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I N T H I S I S S U E

U P - T O - D AT E H E A LT H I N F O R M AT I O N F O R Y O U & Y O U R FA M I LY

WELLNESS TODAYGreetings from the Executive Director

Asmentioned in our last newsletter, the increased cost of prescription drugs is affecting the NMPSIA prescription drug plan costs. Since the NMPSIA prescription drug plan is self-insured, this means that all prescriptions filled on the plan are paid from your payroll deductions for medical premium and your

employer’s share it contributes toward your premium.

Even though generics are still the most cost effective option, with fewer manufacturers of certain generic drugs and shortages of active ingredients, some generic drugs have increased in costs anywhere from 182% to 812%. The plan is paying at least 11% more on non-specialty prescriptions drugs in comparison to last year, and 31.9% more on specialty drugs.

The following are some interesting facts about this drug spend:• The plan paid $2.5 million last school year to treat patients with HepC, $2.5 million to treat cancer, $4.9 million to

treat inflammatory conditions such as rheumatoid arthritis, psoriasis and Chron’s Disease, and $9 million to treat diabetes.

• The plan paid approximately $50 million in Rx claims last school year, and with the rising costs and use of the Rx Plan, it is expected the plan will pay at least $5 million more this current school year.

• In order to offset some of these increased costs, the generic drug copays will be increasing on January 1, 2016 as follows:

Over-the-counter drugs: Copayments for over-the-counter Proton Pump Inhibitors (PPIs), Non-Sedating Antihistamines (NSAs) and ProAir HFA are the same as for generic drugs.

Effective January 1, 2016, NMPSIA is including a Naprapathy benefit. The in-network benefit will be subject to the deductible, there will be a $50 copayment, and there is a $500 yearly maximum benefit under both the high and low option plan. Visit nmpsia.com to locate a list of contracted providers in Santa Fe, Albuquerque, Mountainair and Farmington. We will update the list as more providers becomes licensed.

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1 Greetings from the Executive Director2 2015-2016 Influenza Season Issues 3 Biosimilars: A Lower Cost Alternative to Specialty Drugs4 Learn About Your Basic Life Specified Disease Benefit From the Standard

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Type of Medicine

Participating Retail Pharmacies

(up to a 30-day supply)

Walgreen’s Pharmacies

(up to a 30-day supply)

Home Delivery from the Express Scripts

PharmacySM

(up to a 90-day supply)

Generic $5 $10 $12.50

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New Mexico Public Schools Insurance Authority protects the privacy and security of your personal information in accordance with state and federal laws. The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that protects the privacy of personal health information. NMPSIA is required by law to maintain the privacy of your health information and to provide you with a notice of its legal duties and privacy practices. The NMPSIA HIPAA Privacy Notice can be found at http://nmpsia.com by clicking on the Notice of Privacy Practices link. The Privacy Practices notice describes how medical information about you may be used and disclosed and how you can get access to this information. Your personal information is protected by applicable Federal and State Privacy Laws, and by the policies of NMPSIA. The contents of this newsletter highlight some of the benefits available under your plan. A complete description regarding the terms of coverage and exclusions and limitations will be provided in your summary plan description available online at www.nmpsia.state.nm.us. If there is any discrepancy between the contents of this newsletter and the summary plan description, the summary plan description supersedes.

IT’S EASIER THAN EVER TO GET VACCINATED FOR THE FLU AND OTHER ILLNESSESVaccinations are now available at many convenient retail pharmacies

Many diseases are preventable through the use of vaccinations. To help you stay healthy, you can now receive vaccines administered at your local retail pharmacy

through NMPSIA’s prescription-drug benefit at NO CHARGE when you present your Express Scripts ID Card. Vaccines administered at your retail pharmacy typically do not require an appointment and are the same effective medications as your physician’s office. Visit nmpsia.com, click on Insurance Carriers, and click on Express Scripts to locate the certified pharmacist list.

Along with protection from the flu, your prescription-drug benefit plan may cover several other vaccines, which are now available at many retail pharmacies. Refer to Page 37 of the NMPSIA Program Guide at nmpsia.com for information about this vaccine benefit.

One of the best ways to avoid influenza and related complications is to get a flu shot. According to the Centers for Disease Control and Prevention (CDC), every year in the U.S. an estimated 5-20% of the population gets the flu, and the single best way to prevent seasonal flu is to get vaccinated each year. CDC recommends a yearly flu vaccine for everyone 6 months of age and older.

Contact your network pharmacy in advance to inquire about vaccine availability, age restrictions, and current vaccination schedules. Also, don’t forget to present your member ID card to the pharmacist.

Are there other ways to prevent the spread of illness? According to the CDC, everyday actions can help you stay healthy:• Cover your nose and mouth with a tissue when you cough

or sneeze. Throw the tissue in the trash after you use it.• Wash your hands often with soap and water, especially after

you cough or sneeze. If soap and water are not available, use an alcohol-based hand rub such as Germ-X® or Purell®.

• Avoid touching your eyes, nose or mouth. Germs spread that way.

• Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

Greetings from the Executive Director cont’d from pg1

What is Naprapathy? Naprapathy is a branch of medicine (manual medicine) that focuses on the evaluation and treatment of neuro-musculoskeletal conditions. Doctors of Naprapathy are connective tissue specialists. Naprapaths do hands-on soft and Connective Tissue Manipulations (SCTM) using techniques as spinal manipulation/mobilization, stretching and massage, to stretch the definite strands of shrunken soft and connective tissue in order to decrease pain and disability.

