PL Detail-Document #290901 −This PL Detail-Document gives subscribers additional insight related to the Recommendations published in−

PHARMACIST’S LETTER / PRESCRIBER’S LETTER September 2013

Choosing a Health Plan Under the Affordable Care Act A big milestone of the Affordable Care Act (ACA) happens in 2014, when individuals will be required to have health insurance or incur penalties. Open enrollment for health insurance (for those who do not currently have a plan that meets minimum requirements and for those who are considering a change) begins on October 1, 2013 and ends March 31, 2014. Individuals will be able to choose between different insurance carriers and levels of coverage ranging from Bronze to Platinum, in order to select a plan that best suits them, similar to Medicare Part D. All plans will have a minimum of ten essential benefits, including outpatient care, inpatient care, emergency care, and prescription drug coverage. Those with incomes up to four times the national poverty level will qualify for government subsidies to help pay premiums. Some general changes that are expected for health care professionals include a significant increase in the number of patients to be seen and disease states requiring treatment, as well as the opportunity to provide more preventive care. The following table lists patient- and provider-focused resources to help with navigating the upcoming changes associated with the Affordable Care Act.

Patient-focused Resources U.S. Department of Health and Human Services (HHS) (http://www.hhs.gov/opa/affordablecare-act/index.html)

Centers for Medicare and Medicaid Services (CMS)

Includes links to:  Up-to-date information about enrollment and implementation of ACA  Informational video about the new Health Care Marketplace  Fact sheets about state plans  Special information for women, clinicians, small businesses, etc.  Opportunity to sign up for text and email updates about state implementation of ACA Health Insurance Marketplace (https://www.healthcare.gov/)  Applications (open enrollment) will launch on October 1, 2013. Info about many ACA-related topics for patients is already available on this site.  Will allow users to see all health plans available in their geographic locations (in a standardized format) and compare plans according to cost, benefits, etc  Will provide info about how to get lower premiums, qualification for free or low-cost coverage, etc  Individuals can also get more information or apply for insurance coverage by phone (800-318-2596, 24 hours a day, seven days a week). Live chat assistance is available on the website. Hospital Compare (http://www.medicare.gov/hospitalcompare/search.html)  Info about quality of care at over 4000 hospitals, such as timeliness and effectiveness of care; readmissions, complications, and deaths; and patient surveys More. . .

Copyright © 2013 by Therapeutic Research Center 3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249 www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~ www.PharmacyTechniciansLetter.com

(PL Detail-Document #290901: Page 2 of 4)

Patient-focused Resources, continued Internal Revenue Service (IRS)

The White House (http://www.whitehouse.gov/healthre form)

Pharmacist’s Letter/ Prescriber’s Letter

Affordable Care Act Tax Provisions for Individuals and Families (http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisionsfor-Individuals-and-Families)  Info and link to fact sheet about tax credits for ACA (available and calculated on a sliding scale for those with incomes between 100% and 400% of the federal poverty line) Includes links to:  Health reform myths and facts  Summary of coverage  Health reform timeline  Health reform news      

PL Patient Education Handout, Questions and Answers About the Affordable Care Act PL Patient Education Handout, Tips for Getting to a Healthy Weight PL Patient Education Handout, Why It’s Important to Take Your Blood Thinning Meds PL Patient Education Handout, Aspirin and Your Heart PL Patient Education Handout, Blood Pressure Medications and You Go to our website for our full library of PL Patient Education Handouts

Provider-focused and General Resources U.S. Department of Health and Human Services (HHS) (http://www.hhs.gov/opa/affordablecare-act/index.html)

Includes links to:  Grants to help with implementation of aspects of ACA  Regulations and guidance related to ACA  ACA info and fact sheets  Training programs ACA Timeline-general overview (http://www.hhs.gov/healthcare/facts/timeline/timeline-text.html)

Centers for Medicare and Medicaid Services (CMS)

ACA Timeline-Medicaid- and Children’s Health Insurance Program (CHIP)-related (http://www.medicaid.gov/AffordableCareAct/Timeline/Timeline .html) Provisions of the ACA-Medicaid- and CHIP-related (http://www.medicaid.gov/AffordableCareAct/Provisions/Provisi ons.html) ICD-10 (http://www.cms.gov/Medicare/Coding/ICD10/index.html)  Fact sheets  Resources for providers  Continuing education More. . .

