H1N1 Information and Updates : Bureau of Insurance

H1N1 Information and Updates:

UPDATE: Nov. 18 - Reducing Barriers to Treatment

UPDATE : Oct. 19 - Roster Billing and other information

On Sept.1, Gov. Baldacci signed a Proclamation of Civil Emergency Due to a Highly Infectious Agent, H1N1 influenza, which was renewed on Sept. 30.

The Bureau of Insurance is working with the Maine CDC and other state agencies to help address the H1N1 pandemic.

To assist in the state-wide effort to be prepared, Superintendent Kofman established a special working group at the Bureau of Insurance including senior members of her staff.

Voluntary actions by Maine’s health plans. The working group has held weekly calls with the members of the Maine Association of Health Plans to develop strategies to address the public health issues resulting from the spread of H1N1 pandemic. To date, most of Maine’s licensed health insurers, including Aetna, Anthem, CIGNA, Harvard Pilgrim and UnitedHealth Group, have voluntarily agreed to eliminate barriers to accessing the H1N1 vaccine, and treatment for diagnosed cases of H1N1.
New Rules. To be better prepared for a widespread insurance emergency, the Maine Bureau of Insurance promulgated new emergency preparedness rules for health plans. An emergency rule went into effect June 16, 2009, and Maine Insurance Rule Chapter 765 became a final rule, effective Sept. 16, 2009.
Superintendent Kofman issued Bulletin 358, Business Continuity Planning on June 25, to ensure that insurers operating in Maine are adequately prepared for an insurance disaster.

For more information about H1N1 resources, visit the Maine CDC Web site at http://www.maine.gov/dhhs/boh/index.shtml.

For additional information, contact Katie Dunton, Outreach and Communications Advisor to the Superintendent, at 624-8477 or Katie.dunton@maine.gov.

UPDATE: November, 18, 2009
Steps being taken to remove or reduce barriers to access to antivirals, used specifically for treatment of diagnosed cases or prophylactic actions for H1N1:

	Aetna	Anthem	CIGNA	Harvard Pilgrim	United Health Care	MEGA Life & Health*
On formulary¹	a	a	a	a	a	MEGA Life & Health does not offer prescription drug coverage in some states, including Maine
Moved antiviral from tier 3 to tier 2, resulting in lower cost-sharing for patients²	a	a	a	a	a
No prior authorization required for antivirals prescribed to treat H1N1	a	a	a	a	a
Waiver or review available for additional and extended treatment	a	a	a	a	a
Follows CDC guidelines for frequency and quantity of antiviral doses www.cdc.gov/H1N1flu/recommendations.htm#1	a	a	a	a	a
Can respond within 24 hours to CDC changes in recommendations for H1N1 treatment (e.g., outbreaks in April resulted in formulary changes on the next business day)		a	a	a
Ability to address claim processing for compounds to ensure claims process quickly and correctly			a	a
Special provisions made for health care providers with multiple exposures			a

NOTE: Some have indicated that Roche, manufacturer of Tamiflu is not taking any steps to assist with price of the medication. There is no FDA-approved generic option.

¹ For plans that include a pharmacy benefit.
² Some plans have established a process for patients with coverage that has a deductible for RX and co-insurance requirements that create a significant financial burden for patients in high-risk groups (as identified by the CDC). Patients should contact their health plans if they are having trouble meeting their deductible or have a financial burden re: accessing antivirals for treatment of H1N1.

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