Quarterly Newsletters 18-19 First Quarter Newsletter(clone) | Page 7

NMPSIA replaced the HMO Plan under True Health New Mexico with an EPO (Exclusive Provider Organization) Plan under NMBCBS. The providers, who have agreed to be part of the EPO Plan network, are committed to follow patients closely in order to assist them to make the best decisions with handling their care. These providers have agreed to accept lower reimbursement fees for their services. The network is new, so it will take time for BCBSNM to grow it. Members are encouraged to consider this plan. The NMPSIA website (nmpsia.com) provides a link to locate contracted providers and hospital systems. School employees should research the network to ensure the plan will work for them.

NMPSIA’s wellness programs offered through the medical plans are improving member engagement.  NMPSIA is asking for your support in considering implementation of wellness at work program in an attempt to improve the overall health of the NMPSIA membership.  These programs may also contribute to less absenteeism and improve presentism, as well as encourage members to develop a relationship with a primary care physician in order to ensure they become aware of whether or not they may be at risk of developing a chronic medical condition.  The programs can be designed to fit the needs of your district/school, as one-size does not fit all.  If you would like more information, please contact Ms. Katherine Chavez, Benefits and Wellness Operations Manager, at [email protected] at 1.800.548.3724.  Please allow NMPSIA to help you come up with a strategic plan for your district/school.  Remember, wellness is not just about nutrition and exercise, it is about our emotional, financial, occupational, environmental, spiritual, and social state of mind.  Please visit nmpsia.com and review the presentations made during the July Regional Benefit Training sessions.  The trainings were geared toward improving overall health.

The Express Scripts Annual report for FY17 indicates that specialty drugs are the cause for the increased prescription drug trend.  The specialty drugs per member per month trend increased by 16.4%.  Inflammatory conditions (such as rheumatoid arthritis, Crohn’s Disease, and psoriasis) are the primary driver in the specialty trend increase. Other conditions such as diabetes, cancer, MS, hemophilia, asthma, Hep C, and HIV are also the cause of the increased trend.  The top ten conditions being treated by specialty drugs represent 65.3% of NMPSIA’s total Rx plan cost of $53,056,015 (for both non-specialty and specialty drugs).

The net per member per month plan cost for prescription drugs decreased by 12.6% in FY18, primarily driven by the cost share trend component. The specialty drug per member per month plan cost decreased by 11.1%, driven by specialty cost share and the new Saveon Program (patient financial copay assistance program). The top ten conditions being treated represent 67.6% of the total plan cost, which was $48.6 million in FY18.

NMPSIA will be participating in a joint RFP with the NMRHCA, Albuquerque Public Schools and State Risk Management for life and disability to be released within the next couple of months.  Currently, the contract with The Standard expires 6/30/19.

If you have any concerns or questions related to benefit matters, please contact Ernestine Chavez at NMPSIA.

Risk Division

The Risk Services side of NMPSIA provides insurance for Property, Liability, School Board Legal Liability, Crime, Cyber Liability and Workers’ Compensation coverages. NMPSIA members consist of K-12, Charter Schools and Universities. Insurance is provided by the use of a coverage document that is called a Memorandum of Coverage (MOC). NMPSIA maintains large self-insured retentions/deductibles, which means that NMPSIA pays losses on most cases that are filed on behalf of its Members. NMPSIA then purchases excess insurance from carriers that provide large limits of liability in case a claim exceeds retentions. NMPSIA contracts with various professionals

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