NEW YORK | 2012 | ISSUE II

Numbers to Know

In this Issue

MEMBERFOCUS

Is your home safe for your family?

Ten Tips for Home SafetyPrevent Falls

1. Install grab bars in the tub and shower. Use non-slip mats. 2. Have bright lights over stairs and steps and on landings. Keep stairs clear

of clutter.

Prevent Poisonings

3. Keep cleaners, medications and beauty products in a place where children can’t reach them. Use child safety locks.

4. For poison help, call the toll-free Poison Help line at 1-800-222-1222. Call if you need help or want information about poisons. Call 911 if someone needs to go to the hospital right away.

Prevent Fires & Burns

5. Have working smoke alarms and hold fire drills.6. Stay by the stove when cooking, especially when you are frying food.

Use back burners and turn pot handles toward the back of your stove.7. Keep your hot water at 120˚F to prevent burns.

Prevent Choking & Suffocation/Drowning

8. Things that can fit through a toilet paper tube can cause a young child to choke. Keep these things, including food, where children cannot see or touch them.

9. Place babies to sleep on their backs, alone in their crib. Don’t put pillows, blankets, comforters or toys in cribs.

10. When your children are in or near water, stay close enough to reach out and touch them. This includes bathtubs, toilets, pools and spas – even buckets of water.

Source: Home Safety Counsel

Common everyday child injuries result in an average of over 18,000 trips to the hospital each year. Source: New York State Department of Health and Safekids.org

We hope you’ll take a minute from your day to read through this issue. Think of it as a little hello from us, full of information and articles that’ll help you and your family not only get the most from your plan, but also live better. This quarter features:

• Back to the doctor!• Protect children from lead• When should dental care start?• A formulary update• Better quality is our goal• And more

We’re just a phone call (or click) away!Call Customer Service:

1-800-288-5441

TTY/TDD 1-877-247-6272

Monday–Friday, 8 a.m. to 6 p.m. Eastern

Or visit www.wellcare.com/ medicaid/newyork anytime!

Keep Your Member ID Card Handy Your member ID card is very important. When you need care, you will give it to your doctor. Your card has important information about your health plan. Keep it with you at all times. If your primary care physician or your personal information changes, please call Customer Service at 1-800-288-5441. TTY/TDD users, call 1-877-247-6272. You may also update that information online at www.wellcare.com.

Back To The Doctor!

The When and What… A Guide for Childhood Checkups You will be making many visits to your child’s doctor as they grow. These visits make sure that your child’s growth and development are closely watched. The first visit to the doctor is usually when your baby is 2 weeks old. Remember to write down any questions you may have for their doctor before each checkup. This is what you should expect as your child grows:

At 2 Weeks1. Examination of growth and development2. Screening height, weight and head circumference3. Newborn screening test 4. Appropriate immunizations

Every Two Months Beginning at 8 Weeks1. Examination of growth and development2. Review of feeding and sleep schedules3. Screening height, weight and head circumference4. Counseling for injury prevention and diet 5. Appropriate immunizations

At 9 Months 1 - 5 above plus:

• Screenings for anemia and lead poisoning risk

At 12, 15 and 18 Months1 – 5 above plus:

• Counseling for injury prevention, dental health and diet

At 2 Years1 - 5 above plus:

• Screenings for anemia and lead poisoning risk• Counseling for injury prevention, dental health and diet

At 3 Years1. Examination of growth and development2. Screening height, weight and blood pressure3. Counseling for injury prevention, dental health and diet4. Screening test: vision test

At 4, 5 and 6 Years 1 – 4 above plus:

• Review of school readiness• Counseling for exercise• Appropriate immunizations• Screening test: hearing test

At 8 and 10 Years1. Examination of growth and development2. Screening height, weight and blood pressure3. Review of school performance4. Counseling for injury prevention, drug/alcohol/tobacco

use, sexual development, dental health, diet and exercise5. Appropriate immunizations 6. Screening tests: vision and hearing test (if not already passed)

At 12 and 14 Years1 – 6 above plus:

• Screening test: scoliosis

At 16 and 18 Years1. Examination of growth and development2. Screening height, weight and blood pressure3. Review of school performance, graduation plans4. Counseling for injury prevention (including driving safety),

drug/alcohol/tobacco use, sexual behavior, dental health, diet and exercise

5. Appropriate immunizationsNote: Meningococcal disease is a serious illness. It can cause bacterial meningitis and blood infections. College freshmen are at a higher risk of getting the disease. They should think about getting the vaccine that fights it.

