NOVEMBER 2014

IN THIS ISSUEGet a flu shot2 /thehealthplan3 Top honors 4 Holiday feasts5 New physicians6 Formulary update7 Quit tobacco

Member Update

We make it easy to protect yourself against the seasonal flu, in two convenient, no-cost ways.1. Your physicianYour primary care physician will administer the flu vaccine. Call your doctor today.

2. PharmacyLocal retail pharmacies can administer the flu vaccine. Visit TheHealthPlan.com to search for participating pharmacies in your area.

■■ The vaccine must be administered by a pharmacist and billed through the online pharmacy claims system.

■■ Not all pharmacies offer flu vaccines.

■■ Note: There are state regulations, such as age, regarding who can receive a vaccine from a pharmacist.*Many other retail and pharmacy locations offer the flu vaccine, administered by a third party. Members are responsible for the costs of the service if received from a third party.

Aches Pains Coughing

Congestion Vomiting Diarrhea

Fever Contagious Easily spread

Illness Missing work Fatigue

Missing family Bed-ridden

Down with the flu!

Call your primary care physician or visit an in-network urgent care site if you develop these symptoms:

■ Cough up colorful phlegm. ■ Have a fever above 1030F.■ Feel short of breath. ■ Feel lightheaded/pass out.■ Get an earache. ■ Get chest pains with deep breaths.

You’ve gotten sick. What should you do?

Give the flu the cold shoulder

The Member Update is published

quarterly by Geisinger Health Plan

and serves as an informational

resource for members.

Comments are welcomed.

Please email: memberupdate@

thehealthplan.com.

This issue and previous issues of the

Member Update can be viewed at

TheHealthPlan.com.

Geisinger Health Plan and Geisinger

Choice are referred collectively as

“Geisinger Health Plan” or “GHP,”

unless otherwise noted.

FluA fever is usually 102 degrees, but can go up to 104 and usually lasts three to four days.

ColdA fever is rare in adults, but can be as high as 102 degrees in infants and small children.

102

104

100

98

GEISINGER CHOICE | MEMBER UPDATE

You can't get the flu from a flu shot. The viruses in the flu shots are either dead or don’t contain virus particles, according to the Centers for Disease Control and Prevention. The most common side effects are soreness, redness or swelling at the flu shot site.

Antibodies develop about two weeks after a flu shot. Who should get vaccinated? Everyone 6 months of age and older, with rare exceptions. Talk with your physician if you have any questions.

Fact ch

eck

at your fingertips

The Centers for Disease Control and Prevention recommends:

■■ Stay at home and rest.

■■ Avoid close contact with well people in your house so you won’t make them sick.

■■ Drink plenty of water and other clear liquids to prevent fluid loss and dehydration.

■■ If you get very sick, are pregnant, or are 65 years or older, or are otherwise at high risk of flu-related complications, call your doctor. You might need antiviral drugs to treat the flu.

■■ Treat fever and cough with medicines you can buy at the store.

Cold & Flu prevention and tipsGeisinger Health Plan

9 Pins

.com/thehealthplan

Flu & cold information

5 steps to take if you get the flu

Follow

How to treat a feverWithout medicine

■■ Put a cool, damp washcloth on forehead.

■■ Wash arms and body with a cool cloth.

■■ Take a warm bath.

With medicineLook for the ingredients “acetaminophen” or “ibuprofen” on labels. These medicines may take 30 to 45 minutes to start working. They may not bring fevers down to normal temperature. Any child younger than 3 months who has a fever should see a doctor.

Connect with us on Pinterest, Facebook and Twitter for health tips and news. Just search our name.

Geisinger Health Plan, Geisinger Gold PA’s top-rated plans

* NCQA’s Private Health Insurance Plan Rankings 2010-2015 and NCQA’s Medicare Health Insurance Plan Rankings 2010-2015. U.S. News/NCQA America’s Best Health Insurance Plans 2008-2009 (annual). “America’s Best Health Insurance Plans” is a trademark of U.S. News & World Report.

