Beginning June 15, 2008, HNE will partner with a new pharmacy benefit manager (PBM). This change will enhance the service and benefits our members receive and improve the efficiency of administering this benefit. On that date, we also will change the vendors we use for mail order and specialty pharmacy services. The new PBM and pharmacy vendors are:

	New Vendor	Former Vendor
PBM	MedMetrics Health Partners	Express Scripts
Mail order pharmacy	WellDyne Rx	Express Scripts
Specialty pharmacy	ICORE Healthcare	Curascript

Note: Mail order pharmacy is not available for HNE’s guaranteed issue non-group plans.

In addition to the formulary changes outlined on the following pages, HNE members will receive these enhancements to their pharmacy benefit:

• Access 90: Members can fill prescriptions for a 90-day supply at participating pharmacies. Three 30-day copays will apply. Access 90 does not apply to prescriptions filled at HNE’s Specialty pharmacy vendor, or if prohibited by law.

• Over-the-counter (OTC) medications – More OTC medications will be covered at a Tier 1 copay or less (does not apply to HNE Performance Formulary). see the table under “Tier Assignments”

Over the past several months, we have been working closely with our new partners to ensure a seamless transition for our members. HNE will:

• Transfer active prescriptions with remaining refills from Express Scripts mail-order to WellDyne Rx mail-order.
• Require no copay for prescriptions filled by our specialty pharmacy, ICORE Healthcare, until January 1, 2009. Please note; members are required to use the specialty pharmacy to fill all self-injectable, and oral oncology medications.

• Mail new ID cards with updated information to all affected HNE subscribers.

• Notify by phone and mail members and providers who use specialty pharmacy or mail-order services.

• Notify local pharmacies of these changes.

As always, HNE’s friendly, knowledgeable Member Services staff will be available to answer our members’ questions and address any concerns.

Which formulary does your plan have?

HNE Formulary HNE Performance Formulary

Not sure? Go to HNEDirect or call Member Services

Tier Assignments HNE Formulary The member copay per tier will remain the same.
The following prescription drugs are added to the HNE Formulary as Tier 1 drugs:
Alaway OTC® (opthalmic) Cetirizine OTC (oral)	Loratadine D OTC (oral) Loratadine OTC (tablet & suspension)			Omeprazole OTC (tablet) Zyrtec OTC suspension
The following Prescription Drugs are changing from a Tier 2 Copayment to a Tier 3 Copayment:
Astelin® Avonex® Foradil®		Nutropin AQ® Optivar® Peg-Intron®	Rhinocort AQ® Serevent® Vytorin®
The following Prescription Drugs are changing from a Tier 3 Copayment to a Tier 2 Copayment:
Actoplus Met® Avandamet® Avandaryl® Crestor®		Duetact® Geodon® Norditropin® Oxycontin®	Qvar® Symbicort® Tev-Tropin®

Drug Specific Coverage Limitations HNE limits the coverage of specific drugs to control costs and ensure safe and effective use. HNE may place limits on the quantity of a drug covered, the amount that can be obtained for each Copayment, or the medical conditions for which a covered drug may be prescribed.
Prior Approval: The following Prescription Drugs are added to the list of those that require Prior Approval.
Forteo® Pegasys®	Peg-Intron® Suboxone®		Subutex® Symlin®
The following Prescription Drugs are added to the list of Quantity Limitations
Drug/Supply Name		Quantity
All diabetic testing strips, all brands		250 test strips
Self injectable drugs and oral oncology drugs
All self-injectable drugs and oral oncology drugs must be filled at ICORE Healthcare, HNE’s specialty pharmacy vendor. No copay will apply through December 2008. Beginning January 2009, these drugs will be subject to a tiered copayment. Only urgently needed injectable medical drugs may be filled at contracted retail pharmacies. These will be subject to a tiered copay.

Step Therapy:
For HNE to cover the Step Therapy drugs listed here, you first must try one of the corresponding First Line drugs. If HNE has paid a claim for the First Line drug within the previous 180 days, then you are eligible for coverage of the Step Therapy drug.