6. Screening tests: scoliosis, vision and hearing test (if necessary)

Source: www.keepkidshealthy.com

2 Member Newsletter

Children need several series of shots between birth and age 10.

Pre-Teens need certain shots between ages 11 and 12.

Teens need shots between ages 13 and 18, plus catch-up or booster shots.

Source: Centers for Disease Control and Prevention

Immunizations: A Plan for PreventionEveryone needs immunizations (also called vaccines or shots). They protect us from serious diseases. These include measles, diphtheria and rubella This, in turn, keeps our children and communities safe.

WellCare wants to remind you how important shots are, especially for your child. You should know what shots your child needs and when to get them.

For current recommendations or more information:

• Talk to your child’s doctor or nurse• Visit the Centers for Disease Control

and Prevention at www.cdc.gov, key word Immunization Schedules

When Should Dental Care Start?Many parents have a tough time judging how much dental care their kids need. They know they want to prevent cavities, but they don’t always know the best way to do so.

Easy Dental Guidelines• Run a damp washcloth over your baby’s gums following feedings• Schedule your child’s first dental visit when their first tooth comes in, but no later than their first birthday• Take your child for a dental checkup between ages 1 and 2, and then every six months • Brushing with just water and a soft toothbrush is recommended for children under age 2• Use a pea-sized amount of toothpaste with fluoride for children 2 and over• Begin using floss once your child has two teeth that touch

Ask Your Child’s Pediatrician About Fluoride VarnishWhat is it?Fluoride varnish is a coating that is painted on a child’s teeth to prevent or stop cavities. If your child does not see a dentist regularly, you should ask your pediatrician about fluoride varnish.

Why is it recommended?Cavities can cause pain and infections that can be bad for children’s general health and lead to problems with eating, speaking, playing and learning. Fluoride varnish makes teeth stronger, stops cavities from getting bigger and prevents new cavities from forming.

Is it safe?Yes. Fluoride varnish is safe for children of any age. It can be used on babies from the time their first teeth come in.

Member Newsletter 3

Keeping Kids SafeCommon everyday injuries are the leading cause of death for children in New York State. They result in an average of over 18,000 trips to the hospital each year. Your child’s doctor should be giving you “Anticipatory Guidance.” This means the doctor should train you on things to watch for, based on the age of your child. Topics the doctor should cover include:

• Bike and wheels safety • Burn prevention • Children in and around cars • Car passenger safety: Infant, Toddler,

Booster, Seat Belt• Fall prevention • Fire safety • Home safety • Pedestrian safety • Poison prevention • Water/sun safety

Want to know more about these topics? Go to www.Safekids.org. Or visit http://www.nyhealth.gov/prevention/injury_prevention/.

Source: New York State Department of Health and Safekids.org

4 Member Newsletter

Protect Children from LeadSimple steps can help you save children from hazards around the home. Many homes built before 1978 have lead-based paint. If you plan to remodel, get your home tested. Don’t try to remove lead paint yourself.

Ask about lead when looking for a new home. Sellers and landlords must disclose known lead hazards in houses or apartments built before 1978.

Get your child tested for lead. There are no visible signs of lead poisoning. Children may suffer behavior or learning problems if they have been exposed to lead hazards.

Finally, wash children’s hands, toys and bottles often. Regularly clean floors, window sills and other surfaces to reduce the chance of being exposed to lead.

Do you think your child may have been exposed to lead? Make an appointment with your child’s doctor for a lead screening right away.

Source: U.S. Environmental Protection Agency and New York State Department of Health

If your child has had contact with chemicals and is unconscious or having trouble breathing, call 911 and ask for an ambulance right away. You may also contact your area Poison Control Center 24 hours a day, 7 days a week.

Call Toll-Free: 1-800-222-1222 TTY/TDD: 1-212-689-9014 or 1-315-464-5424

Member Newsletter 5

What You Should Know About Sun-Sensitive Medications

What are sun-sensitive drugs?They are drugs that can cause a bad reaction when someone taking them is in the sun. Here are some things you should know about sun-sensitive drugs:

• When used or applied to the skin, they can cause either a photoallergic or a phototoxic reaction.• A photoallergic reaction is a fairly rare allergic response. It happens when you are exposed to the sun. The UV light of the

sun causes the medicine to change its structure. This causes an allergic reaction which usually results in a rash like eczema.• A phototoxic response is more common. It also happens when you are exposed to the sun. The medicine absorbs the UV

light of the sun. This causes damage to the skin, similar to sunburn. This can happen the first time you are exposed to the sun or within a few days of being exposed.

