New Mexico Health Connections | my connection | Summer 2018

{ MY CONNECTION } 3 Are you getting the most out of your prescription drug benefit? NMHC partners with OptumRx ® to provide your pharmacy coverage, process your prescription claims and manage the NMHC pharmacy network. On mynmhc.org/formulary.aspx , you will find lots of information to help you manage your prescriptions and your health, such as: •   A formulary (list of covered medications), updated twice per year, including a list of $0 copay generic medications (available on most plans). •   Lists to help you find alternatives to drugs that are not on the formulary or that need prior authorization or step therapy. •   Information on BriovaRx ® Specialty Pharmacy, which manages medications prescribed for specific, complex health problems. •   An important note on prior authorizations for members whose subscriber ID numbers may have changed. •   A link to download the OptumRx mobile app, which you can use to keep all of your prescription information in one handy place. •   Forms you may need. •   And much more! Important change to your mail-order pharmacy benefit Your mail-order pharmacy benefits changed in 2018. Here’s a summary of the changes: Individual plan members Small group plan members Individual members may use OptumRx Home Delivery, but can receive only a 30-day supply of medication via mail-order. Ninety-day medication supplies are not a covered benefit for individual members. Group plan members can use OptumRx Home Delivery and can receive up to a 90-day supply of medication via mail-order. The copay will be the same for mail-order as it is at a retail pharmacy. Beginning July 1, 2018, OptumRx Home Delivery will no longer dispense more than a 30-day supply of opioid medications at one time for any patient (whether on an individual or a SHOP plan). We are making this change to support safe, appropriate use of opioids and to limit excess supply in the market. Not all members have a mail-order pharmacy benefit. Please call Customer Service at 855-769-6642 to determine your mail-order pharmacy coverage. OptumRx Home Delivery does not provide Specialty Pharmacy medications by mail. Not sure which type of NMHC plan you have? Look at your ID card. •   Individual members have an ID number beginning with 000 or P7. •   Group plan members have a five-digit ID number. “Back so soon?” These probably aren’t the words most people want to hear when checking into a hospital. Yet many patients find themselves returning for another hospital stay shortly after they’ve been discharged. Hospitals are working hard to reduce readmissions, when discharged patients return just weeks or months later for the same or a related health condition. But there are also steps you can take to avoid making that round trip the next time you’re in the hospital. Often, it comes down to knowing how to take good care of yourself before and after you go home: Speak up! As you prepare to leave the hospital, make sure you understand your discharge instructions and what you can do to stay well. Take notes. If any aspect of your care isn’t clear, ask the staff to explain it again. Be sure to get written instructions as well. It can be helpful to have a friend or family member there, too. Don’t be a stranger. Make an appointment to see your regular doctor or one who specializes in your condition—and follow through. If you were hospitalized for a behavioral health condition, call your be- havioral healthcare specialist or local behavioral health center to get an appointment as soon as possible. If you don’t have a regular physical or behavioral healthcare provider, our care coordinators can help you find someone in your area who is in our provider network. Call 844-691-9984 . Also follow through with any lab work or other tests you need. Get to know your meds. You may leave the hospital with new medicines to take, along with your usual ones—it can be a lot to juggle! To help avoid confusion, make sure you understand when and how to take your medications. And keep all of your doctors or behavioral healthcare providers up-to-date on every- thing you’re taking, including vitamins, herbs, prescription medicines and over-the-counter remedies. Who you gonna call? Ask the hospital staff what problems (like a new or worsening symptom) to watch for and what to do if you start to get into trouble. Write down the name and number of the per- son to call if you have any questions or concerns about your condition. Find the support you need. Ask about classes or programs at the hospital or in the area that can help you learn to live better with a health condition. Sources: AARP; Agency for Healthcare Research and Quality; Centers for Medicare &Medicaid Services 1 2 3 4 5 SUMMER 2018 MY CONNECTION is published as a health and wellness service for the members of NEW MEXICO HEALTH CONNECTIONS. Information comes from a wide range of medical experts. If you have any concerns or questions about specific content that may affect your health, please contact your primary care provider. Models may be used in photos and illustrations. 2018 © Coffey Communications, Inc. All rights reserved. ID0645-0618 Find us online: mynmhc.org Contact us: Customer Service : 855-769-6642 mynmhc.org/contact_us.aspx Michelle McRuiz, editor michelle.mcruiz@mynmhc.org Facebook “f”Logo CMYK / .ai Heading home— and staying there 5 STEPS TO AVOID A HOSPITAL READMISSION { W E L L N E S S }