Rx and Medical Scenarios

Knowledge is power When members understand the cost of health care, they make more informed decisions Prescription Costs Talk to provider and pharmacist Emergency Room vs Urgent Care vs PCP vs Telemedicine or Nurse Hotline

Prescription Costs: does it really matter? YES! Total cost 30 day supply today at the pharmacy 30 day member copay today (all plans) member cost VEHI 2018 Platinum/Gold VEHI 2018 Gold/Silver CDHP* Lipitor 40 mg (non-preferred brand) $354.66 $45 $177.33 Atorvastatin 40 mg (generic tier 1) $4.16 $5 $4 Cozaar 50 mg (non-preferred brand) $104.82 $52.41 Losartan pot 50 mg (generic tier 1) $1.88 Celebrex 100 mg (preferred brand) $200.63 $20 Celecoxib 100 mg (generic tier 1) $18.77 Full cost until deductible is met, 20% until out of pocket maximum is met

Prescription Costs: does it really matter? YES! Total cost 30 day supply today at the pharmacy 30 day member copay today (all plans) 30 day member cost VEHI 2018 Platinum/Gold member cost VEHI 2018 Gold/Silver CDHP* Zomig 2.5 mg (1 tab!) (non-preferred brand) $89.37 $45 $44.69 Zolmitriptan 2.5 mg tab (1) generic $11.05 $5 $4 Prozac 40 mg (non-preferred brand) $750.66 $375.33 Fluoxetine 40 mg (generic tier 1) $7.39 Nexium Dr 40 mg (non-preferred/step therapy) $250.26 $125.13 Esomeprazole mag dr 40 mg (generic tier 2) $36.14 $10 Full cost until deductible is met, 20% until out of pocket maximum is met

location, location, location… Selecting the right location for can result in improved health care and lower cost for the member and VEHI ! Your home or office (Nurse Hotline or Telemedicine) Your PCP – knows you and your history! Urgent Care Center Emergency Room

location, location, location… Emergency medical care – a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in: a condition that places the health of the individual (or, with respect to a pregnant woman, the health of the woman and/or her unborn Child) in serious jeopardy; or serious impairment to bodily functions; or serious dysfunction of any bodily organ or part.

location, location, location… Urgent care – Medical services necessary to treat a condition or illness of an individual that, if not treated within 24 hours, presents a serious risk of harm; or, applying the judgment of a prudent layperson who possesses an average knowledge of health and medicine, could seriously jeopardize the ability of the individual to regain maximum function; or, in the opinion of a Provider with knowledge of the individual’s medical condition, would subject the individual to severe pain that cannot be adequately managed without care within 24 hours. PCP office visit – non-urgent medical condition or preventive care, many PCPs will see a current patient the same day or week if requested and the condition warrants. For routine care, PCP will schedule patient for next available appointment.

Location… Telemedicine – BCBSVT members have access to American Well (Amwell) a nationally acclaimed telemedicine provider to have 24/7 access to medical providers anytime and anywhere. Top 10 conditions that use telemedicine: • Sinusitis (sinus infection) • Upper respiratory infection • Bronchitis • Urinary tract infection • Pharyngitis (sore throat) • Conjunctivitis (pink eye) • Cough • Influenza • Allergies • Dysuria • Asthma In 2018 the cost for an Amwell visit is $39 for a CDHP plan, or $25 copayment for the non-CDHP plans. (Currently $15 for VHP plans, $20 for the Comp $1,200 plan or $39 towards ded/coins for $300 Comp plan) http://www.bcbsvt.com/member/telemedicine Nurseline – Real nurses - expert advice for real situations Whether it's removing a splinter, caring for a child with a fever or getting background information about surgical options, our nurses are here to offer expert advice. Talk with a nurse about hundreds of health issues ranging from asthma to zinc, like: • Coughs • Colds • Fever • Headache • Abdominal pain • Children's health • Food & diet • Smoking • Weight loss • Sexually transmitted diseases and much more! http://www.bcbsvt.com/nurseline 866-612-0285 24/7 access