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CST: 11/12/2019 17:25:17   

UPMC Health Plan Expands Commitment to Holistic Diabetes Wellness

70 Days ago

New UPMC for Life program includes significantly-reduced prescription medicine copays and enhanced wellness offerings for its members with diabetes and pre-diabetes

Pittsburgh, PA, Oct. 02, 2019 (GLOBE NEWSWIRE) -- UPMC Health Plan has announced a bold, comprehensive, and holistic wellness program to help Pennsylvanians who have diabetes or diabetes risk factors manage their care.

Beginning in 2020, UPMC Health Plan’s Medicare Advantage product, UPMC for Life, will offer most members reduced copays for diabetes medications. Members will also continue to have no copay for a select set of preferred generic diabetes medications.

“When they use a preferred pharmacy or mail order, UPMC for Life members will be able to purchase a three-month supply of insulin for $20, which can lead to potential savings of over $300 each year,” said Chronis Manolis, chief pharmacy officer at UPMC Health Plan. “In addition to insulin, we are also making additional prescriptions more affordable for our members by reducing copays for all brand diabetes medications on our formulary. These efforts will help our UPMC for Life members achieve a healthier life and better manage their long-term conditions.”

All brand diabetes medications on the UPMC for Life formulary will be moving from Tier 3 to Tier 2, which means UPMC for Life members will have copays as low as $10 for a 30-day supply when they are filled at a preferred pharmacy in 2020. In addition, UPMC for Life will continue to offer many commonly used medications at a $0 copay for preferred generics (Tier 1).

Members receive the biggest cost savings when filling a 90-day supply at a preferred pharmacy location across Pennsylvania, including Giant Eagle, Rite Aid, Sam’s Club, Walgreens, and Walmart or by using mail-order, which provides an added convenience.

Members who choose one of the following six UPMC for Life plans will receive lower copays when they fill their diabetes prescriptions at an in-network pharmacy beginning on Jan. 1, 2020:

  • HMO Deductible Rx (HMO)
  • HMO Rx Choice (HMO)
  • HMO Rx (HMO)
  • HMO Rx Enhanced (HMO)
  • PPO High Deductible RX (PPO)
  • PPO Rx Enhanced (PPO)

Reduced copays do not apply to the HMO Premier Rx (HMO) and some employer group plans.

In collaboration with the reduced copays for diabetes medications, UPMC for Life members are also able to develop personalized wellness plans with UPMC Health Plan health coaches who are specially trained in chronic condition management.

Health coaches will help members stay on track with their goals, including giving reminders to take medications as prescribed and make other lifestyle improvements, such as beginning an exercise program, losing weight, eating healthy, stopping smoking, or reducing stress.

More than 25 percent of UPMC for Life members currently have diabetes, and a significantly larger number of members are considered pre-diabetic, since they have one or more diabetes risk factors. Across the U.S., more than 30 million people have diabetes and 84 million have prediabetes, according to the American Diabetes Association.

“UPMC Health Plan is taking an innovative and holistic approach to help our members manage diabetes and other chronic conditions so that they can live an active, vibrant life,” said Diane Holder, president and CEO of UPMC Health Plan. “Through reduced prescription medicine copays and personalized, evidence-based disease management programs, our members can work with an integrated team of health care professionals to develop a care plan that provides both the knowledge and the support they need to improve their health.”

All UPMC for Life members receive in-network access to UPMC’s top-ranked doctors, award-winning hospitals, and specialized chronic disease care programs available across Pennsylvania, as well as best-in-class concierge services and member services. UPMC Presbyterian Shadyside has been recognized by U.S. News & World Report as one of the nation’s top-ranked hospitals (7-30-19).

And many UPMC for Life members also have access to a free Diabetes Prevention Program that helps members lose weight, adopt healthy habits, and reduce the risk of developing type 2 diabetes through a series of weekly one-on-one sessions with a health coach and small group sessions to gather support from both clinical experts and peers.

Some UPMC for Life HMO plans will also include a quarterly allowance that can be used to buy covered health and wellness items in 2020. Members will be sent a mail-order catalog with hundreds of covered items to choose from.

Enhanced Plan Benefits

In addition to the reduced copays and lifestyle management programs, UPMC for Life has enhanced many of its plan benefits for the upcoming year. All plans include:

  • The SilverSneakers® fitness program, which provides free unlimited access to participating fitness facilities, one free personal training session per year, support from trained instructors, access to a variety of fitness amenities, the option to work out at home with fitness kits, and online support at www.SilverSneakers.com.
  • Preventive dental coverage for cleanings and oral exams every six months, as well as one bitewing x-ray every year. Some plans also include an allowance for fillings and simple tooth extractions.
  • Coverage for routine vision exams and a vision allowance for contacts or glasses every one or two years, depending on the plan.
  • Some HMO plans will have a quarterly allowance that members can use to buy covered wellness items through a mail order catalog.
  • One free in-home safety assessment each year and up to three bathroom safety products each year at no additional cost.
  • Six personal counseling sessions and six additional caregiver counseling sessions each year with a licensed counselor.
  • HMO plan members will have in-network medical coverage when they travel to Arizona, Florida, Georgia, North Carolina, South Carolina, and Tennessee.
  • Worldwide emergency assistance with the Assist America program, which provides help 24/7 when members travel more than 100 miles from home or to another country.
  • Convenient access to care for common medical conditions through an online virtual urgent care visit with UPMC AnywhereCare. This service lets members virtually visit with a UPMC provider from their computer or smartphone 24/7.
  • For members with a serious or advanced illness, UPMC for Life offers additional care and support at no additional cost. Members receive a personal care plan, help with symptom and medication management, and home-delivered meals, if needed.

Enrollment Details

The 2020 Annual Election Period is Oct. 15 through Dec. 7, 2019. Medicare beneficiaries can add or drop Part D prescription drug coverage, switch or change to a Medicare Advantage plan, or change to Original Medicare. Changes in coverage will be effective Jan. 1.

Medicare beneficiaries who are interested in UPMC for Life can get information on the 2020 plans online at www.upmchealthplan.com/medicare or by calling UPMC for Life toll-free at
1-877-381-3765 seven days a week from 8 a.m. to 8 p.m. TTY users should call 711.

Reduced diabetic drug copays apply only during the Initial Coverage Stage. Members who receive Low Income Subsidy (extra assistance paying for Part D prescriptions) may not have these copays. Members should review their plan-specific formulary for the complete details.

UPMC for Life has a contract with Medicare to provide HMO, HMO SNP, and PPO plans. The HMO SNP plans have a contract with the PA State Medical Assistance program. Enrollment in UPMC for Life depends on contract renewal. UPMC for Life is a product of and operated by UPMC Health Plan Inc., UPMC Health Network Inc., UPMC Health Benefits Inc., UPMC Health Coverage Inc., and UPMC for You Inc.

Tivity Health and SilverSneakers are registered trademarks or trademarks of Tivity Health, Inc. and/or its subsidiaries and/or affiliates in the USA and/or other countries.

About the UPMC Insurance Services Division

The UPMC Insurance Services Division is owned and operated by UPMC, a world-renowned health care provider and insurer based in Pittsburgh, Pa. The UPMC Insurance Services Division—which includes UPMC Health Plan, WorkPartners, UPMC for Life, UPMC for You, UPMC for Kids, and Community Care Behavioral Health—offers a full range of group health insurance, Medicare, Special Needs, CHIP, Medical Assistance, behavioral health, employee assistance and workers' compensation products and services to 3.5 million members. For more information, visit www.upmchealthplan.com.

Ned Schano
UPMC Health Plan
4124540131
schanon@upmc.edu

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