The following is a short list of common photosensitive drugs by therapeutic class (generic name is all lowercase):

Can I prevent these reactions? The answer is yes. Here are some tips that can help:

• Protect your skin with UVA-protective sunscreens and clothing.• Remember that you need to reapply sunscreen while out in the sun because it only lasts about two hours after you put it on.• Be sure to use a good amount of sunscreen when you apply and reapply. One ounce – about enough to fill a shot glass –

is needed to cover the exposed areas of the body.

References: Kelly Shields, Pharm D, Drug-induced Photosensitivity, Pharmacist’s Letter, May 2004, vol. 20, Number 200509. Siamak T. Nabili, MD, MPH, Sun-Sensitive Drugs (Photosensitivity to Drugs), Medicinenet.com, 2012.

PHOTOALLERGIC DRUGS

Sunscreens para-aminobenzoic acid (PABA), oxybenzone, cyclobenzone, cyclohexanol, salicylates

Anti-microbials chlorhexidine (Peridex), hexachlorophene (Phisohex, Septisol), dapsone (DDS)

Painkillers celecoxib (Celebrex)

Cancer chemotherapy 5-fluorouracil (5-FU, Efudex, Carac, Fluoroplex)

Fragrances musk, 6-methylcoumarine

PHOTOTOXIC DRUGS

Antibioticsciprofloxacin (Cipro), doxycycline (Vibramycin), levofloxacin (Levaquin), demeclocycline (Declomycin), cefazolin (Ancef), sulfamethoxazole and trimethoprim (Bactrim)

Antihistamines diphenhydramine (Benadryl), cetirizine (Zyrtec), loratadine (Claritin)

Antifungals terconazole (Terazol), voriconazole (VFEND), ketoconazole (Nizoral)

Cancer chemotherapy vinblastine (Velban), dacarbazine (DTIC-Dome)

Cardiovascular amiodarone (Cordarone), diltiazem (Cardizem), captopril (Capoten)

Diuretics hydrochlorothiazide (Microzide), furosemide (Lasix)

Diabetic chlorpropamide (Diabinese), glyburide (Diabeta), glipizide (Glucotrol), glimepiride (Amaryl)

Painkillers ibuprofen (Motrin, Advil), meloxicam (Mobic), naproxen (Aleve)

Acne/Skin isotretinoin (Accutane), acitretin (Soriatane)

Hormone oral contraceptives, corticosteroids

Psychiatric chlorpromazine (Thorazine), desipramine (Norpramin), imipramine (Tofranil)

6 Member Newsletter

Our Case And Disease Management Programs

Case ManagementCase Management helps members with special needs. It pairs a member with a case manager. The case manager is a nurse who can help the member with many issues. Some of these are:

• Complex medical needs• Solid organ and tissue transplants• Chronic illnesses such as asthma, diabetes, hypertension and heart disease• Children with special health care needs• Lead poisoning

We’re here to help you! Contact us for more information on our program. A WellCare staff member will tell you about the program. This no-cost program gives access to a registered nurse (RN) Monday–Friday from 8 a.m. to 6 p.m. Eastern.

Disease Management Disease Management is a similar program. It gives support to members with health problems. These may include:

• Asthma• Diabetes• Hypertension• Heart disease• HIV/AIDS

Members in this program get educational materials. In some cases, they get coaching from a registered nurse.

Please contact us to learn more. Just call 1-800-288-5441 Monday–Friday, from 8 a.m. to 6 p.m. Eastern. TTY/TDD users, call 1-877-247-6272.

Member Newsletter 7

2012 Q2 Medicaid Member Newsletter Formulary UpdateMembers can now get the generic drugs below at a lower co-pay. The brand-name drugs have been removed from the WellCare of New York Medicaid Preferred Drug List.

