These proposed benefit changes for fully-insured plans are subject to the review and approval of regulatory agencies. In addition to these upcoming benefit changes, CareFirst members currently have access to care support programs that help members living with diabetes manage their condition. CareFirst will also provide its self-insured plans with an option to waive the cost of insulin to members. Many large employers set their own health benefits and are referred to as “self-insured” plans. The insulin benefit change applies only to members in commercial fully-insured plans. This is one step among a series of aggressive actions that CareFirst is and will continue to take to confront a health crisis that is facing the nation.” While we have taken this step to ensure our members have access to insulin and diabetic supplies, we urge policymakers to join us in taking action to lower the price of prescription drugs so that members will have access to the medication and services they need. “Removing financial barriers to care will enhance access to diabetes management tools and drugs, ultimately resulting in better health outcomes for our members. “As a not-for-profit healthcare company, we are committed to providing access to affordable health coverage for individuals and families throughout the communities we serve,” said CareFirst President and CEO, Brian D. In 2019, members in fully-insured plans paid nearly $6M in out-of-pocket costs for insulin, which averaged to approximately $119 per fill. Medication is the largest contributor to overall spend at CareFirst, exceeding $2.5 billion annually, and the costs continue to grow at an unsustainable rate. The cost of insulin and other prescription drugs continue to increase, creating affordability challenges for members. – To advance its mission to provide affordable access to health coverage, CareFirst BlueCross BlueShield (CareFirst) today announced it will offer insulin and diabetic supplies coverage to members at $0 out-of-pocket, prior to meeting a deductible in 2021.īeginning January 1, 2021, CareFirst will provide access to preferred brand insulin and diabetic supplies, such as glucometer test strips and insulin syringes, as a covered benefit with no member cost-sharing in plans where CareFirst sets the health benefits and manages the financial risk, referred to as “fully-insured” plans. Capabilities & Initiatives Show Capabilities & Initiatives submenuīaltimore, Md./Washington, D.C.The BCBS System Show The BCBS System submenu.Individuals & Families Show Individuals & Families submenu.Member Services Show Member Services submenu.In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The member's benefit plan determines coverage. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Members should discuss any matters related to their coverage or condition with their treating provider.Įach benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Treating providers are solely responsible for medical advice and treatment of members. The ABA Medical Necessity Guide does not constitute medical advice. The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. By clicking on “I Accept”, I acknowledge and accept that:
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