Beginning January 1, 2016, we will be offering video visits for members enrolled with Presbyterian Health Plan. The copays will be a follows: $10 for High option Plan members and $15 for Low Option Plan members.

Some common conditions adults use for video visits are as follows; acne, allergies, bronchitis, cold and flu, gout, headache, urinary tract infection, joint aches and pains, nausea and vomiting, eye infections, rashes, sinus infection, sore throat, and

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3New Mexico Public Schools Insurance Authority protects the privacy and security of your personal information in accordance with state and federal laws. The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that protects the privacy of personal health information. NMPSIA is required by law to maintain the privacy of your health information and to provide you with a notice of its legal duties and privacy practices. The NMPSIA HIPAA Privacy Notice can be found at http://nmpsia.com by clicking on the Notice of Privacy Practices link. The Privacy Practices notice describes how medical information about you may be used and disclosed and how you can get access to this information. Your personal information is protected by applicable Federal and State Privacy Laws, and by the policies of NMPSIA. The contents of this newsletter highlight some of the benefits available under your plan. A complete description regarding the terms of coverage and exclusions and limitations will be provided in your summary plan description available online at www.nmpsia.state.nm.us. If there is any discrepancy between the contents of this newsletter and the summary plan description, the summary plan description supersedes.

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BIOSIMILARS:A Lower Cost Alternative to Specialty Drugs!One Giant Leap for More Affordable Specialty Drugs

W ith spending on prescription drugs continuing to rise, topped by double-digit trends in specialty medications, biosimilars will play an important part in keeping healthcare benefits

affordable and accessible for Americans.

There are more than 4,000 pharmaceutical products already in the U.S. market. In September 2015, Zarxio™ (filgrastim-sndz) became available. But this additional product is not just any new specialty drug—it is the first biosimilar available in the U.S. And it could open the door to a wave of biosimilars that may save $250 billion in drug spend for the country over the next decade and deliver patient access to these life-sustaining therapy classes.

Biosimilars will do for the biotech market, primarily made up of very expensive injectable drugs, what generic drugs did for traditional oral solid pills a decade ago: lower the cost for safe, effective treatments that improve and save lives. They will revolutionize the category of spending that is among the fastest-growing and most worrisome for payers who want to continue providing sustainable, high-quality benefits for their members.

While biosimilars have been safely used in the European Union, Japan and other countries for years—with prices 30% lower than their brand-name counterparts—applications here have been bogged down in the regulatory process and patent litigation.

The High Cost of Delayed Access Zarxio, a non-interchangeable biosimilar to Neupogen® (filgrastim), was approved by the U.S. Food and Drug Administration (FDA) on March 6. However, due to litigation between the manufacturers of the biosimilar and the originator product, Zarxio’s release was postponed. Thanks to a July 21 appeals court ruling, Zarzio launced in the U.S. in early September. Express Scripts estimates that the U.S. has likely wasted more than $45 million for every month that Zarxio was delayed from coming to market.

Bold Advocacy and Superior Care That Puts Medicine Within Reach For several years, Express Scripts has advocated strongly for biosimilars in the U.S. market, and we are pleased that this moment has arrived.

With more than 1,000 extensively trained specialist pharmacists and nurses working in our condition-specific Therapeutic Resource CentersSM, our specialty pharmacy Accredo provides proactive therapy management, develops a deeper understanding of each patient through one-on-one consultation, and delivers personalized education that motivates patients to remain adherent. This comprehensive, end-to-end approach will enable us to improve patient care while reducing wasteful spending in therapy classes where a biosimilar is available.

With spending on prescription drugs continuing to rise, topped by double-digit trends in specialty medications, biosimilars will play an important part in keeping healthcare benefits affordable and accessible for Americans.

sunburn. For pediatric care, video visits may be used for cold and flu, constipation, ear infections, nausea and vomiting, and eye infections.

To access this benefit, go to phs.org; go to myPRES Login. Once you create an account and log in, look for the video visits link. When you access myPRES, you will also have access to your claims, your medical charts from Presbyterian Medical Group and the Presbyterian Hospital, and other health related information.

Best Regards,Sammy J. Quintana, Executive Director, NMPSIA • 800 548 3724

410 Old Taos HighwaySanta Fe, New Mexico 87501

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Learn About Your Basic Life Specified Disease Benefit From The Standard

You may already know about some of the additional benefits that are included in your Life Insurance coverage from The Standard, such as Accidental Death & Dismemberment coverage and Travel Assistance. But do you know about the Specified Disease Benefit?

For employees with Basic Life coverage who work at least 15 hours per week, the Specified Disease Benefit allows for payment of up to 25% (not to exceed $12,500) of your Basic Life Insurance. To qualify, a physician must diagnose you with one of the following conditions while you are insured:• Life threatening cancer • Stroke• Myocardial infarction (heart attack) • Major organ transplant• Coronary artery bypass procedure • Acquired immune deficiency syndrome (AIDS)• Renal failure

The Specified Disease Benefit is available only once per lifetime. For instance, if you collected the benefit because you suffered from renal failure and then a few months later you had a stroke, you would not be eligible for another round of Specified Disease Benefits. To apply for this benefit, you will need to complete the Specified Disease Claim Form, including a statement from your physician. Visit https://nmpsia.com/The%20Standard.html to review the Basic Life Certificate for complete coverage details and to download the Specified Disease Claim Form.

These policies have exclusions, limitations, reductions of benefits and terms under which the policies may be continued in force or terminated. The Certificate of Coverage supersedes any information listed here. Please visit https://nmpsia.com/The%20Standard.html for additional information, including costs and complete coverage details.