Copyright © 2013 by Therapeutic Research Center 3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249 www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~ www.PharmacyTechniciansLetter.com

(PL Detail-Document #290901: Page 3 of 4)

Provider-focused and General Resources, continued U.S. Government Printing Office (GPO)

The Patient Protection and Affordable Care Act-full text (http://www.gpo.gov/fdsys/pkg/BILLS111hr3590enr/pdf/BILLS-111hr3590enr.pdf)

Responsible Reform for the Middle Detailed summary of the ACA (http://www.dpc.senate.gov/healthreformbill/healthbill04.pdf) Class

Kaiser Family Foundation

Detailed summary of the ACA (http://kaiserfamilyfoundation.files.wordpress.com/2011/04/8061 -021.pdf)

Pharmacist’s Letter/Prescriber’s Letter

Selected resources for incentives and preventive care:  PL Chart, Smoking Cessation Therapy  PL CE, Clearing the Air: How to Help Patients Quit Smoking  PL Chart, Drugs for Weight Loss  PL Detail-Document, Medication Therapy Management  PL Chart, Aspirin Dose for Cardiovascular Indications  PL Detail-Document, Benefit of Treating Mild Hypertension  PL Chart, Non-Statin Lipid-Lowering Agents  PL Chart, Statin Dose Comparison  PL Detail-Document, Depression Guidelines: Overview of Pharmacotherapy  PL Detail Document, Pharmacy Immunization Clinics: Making It Happen  PL Chart, Comparison of Meds for Osteoporosis

Users of this PL Detail-Document are cautioned to use their own professional judgment and consult any other necessary or appropriate sources prior to making clinical judgments based on the content of this document. Our editors have researched the information with input from experts, government agencies, and national organizations. Information and internet links in this article were current as of the date of publication.

More. . . Copyright © 2013 by Therapeutic Research Center 3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249 www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~ www.PharmacyTechniciansLetter.com

(PL Detail-Document #290901: Page 4 of 4)

Project Leader in preparation of this PL DetailDocument: Stacy A. Hester, R.Ph., BCPS, Assistant Editor Cite this document as follows: PL Detail-Document, Choosing a Health Plan Under the Affordable Care Act (ACA). Pharmacist’s Letter/Prescriber’s Letter. September 2013.

Evidence and Recommendations You Can Trust… 3120 West March Lane, Stockton, CA 95219 ~ TEL (209) 472-2240 ~ FAX (209) 472-2249 Copyright  2013 by Therapeutic Research Center

Subscribers to the Letter can get PL Detail-Documents, like this one, on any topic covered in any issue by going to www.PharmacistsLetter.com, www.PrescribersLetter.com, or www.PharmacyTechniciansLetter.com

Questions and Answers About the Affordable Care Act When can I sign up? Starting October 1, 2013 you can sign up for health insurance under the Affordable Care Act (ACA, “Obamacare”). If you already have health insurance, such as through your job, you may not need to sign up. But, you must have a certain amount of health insurance. Otherwise you risk being fined. This fine will get bigger over the next few years. The last day to sign up for coverage in 2014 is March 31. What will my options be? You will be able to pick from plans that have different premiums, copays, deductibles, and coverage. Different plans will work with different providers. Make sure your provider is “in network” if you want to keep seeing him or her. Also, check the plan to make sure your medicines will be covered. How do I sign up? Go to www.healthcare.gov to learn about plans in your area and to sign up for a plan. Or, you can call 800-318-2596. These resources can also help you find out if you can get financial help with your plan or a tax credit. You may get lower costs if you don’t smoke and if you try to keep a healthy weight. Can I be turned down by a plan? You can’t be turned away or charged more because of a condition you already have. You can’t be charged more for a plan if you’re a woman. There are no lifetime or yearly spending limits on your care. And if your plan covers dependents, your children may be able to stay on the plan until they’re 26 years old. What kind of benefits will I get? All plans will at least cover the following:  Outpatient care  Emergency services  Hospital care  Maternity and newborn care  Mental health and substance abuse care

 Rehabilitation  Labwork  Prescription medicines  Wellness services  Pediatric care