We’re ranked in the state for:Customer service

Rating of personal doctorRating of specialist

Geisinger Gold and Geisinger Health Plan have been named the No. 1 Medicare and Private health plans in Pennsylvania for quality and service by the National Committee for Quality Assurance’s (NCQA) annual Health Insurance Plan rankings. Nationally, Geisinger Gold’s health maintenance organization (HMO) is ranked No. 10, and GHP’s HMO is ranked No. 12.* The information is available on the private, nonprofit organization’s website, www.ncqa.org.

“It’s an honor to have both GHP and Geisinger Gold recognized among the top health plans nationally and as the No. 1 plans in the state,” GHP President and CEO Steven Youso said. “But most importantly, this means our members are getting the preventive care and treatment they need from their providers and the customer experience they expect from Geisinger Health Plan.”

This year, NCQA, which is dedicated to improving health care quality, ranked more than 400 Medicare plans and more than 500 private plans. These lists are the only apples-to-apples comparison of health-care quality and customer satisfaction in the nation. Geisinger Gold has been consecutively ranked the No. 1 plan in PA for the last seven years. GHP has been ranked the No. 1 plan in Pennsylvania for six of those years.

“We collaborate with Geisinger Health System and community providers to design tools, create resources and build programs. These tools help our members get the preventive services they need to stay healthy and the care they need to manage chronic conditions such as diabetes and asthma,” said Ray Roth, D.O., MBA, vice president and chief medical officer. “This ranking is a testament to the commitment of GHP, our participating providers and our members to improving their health and wellness.”

GEISINGER CHOICE | MEMBER UPDATE

What means for youOur members are more likely to get medicine needed after a heart attack.

GEISINGER CHOICE | MEMBER UPDATE

Online extra! Find Geisinger Health Plan online for holiday recipes.

TurkeyAvoid buying a “basted” or “self-basting” turkey if you are going to brine your turkey, as they already contain natural broth, stock and seasonings. Brining a “self-basting” turkey makes it too salty. If you are deep-frying your turkey, use peanut oil instead of traditional vegetable oil or canola oil as it is healthier, has a high flash point, and tastes great!

CranberryDitch the canned cranberry sauce and make your own. Most canned cranberry sauces come sweetened, and one serving can pack 21 grams of sugar. Some homemade recipes using fresh cranberries even call for up to a cup of sugar. Make your cranberry sauce more health-friendly by swapping sugar for a substitute like Stevia.

Pumpkin pie Bake a healthier pumpkin pie. The average slice of pumpkin pie has 323 calories, and we haven’t even added the whipped cream and side of vanilla ice cream. Instead of buying a store-bought pie, make a healthier version of it at home. Try 2% evaporated milk instead of whole. Any dessert that is homemade allows you to control the ingredients.

Stuffing Use an alternative “stuffing.” While some people may have difficulty parting from the traditional carb-packed white bread or corn bread stuffing, take a walk on the wild side by using wild rice or quinoa. Both of these grains are packed with nutrients and are gluten-free. Add an apple if you really want to take the recipe up a notch.

Green beans Cut the fat and the sodium from green bean casseroles. Start by choosing a can of cream of mushroom soup that is either “reduced-fat” or “low sodium.” As for those fried onions, sauté them instead.

Don’t fall off the wagon■ Stick to small portions and only choose what you like. This will prevent you from overeating and cut down on wasted food.

■ Pace yourself. It’s Thanksgiving, not your last meal. Take your time and chew your food slowly to prevent indigestion, heartburn and other stomach problems.

■ Don’t begin a dieting regimen around this time of year. There is a lot of temptation during the holidays and you don’t want your hard work to go to waste.

■ Continue your current exercise routine the next day. It’s all right if you take it easy as you may feel sluggish the following morning.