BRAND NAME GENERIC NAME THERAPEUTIC CLASS

Combivir® 150mg/300mg tabletLamivudine-Zidovudine 150mg/300mg tablet

Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors

Derma-Smoothe/FS® body oil Fluocinolone Acetonide 0.01% body oil Glucocorticoids/Mineralocorticoids

Derma-Smoothe/FS® scalp oil Fluocinolone Acetonide 0.01% scalp oil Glucocorticoids/Mineralocorticoids

Epivir® 150mg and 300mg tablets Lamivudine 150mg and 300mg tabletsAnti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors

Lipitor® 10mg, 20mg, 40mg and 80mg tablets (ST)

Atorvastatin 10mg, 20mg, 40mg and 80mg tablets (ST)

HMG-CoA Reductase Inhibitors

ST = Step Therapy

The following changes have been made to the WellCare of New York Medicaid Preferred Drug List:

ADDITIONS

Calcium Acetate 667mg tablet (QL: 372 tablets/31 days)

Cilostazol 50mg and 100mg tablets

Diabetic Tussin® DM liquid

Erivedge™ 150mg capsule (PA)

Erwinaze™ 10,000 units vial (PA)

EryPed® 400mg suspension

Fer-In-Sol® drops

Fer-Iron drops

Firazyr® 10mg/mL syringe (PA)

Fluoxetine 40mg capsules

Gemcitabine 200mg/5.26mL, 2gm/52.6mL, 1gm/26.3mL injection (PA)

Glipizide/metformin 2.5mg/500mg, 5mg/250mg and 5mg/500mg tablets

Halobetasol Propionate 0.05% cream and ointment

Hypercare™ 20% solution

Jakafi® 5mg, 10mg, 15mg, 20mg, 25mg tablets (PA)

Juvisync® 100mg/10mg, 100mg/20mg, 100mg/40mg tablets (ST)

Kalydeco® 150mg tablet (PA)

Levothyroxine 100mcg vial

Lumizyme® 50mg vial (PA)

8 Member Newsletter

ADDITIONS (CONTINUED)

Nohist-DM liquid

Omeprazole DR 20mg tablets (OTC covered with Rx)

Oxycodone HCl 10mg and 20mg tablets (QL: 248 tablets/31 days)

Oxycodone HCl/Acetaminophen 10mg/650mg tablet (QL: 186 tablets/31 days)

Pegasys ProClick™ 135mg/0.5mL, 180mg/0.5mL Autoinjector (PA)

Pegasys® 180mcg/0.5mL syringe (PA)

Prolia® 60mg/mL syringe (PA)

Robafen CF syrup

Robitussin® Pediatric cough syrup

Sandimmune® 50mg/mL ampule

Suprax® 400mg tablet (QL: 1 tablet/31 days)

Terbinafine 1% cream

Trospium 20mg tablets

Viracept 625mg tablet (QL: 310 tablets/31 days)

Zenpep® (Lipase 25,000 unit) DR capsules

Zinc Sulfate 220mg tablet

PA = Prior Authorization QL = Quantity Limit ST = Step Therapy

REMOVALS

BPM PE liquid

Calcium Acetate 667mg capsule

Clotrimazole/betamethasone cream, lotion

Crixivan® 100mg capsule

Diflorasone 0.05% cream and ointment

Doxycycline monohydrate 25mg/mL powder for suspension

Doxycycline monohydrate 50mg, 75mg, 100mg capsules

Ed-A-Hist DM liquid

Gani-Tuss NR liquid

Gani-Tuss-DM NR liquid

Mebendazole 100mg chewable tablets

Nystatin-Triamcinolone cream and ointment

Paregoric liquid

Poly-Pred® ophthalmic suspension

Poly-vitamin/iron/fluoride 0.5mg liquid

Robafen AC syrup

Vesicare® 5mg, 10mg tablets

Member Newsletter 9

DRUG NAME CHANGE

Accu-Chek® Active; Accu-Chek® Aviva Plus; Accu-Chek® Comfort Curve; Accu-Chek® Compact; FreeStyle®; FreeStyle® Lite; Precision Xtra® Test Strips

Increased QL for members 21 years of age and younger: 200/31 days

Nortriptyline 10mg/5mL solution QL added: 1500mL/31 days

Ovide® lotion, 0.5% QL increased: 118mL/31 days

Ranitidine 75mg/5mL syrup AL added (AL: max 5 years; QL: 600mL/31 days)

Vitamin D 50,000 units capsule QL added (QL: 4 capsules/31 days)

AL = Age Limit QL = Quantity Limit

We have changed the utilization management criteria for the following medications on the WellCare of New York Medicaid Preferred Drug List:

Would you like to view the current Preferred Drug List and pharmacy updates? Visit our website. Go to www.wellcare.com/medicaid/newyork.

