Complementary Alternative Medicine Program

Humana-insured patients now have access to a valuable program that provides discounts on such services as chiropractic care, acupuncture and massage therapy. The new program, introduced August 1, 2002, allows members who do not have a complementary alternative medicine (CAM) benefit — or those who have exhausted their CAM or chiropractic benefit — to save as much as 30 percent on services provided through Humana's CAM network, American WholeHealth Network.

The CAM discount program is offered at no charge to fully insured commercial members and Administrative Services Only (ASO)* members and is a value-added service for the growing number of members who are seeking CAM services. No referral is needed, and no special enrollment procedure is required to use the discount program. Those who wish to access the discounted services need only identify themselves as Humana members by presenting their member ID cards at the point-of-service. In addition, there is no limit to the number of services members may obtain under the discount program.

A list of American WholeHealth participating practitioners can be found on the Humana Web site, www.humana.com, under the member's personal page, "Special Discounts" panel. Searches can also be conducted using the provider search tool, http://humana.wholehealthmd.com. Members can also obtain information about practitioners in their area and the amount of the discount by calling the customer service number on the back of their Humana medical ID card.

"It's clear that our members are using complementary alternative medicine and that CAM has established itself now as an integral part of mainstream medicine," said Samuel Benjamin, M.D., Humana's corporate medical director of integrative strategies. "With this program, we’re accommodating our providers as well, who want to have options for referring their patients to appropriate sources for CAM therapies." Benjamin noted that the providers in the CAM network have been credentialed by American WholeHealth Network.

The program has been designed for ease of use for both the members and CAM network practitioners, and it provides members with more choices and more flexibility in seeking services not covered under their primary benefit plan. "This program substantially expands the range of treatment modalities that practitioners in Humana's network can use. But we believe that we are expanding the scope of the mainstream, rather than trying to support alternative medicine," said Benjamin.

Many members who seek CAM services now pay out of pocket for those services, so the discount program is intended to help them better manage those health care costs. For members who do have a full CAM benefit or a chiropractic benefit, the discount program may be used when those benefits have been exhausted. (The new offering is not a covered medical plan, nor does it replace chiropractic benefits in states where those benefits are mandated.) The new program is available only to fully insured commercial members, ASO members and Humana associates.

CAM providers who are not currently members of the American WholeHealth Network and wish to inquire about joining the program should call 1-800-274-7526.

* At this time, the program is not available in Arkansas, Oklahoma and Tennessee, and where laws prohibit the provision of discount health care programs.

It's Not Too Late to Vaccinate

The 2002-03 flu season is in full swing in some areas of the country, but it's not too late to vaccinate. This year, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) issued new recommendations urging physicians to continue vaccinating patients throughout the winter. The ACIP also is encouraging physicians to vaccinate healthy children 6 months to 23 months of age when feasible, as studies indicate this group is at a substantially increased risk for influenza-related hospitalization. (Please note that member benefits vary by plan and can be verified by calling the Humana customer service phone number on the back of the member’s ID card.)

The ACIP confirmed that a vaccine shortage is not expected this season, as occurred in some recent years, and that substantial quantities of the vaccine remained unused during the last two seasons.

For details on the ACIP recommendations and a flu activity update, check out the following CDC Web pages:

www.cdc.gov/nip/flu

www.cdc.gov/ncidod/diseases/flu/hc_providers.htm

www.cdc.gov/mmwr/preview/mmwrhtml/rr5103a1.htm

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Drug List Changes Announced

Effective January 1, 2003, Humana's Drug List for both the Rx3 and Rx4 prescription drug benefit plans will change. These changes include additions and deletions from the Rx3 Drug List and some tier changes in the Rx4 Drug List.

In some cases, tier changes mean that your Humana-insured patients will still have access to the drug, but may be required to pay a higher copayment than they paid in 2002. Some of the products that are moving to a higher tier include the nonsedating antihistamines (NSAs). Products like Claritin, Allegra and Clarinex will still be available to your patients, but they will pay a higher copayment.

To view all of the changes to the Humana Drug List, please go to www.humana.com and click on the "Physician/Provider" link. Click on "Prescription Drug Benefits and Services" and then click on "Prescription Resources," which will take you to a printable version of the Drug List and information about changes for 2003.

In December, physicians will receive a copy of the 2003 Drug List, which will outline the prescription drugs on the Rx3 Drug List and the most widely prescribed drugs in each tier of the Rx4 Drug List.

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Letter from Jack Lord
ePharmacy Functions Tally High Member Usage
Overpayment Reminder
Complementary Alternative Medicine Program
It's Not Too Late to Vaccinate
Drug List Changes Announced
The Merits of Disease Management
ESRD Early Referral Initiative Seeks to Improve
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