Trimming the trimmingsThe holidays are upon us, which means indulging in turkey, stuffing and pumpkin pie.

These Thanksgiving staples may be delicious, but they can also be loaded with fat, sodium and sugar. And while Thanksgiving only comes once a year, you can still create a healthy meal that cuts the calories without sacrificing those classic, holiday flavors.

It’s estimated that the average American will consume over 4,500 calories on Thanksgiving Day. This will include breakfast, lunch, pre-dinner snacking, beverages, dinner, and finally, dessert. Be kind to your waistline this year and check out these guilt-free options for your Thanksgiving meal:

GEISINGER CHOICE | MEMBER UPDATE

New physiciansThis list includes new primary care physicians (PCPs) who have joined our network since April 1, 2014. 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)

What means for youOur members are more likely to get childhood immunizations.

BerksRonald L. Burinsky DO - FP Magda Gabriely MD - IM Aalok V. Malankar DO - FPAnne Marie Rohrbach MD - IM

BedfordErba Carskadden DO- FPChad M. Good DO - FP Miguel A. Salomon MD- FPAngela Tama-Zang MD - P

BucksMichelle Lindley MD - PChaminie A. Wheeler DO - P

CarbonJill D. Crosson DO - FP

CentreNicholas J. Meyer MD - FP

ClearfieldBakhti Jehangir Sinor MD - IM

ClintonRonald N. Eister MD - FP

ColumbiaJason J. Clarity DO - IM Lakshmi Nulu MD - P

CumberlandBruce O. Bailey MD - FPSadee Tricia Forde-Cuffie MD - IMGregory Andrew Formanek MD - IMAmy E. Maley DO - FPTina M. Metropoulos DO - FP Shenil S. Shah MD - IMKatherine R. Violago MD - FP

DauphinIjeoma C. Anyanwu MD - PBurhanuddin M. Farooqi MD - FPSadee Tricia Forde-Cuffie MD - IMMadiha Jamil MD - PShaymal Mozumdar DO - FPShenil S. Shah MD - IMSapna Shah MD - PAzra Ifran Shaikh MD - IMKatherine R. Violago MD - FPArthur L. Williams MD - IM Elizabeth A. Wolff MD - FP

LackawannaJumee Barooah MD- IM Nathan A. Greczek DO - FP Nalini G. Kakimallaiah MD - IM Maureen C. Kozloski MD - IM Faizmohamed M. Mansuri MD - IM Dipti Samir Pancholy MD - IM Sarah M. Sitoski DO - P Michael J. Turock MD - FPSreelatha Chintalalpati Varma MD- IM

LancasterSuzanne Elisabeth Andrews MD- FPSalim Baghli MD - IM Matthew Evans DO - IM Thomas Charles Grana DO - IM Sana Hanafi MD - FP Adrienne K. Kuhlengel MD - FP Naeem Latif MD - IM Katherine A. McGeary MD - P Daniel H. McGrath MD - FP Rudolph F. Rigano MD - IM Justin D. Roberts DO - IM Michael T. Steelman DO - FP Andrea L. Stern MD - FP Carol S. Struminger DO - FP Shannon M. Tapia MD - FP

LebanonAmy Schreiber Gee MD - FP

LehighJill D. Crosson DO - FP Colleen M. Fitzpatrick MD - P

Margaret A. Gallardo-Cochran MD - FP Nicholas C. Kuzma MD - P Ann M. Lam MD - FP Chad E. Lamphere DO - FP Colleen E. Manzella DO - FP Raji G. Mathew MD - FPKathleen A. Melez MD - P Stephanie O. Skuby MD - P Emily E. Souder MD - P Andrew Unger MD- P

LuzerneJames Vincent Martino MD - IM Uchenna Raphael Ofoma MD- IMRuchika Passi MD - PChristina M. Raguckas DO - FP Sreelatha Chintalalpati Varma MD - IM