COMPANY NAME DRUG NAME DATE OF REMOVAL

Lundbeck Inc.Mebaral® (mephobarbital) 32mg tablets, 50mg tablets and 100mg tablets

1/6/2012

ADDITIONAL INFORMATION

Lundbeck can no longer make Mebaral CIV. The tablets the company had in stock expired in March 2012. Because of this, no more tablets could be shipped after February 29, 2012. Once the current stock is gone, the product will no longer be offered.

Some patients may face a hard choice due to this change. The company tried to find ways to keep making Mebaral. But they could not find a way. Patients should work with their doctor to change to other drugs that can help them. Do you want more information? If you have questions, call Lundbeck’s medical information team. They can be reached toll-free at 1-866-402-8520.

Market Drug Withdrawals:

Your Child’s DevelopmentScreening Can Make a Difference: The Early Intervention ProgramIf you have concerns about your child’s development, don’t wait – talk to your child’s doctor right away. Ask about the Early Intervention Program. The early years of a child’s life are very important. During the infant and toddler years, children grow quickly and have so much to learn. Some children and families face special challenges and need extra help. Early help does make a difference!

The Early Intervention Program is a statewide program. It is designed for infants and toddlers with disabilities, as well as their families. The program provides many different types of early help. In New York State, the Department of Health is the state agency that heads up the program.

You can learn more about the Early Intervention Program. You can get local phone numbers for your county’s program. For more information, call “Growing Up Healthy” 24-Hour Hotline: 1-800-522-5006 or in New York City: 311

Source: New York State Department of Health, www.health.ny.gov

FREE SERVICE

10 Member Newsletter

Visit Us On The WebLooking for answers about your plan? Check our website for new information. Just go to www.wellcare.com. Click on “For Medicaid Members.” Then click on “New York.” Next, choose your plan. You’ll find information on the following:

On our website you can also:

• Change your primary care provider (PCP) • Update your address and phone number

You can get printed copies of any of the items listed above. Call us at 1-800-288-5441. TTY/TDD users, call 1-877-247-6272. We can help you Monday–Friday, 8 a.m. to 6 p.m. Eastern. Remember, you can also leave a message for us after hours. We’ll call you back within three business days.

Did you know we offer language services? You may also call to ask for materials in a different format. This includes other languages, large print and audio tapes. There is no charge for this.

• Member handbook• Member newsletters• Provider directory• Pediatric preventive health• Adult preventive health• Childhood obesity• Asthma• Diabetes

• Pregnancy health• Chronic kidney disease• Lead poisoning• Privacy statement• Medical record documents• Schedule of upcoming education events• Quality Improvement (QI) program evaluation• Rights and Responsibilities

Member Newsletter 11

NY018465_CAD_NEW_ENG Internal Approved 05032012©WellCare 2012 NY_03_12 43

671

2011 HIGHLIGHTS:• Audited our internal departments to make sure they follow

proper procedures• Kept and reviewed reports to track health plan standards

set by review agencies• Made quality decisions with a “member first” approach to

improve health outcomes and member involvement in care• Reviewed our HEDIS® (Healthcare Effectiveness Data and

Information Set) improvement action plans and focused on removing things that keep members from getting needed care

• Improved how members rated the plan on the CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey

• Reviewed medical records year-round and educated our providers on the Quality Initiatives and HEDIS measures

• Started using a system for incoming phone calls that let Customer Service reps know when members are due for preventive care and tests

GOALS FOR 2012 INCLUDE:• Ensure that members have easy access to providers• Remind providers why it’s important to update member

information during scheduled appointments• Continue to ensure the health plan is following all state and

federal regulations• Make health information and advice available on the Internet• Review the referral process and make it easier for members

and providers• Look for ways to help providers and members communicate

better• Work to achieve NCQA (National Committee for Quality

Assurance) Health Plan accreditation in 2013• Improve scores related to a tool that rates how well plans

perform, which is called HEDIS (Healthcare Effectiveness Data and Information Set)

• Improve key member and provider satisfaction levels

Better Quality is Our Goal

We’re always looking for ways to do better. We have a program to find out how we can deliver better care. It’s called the Quality Improvement (QI) program.

We want to share some of the things we did to improve in 2011 and let you know what we want to do this year.

WellCare of New York, Inc.110 Fifth Ave., 3rd FloorNew York, NY 10011