Plans will also give you some services that prevent illness for free. You will not be charged a copay or deductible for these. Birth control that requires a prescription will also be available for free. Here are some of the free services:  Blood pressure screening  HIV screening  Cholesterol screening  Vaccines for adults  Colorectal cancer screening  Tobacco use screening  Depression screening  Mammograms for women  Diabetes screening  Cervical cancer screening for women  Diet counseling  Osteoporosis screening for women What information will I need to sign up? Have handy social security numbers, income information, and policy numbers of health insurance plans currently covering your family members. Health insurance coverage can start as soon as January 1, 2014. The sooner you sign up, the sooner your coverage will begin. [August 2013] Prepared for the subscribers of Pharmacist’s Letter / Prescriber’s Letter to give to their patients. Copyright © 2013 by Therapeutic Research Center www.PharmacistsLetter.com ~ www.PrescribersLetter.com

Preguntas Y Respuestas Sobre La Ley Del Cuidado De Salud A Bajo Precio ¿Cuándo puedo registrarme? A partir del 1 de Octubre, 2013 usted puede inscribir para seguros de salud bajo la ley De Cuidado de Salud a Bajo Precio (ACA, “Obamacare”). Si usted ya tiene seguro de salud, tales como a través de su trabajo, puede que no sea necesario registrarse. Pero, usted debe tener cierta cantidad de seguro de salud. De lo contrario usted corre el riesgo de que una multa. Esta multa se volverá más grande en los próximos años. El último día para registrarse para la cobertura en el año 2014 es el 31 de Marzo. ¿Qué opciones tengo? Usted será capaz de recoger en los planes que tienen diferentes primas, copagos, deducibles, y cobertura. Diferentes planes con diferentes proveedores. Si desea seguir con su proveedor asegurarse de que este “en la red.” Además, controlar el plan para asegurarse de que los medicamentos serán cubiertos. ¿Cómo me puedo inscribirme? Ir a www.cuidadodesalud.gov para aprender acerca de los planes en su área y para inscribirse en un plan. Incluso puede llamar al 800-318-2596. Estos recursos también le pueden ayudar a averiguar si puede obtener ayuda financiera para su plan o un crédito fiscal. Usted puede obtener costos más bajos si no fuma y si se mantiene un peso saludable. ¿Se puede ser rechazado por un plan? No puedes ser rechazado o pagar más por una condición que ya tiene. No se le puede cobrar por un plan si usted es una mujer. No hay vida o límites a los gastos anuales en su cuidado. Y si su plan cubre los dependientes, los niños podrán permanecer en el plan hasta que tiene 26 años de edad. ¿Qué tipo de beneficios obtendré? Todos los planes, al menos la siguiente: • Atención ambulatoria • Servicios de emergencia • Atención hospitalaria • Maternidad y atención del recién nacido • Salud mental y cuidado de abuso de sustancias

• Rehabilitación • Laboratorio • Los medicamentos sujetos a prescripción médica • Servicios de bienestar • Atención pediátrica

Los planes también le darán algunos servicios que previenen la enfermedad de forma gratuita. No se le cobrará un copago o deducible para estos. Anticonceptivos que requiere una receta también estará disponible de forma gratuita. Aquí están algunos de los servicios gratuitos:

Prepared for the subscribers of Pharmacist’s Letter / Prescriber’s Letter to give to their patients. Copyright © 2013 by Therapeutic Research Center www.PharmacistsLetter.com ~ www.PrescribersLetter.com

Preguntas Y Respuestas Sobre La Ley Del Cuidado De Salud A Bajo Precio • Revisión de la presión de la sangre • Detección de colesterol • Detección de cáncer colorrectal • Detectar depresión • Detección de la diabetes • Dieta consejería

• Detección del VIH • Vacunas para adultos • Detección del consumo de tabaco • Las mamografías para mujeres • Detección de cáncer de cuello uterino de la mujer • Análisis de osteoporosis de la mujer

¿Qué información necesito para registrarme? Tenga con usted los números de seguro social, información relativa a los ingresos y números de póliza de planes de seguros de salud que cubren actualmente a sus miembros de familia. Cobertura de seguro de salud puede comenzar tan pronto como 1 de Enero, 2014. Cuanto antes se registre, comenzará su cobertura. [Agosto 2013]

Prepared for the subscribers of Pharmacist’s Letter / Prescriber’s Letter to give to their patients. Copyright © 2013 by Therapeutic Research Center www.PharmacistsLetter.com ~ www.PrescribersLetter.com