LycomingJesse D. Hickland MD - FPMatthew James Meeker DO - FPKenneth Chiedu Obiaja MD - FPEddie O. Rodriguez-Lopez MD - FP

MifflinKarina Henriquez MD - IM

Mary M. Naguit MD - FP

MonroeMatthew N. Kozicki MD - FP Colleen E. Manzella DO - FP

MontourNina Ahuja MD - IMMichael Francis Murray MD - IM Uchenna Raphael Ofoma MD - IM

NorthamptonJill D. Crosson DO - FP Colleen M. Fitzpatrick MD - PKathleen A. Melez MD - P Colleen E. Manzella DO - FP Raji G. Mathew MD - FP

NorthumberlandJason J. Clarity DO - IM

SchuylkillColleen E. Manzella DO - FPMargaret J. Young MD - FP

TiogaMadie D. Hartman DO - FP

WayneRichard K. Hacker MD - FP

YorkAdrienne K. Kuhlengel MD - FP Mark E. Lavallee MD - FPMark Morgan DO - FPNiloofar V. Roodsari DO - FPJeffrey Parker Rowand MD - FPAmanda Marie Wonnacott MD - IM

GEISINGER CHOICE | MEMBER UPDATE

Brand Name Status Triple Tier Formulary

4th Tier Application

Traditional Formulary

Prior Authorization

Quantity Limit

Detailed Limit

Formulary Alternatives

Actemra Self Injectable

Formulary 3 Yes 2 Yes Yes 4 syringes per fill

Humira*, Enbrel*

Adempas Formulary 3 Yes 2 Yes Yes 3 tablets per day, 34 day supply per fill

sildenafil*, Adcirca*, Letairis*, Opsumit*, Tracleer, Tyvaso*, Ventavis*

Anoro Ellipta

Non- formulary

Non- formulary

No Non- formulary

Yes No - Advair Diskus 250-50 mcg, Breo Ellipta, Spiriva Handihaler, Tudorza Pressair

Aptiom Formulary 3 No 2 Yes Yes 600 mg tablet: 2 tablets per day. All other strengths: 1 tablet per day.

carbamazepine, divalproex sodium, felbamate, gabapentin, lamotrigine, levetiracetam IR, oxcarbazepine, phenytoin, primidone, tiagabine, topiramate, zonisamide, Lyrica, Potiga*, Vimpat*, Fycompa*, Sabril*

Duavee Formulary 3 No 2 Yes No - clomiphene citrate, estradiol, estradiol/norethindrone acetate, estropipate, norethindrone acetate/ethinyl estradiol, CombiPatch, Estring, Premarin, Premphase, Prempro, Vivelle-Dot, alendronate, ibandronate, raloxifene, risedronate

Epipen & Epipen Jr

Formulary 3 (effective 8/1/14)

No 2 No Yes 2 autoinjectors per fill

Auvi-Q

Farxiga Non- formulary

Non- formulary

No Non- formulary

Yes Yes 1 tablet per day acarbose, metformin, nateglinide, repaglinide, chlorpropamide, glime-piride, glipizide, glipizide/metformin, glyburide, pioglitazone, glyburide/metformin, pioglitazone/glimepiride, pioglitazone/metformin, Invokana*

Fycompa Formulary 3 No 2 Yes Yes 1 tablet per day carbamazepine, gabapentin, lamo-trigine, levetiracetam, oxcarbazepine, valproate, opiramate, phenytoin, tiaga-bine, zonisamide, Lyrica, Gabitril

Gilenya Formulary 2 Yes 2 No No - Betaseron, Copaxone, Tecfidera

Hetlioz Formulary 3 Yes 2 Yes Yes 1 capsule per day, 34-day supply per fill

-

Levocarnitine Formulary 1 No 1 No No - -

Luzu Formulary 3 No 2 Yes No - ciclopirox, clotrimazole, econazole, ketoconazole, griseofulvin, ultramicrosize, griseofulvin microsize