The use of samples does not satisfy the requirements of documented usage of a First Line drug or medical necessity for a Step Therapy drug.

If it is medically necessary for you to use a Step Therapy drug before trying a First Line drug, then your doctor can contact HNE to request a medical review. The member copay per tier will remain the same.

Important Note: The Step Therapy information below only applies if you are trying a drug for the first time. If you are already taking a step therapy drug, you are not required to switch to a first line drug.

Diabetes Step Therapy:

You must try one of the following:

Before HNE will cover:

First Line Drug(s):

Drug Name	Copay Tier
Metformin HCL	Tier 1

Step Therapy Drug(s):

Drug Name	Copay Tier	Drug Name	Copay Tier
Actos®	Tier 2	Avandia®	Tier 2
ActoplusMet®	Tier 2	Duetact®	Tier 2
Avandamet®	Tier 2	Januvia®	Tier 2
Avandaryl®	Tier 2	Janumet®	Tier 2

Byetta® Step Therapy

You must try one of the following:

Before HNE will cover:

First Line Drug(s):

Drug Name

2 covered oral antidiabetic agents

Step Therapy Drug(s):

Drug Name	Copay Tier
Byetta®	Tier 2

Zetia® Step Therapy

You must try one of the following:

Before HNE will cover:

First Line Drug(s):

Drug Name	Copay Tier	Drug Name	Copay Tier	Drug Name	Copay Tier
Fluvastatin	Tier 1	Advicor®	Tier 3	Pravachol®	Tier 3
Lovastatin	Tier 1	Altoprev®	Tier 3	Zocor®	Tier 3
Pravastatin	Tier 1	Simcor®	Tier 3	Pravigard®	Tier 3
Simvastatin	Tier 1	Mevacor®	Tier 3	Caduet®	Tier 3
Crestor®	Tier 2	Lipitor®	Tier 3	Vytorin®	Tier 3
Lescol®	Tier 3	Lescol XL®	Tier 3

Step Therapy Drug(s):

Drug Name	Copay Tier
Zetia®	Tier 2

Proton Pump Inhibitor Step Therapy

Important Note: The following prescription drugs have 3 steps. You must try the First Line drug before HNE will cover the second Step Therapy drug. You must try the second Step Therapy drug before HNE will cover the third Step Therapy drug.

You must try one of the following:

Before HNE will cover (2^nd Step):

Before HNE will cover (3rd Step):

First Line Drug(s):

Drug Name	Copay Tier
Omeprazole OTC	Tier 1
Prilosec OTC®	Tier 1

Step Therapy Drug(s):

Drug Name	Copay Tier
Omeprazole RX	Tier 1
Pantoprazole	Tier 1

Step Therapy Drug(s):

Drug Name	Copay Tier	Drug Name	Copay Tier	Drug Name	Copay Tier
Nexium®	Tier 3	Prevacid®	Tier 3	Prilosec®	Tier 3
Zegerid®	Tier 3	Aciphex®	Tier 3	Protonix®	Tier 3

Nasal Steroids Step Therapy

You must try 2 of these:

Before HNE will cover:

First Line Drug(s):

Drug Name	Copay Tier
Generic nasal steroids	Tier 1
Nasonex®	Tier 2

Step Therapy Drug(s):

Drug Name	Copay Tier	Drug Name	Copay Tier	Drug Name	Copay Tier
Rhinocort AQ®	Tier 3	Nasocort AQ ®	Tier 3	Nasalide ®	Tier 3
Veramyst ®	Tier 3	Flonase ®	Tier 3	Nasarel ®	Tier 3

Allergy (oral) Step Therapy

Important Note: The following prescription drugs have 3 steps. You must try the First Line drug before HNE will cover the second Step Therapy drug. You must try the second Step Therapy drug before HNE will cover the third Step Therapy drug.

You must try one of the following: