‘log on to access your benefits,’ then enter ‘macys’ for the Employer ID. Healthy Pregnancy Healthy Babies Program Making sure your blood pressure is at a healthy level is an important part of looking after you and your baby during pregnancy. Cigna’s Healthy Pregnancy Healthy Babies® program offers prenatal care and educational materials that provide information and support that work-from prenatal to post-delivery. To support you during your pregnancy, you'll receive:

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Information to help you learn about pregnancy and babies

24/7 telephone access to a health advocate

Text messages (text 511411 to get started: BABY for English, BEBE for Spanish)

Support from a registered nurse if you or your baby has special health care needs Call Cigna at 1-800-558-8361, to request your welcome packet. Start today and give your baby a healthy start in life! Express Scripts, Inc. (ESI)

Express Scripts is the prescription drug administrator for the My Choice Plans and the HMSA medical options. Plus, if you’re enrolled in a My Choice Plan medical option, you have access to great pharmacy benefits such as no-cost and deductible waived medications! The annual deductible applies when you need to get most prescriptions, but for brand-name diabetes medications and supplies (including injectables), the deductible is waived and you just pay the 20% coinsurance. If you take a preventive, maintenance and/or diabetic prescription medication that is used to manage health care conditions such as high blood pressure, cholesterol and diabetes, review the prescription drug listings (available on the Helpful Tools page of My IN-SITE) and talk to your doctor about switching to one of the no-cost or deductible-waived medications to save your money! To access this cost-saving benefit from your My Choice Plan medical option, simply fill a 90-day supply prescription at a Walgreens or Duane Reade, or through Express Scripts convenient home-delivery service! 1-877-603-8396; www.express-scripts.com

Sources: Cigna, WebMD, Healthwise, Centers for Disease Control, Mayo Clinic, American Heart Association