Olysio Non- formulary

Non- formulary

No Non- formulary

Yes Yes 1 tablet per day, 28 day supply per fill

-

Opsumit Formulary 3 Yes 2 Yes Yes 1 tablet per day, 34-day supply per fill

sildenafil*, Tracleer, Adcirca*, Letairis, Tyvaso*, Ventavis*

Orenitram Formulary 3 Yes 2 Yes Yes 34-day supply per fill

sildenafil*, Adcirca*, Letairis*, Opsumit*, Tracleer, Tyvaso*, Ventavis*

Pradaxa Formulary 3 No 2 Yes, new starts only

No - Eliquis, Xarelto

Tecfidera Formulary 2 Yes 2 No No - Betaseron, Copaxone, Gilenya

Xerese Formulary 3 No 2 Yes No - famciclovir, valacyclovir, Denavir*, Zovirax cream*

Zykadia Formulary 3 Yes 2 Yes Yes 5 capsules per day, 34-day supply per fill

Xalkori*

*Indicates prior authorization (PA)

Formulary update The table below represents recent updates to Geisinger Health Plan’s 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.

It’s quitting time

What means for youOur members are more likely to get a mammogram.

We know how difficult it is to stop using tobacco. The steps we recommend to help you quit have proven to be successful. Resources are available at no cost:

■■ Our Stop Tobacco Use program, in which a health management nurse will work closely with you and your doctor to help you quit.

■■ Medications such as the nicotine patch, gum or prescription medication.

■■ Methods and strategies that will help you kick the habit.

GEISINGER CHOICE | MEMBER UPDATE

If you use tobacco, your doctor and Geisinger Health Plan want you to quit.

Who should consider the program? Anyone with a tobacco habit should consider participating in this program. Tobacco use is the single most preventable cause of disease and premature death in our country. People who use tobacco (including smokeless tobacco) are at higher risk for heart attacks, strokes, lung diseases, and throat, mouth and other cancers.

How does this strategy work?Professional support is provided through phone, group, web-based or individual counseling to help you unlearn the tobacco habit by teaching you ways to change your behavior. Your health care provider may recommend medication to assist you in the quitting process. Using one or more of these methods and strategies boost your odds of quitting for good.

How much extra will it cost?There is no charge for the counseling program. The program is open to all members. Your health benefits cover the cost of counseling sessions provided by our staff.

What about medications to help?Buproban, the generic form of the smoking cessation medication Zyban, is a covered benefit for members who have a prescription drug rider. Chantix is also available to members who have a prescription drug rider, but coverage is limited to a lifetime supply of 24 weeks. Members are responsible for paying copayments for prescribed medications and the costs of over-the-counter medications (example: nicotine gum, patch and lozenge) and prescription nicotine replacement therapy (example: nicotine nasal spray and inhaler) if needed. Your health care provider can help you decide if medication is right for you.

Does this actually work?Because our program is personalized, it improves the chances for success. A study of 2,400 Geisinger patients measured the short- and medium-term health and quit rates. We used the results to develop and maintain our successful program.

You can enroll by phone or at TheHealthPlan.com. Call our health management department at 800-883-6355.

100 N. Academy Ave.Danville, PA 17822-3240

Geisinger Health Plan takes top honorsWe’re ranked in PA* for:

Customer serviceRating of personal doctor

Rating of specialistWhat does this mean for you?

Better health care.Our members are more likely to get: ■ Medicine needed after a heart attack ■ The right medication for a cold■ A mammogram ■ Childhood immunizations

Geisinger Marketplace is our online market to shop for individual and family coverage. There are high-value options with a variety of monthly premiums and out-of-pocket costs. Under health care reform, many people qualify for financial help.

Learn more at GeisingerMarketplace.com.

Know someone looking for coverage?

Details on Page 3

*NCQA’s Private Health Insurance Plan Rankings 2014-2015 (HMO plan)