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The LSU First Team

The LSU First team is comprised of the following partners working together for your health care benefits:

• LSU - LSU is financially responsible for paying your claims

• WebTPA  - Medical Claims Administrator, Medical Management and Care Coordination Provider. They have a dedicated team of employees for LSU to answer your calls and process your claims. They also review all medical authorizations and provide education and resources about various health conditions, including proactively reaching out to members with specific high risks to help improve health outcomes.

• MedImpact - Pharmacy Benefits Manager. They provide customer service and administer prescription programs such as Step Therapy, Prior Authorization and Drug Quantity Management. They also provide mail order services for home delivery of maintenance and specialty medications.

• Verity HealthNet - Local Network Administrator for the First Choice and Verity networks

• Aetna ASA - National Network Administrator and web-based Employee Assistance Program (EAP) provider

The LSU First Networks

The LSU First Health Plan utilizes the following Networks:

• First Choice (FC) - The First Choice network is a network of local providers within Louisiana. Services are covered at 100% after your HRA is exhausted. This means you pay no out of pocket for covered services with these providers.

• Verity HealthNet - The Verity Network is a network of local providers within Louisiana. After your HRA is exhausted and you meet your deductible, the Plan will pay 80% and you are responsible for 20%.

• Aetna ASA - The Aetna ASA Network is a nationwide network for providers outside of Louisiana and/or providers within Louisiana that are not in the First Choice or Verity networks. After your HRA is exhausted and you meet your deductible, the Plan will pay 80% and you are responsible for 20%.

• Out-of-Network - Any providers not participating in the above networks will be considered Out-of-Network. This may include ancillary services, such as emergency room providers, radiology, anesthesiology, etc. After your HRA is exhausted and you meet your deductible, the Plan will pay 60% of the Maximum Allowable Charge (MAC). Members can be balance billed by Out-of-Network providers for billed services outside of the MAC.

For more information on the networks, please see the Search for Providers webpage.

Tiered Formulary 

The LSU First Health Plan utilizes a 4-tier formulary, managed by MedImpact, that helps members select the most appropriate, lowest-cost medication options. The formulary is reviewed quarterly to reassess drug tiers based on the current prescription drug market. The amount you pay towards prescriptions depends on the tier the drug falls within and the cost of the medication. 

• Tier 1 Generic - Tier 1 Generic medications are covered at 100%. You owe $0 for these medications.

• Tier 2 Preferred Brand - Tier 2 Preferred Brand medications are often less expensive than Non-Preferred Brands, which can save you money. They are covered at 80%. You are responsible for 20%, up to a maximum of $150 for a 30-day supply.

• Tier 3 Non-Preferred Brand - Tier 3 Non-Preferred Brand medications are covered at 80% . You are responsible for 20%, up to a maximum of $150 for a 30-day supply.

• Tier 4 Specialty - Tier 4 Specialty medications are covered at 80% with no HRA or Deductible. You are responsible for 20%, up to a maximum of $150 for a 30-day supply.

LSU First members have the option of receiving a 90-day supply of maintenance medications by mail order through MedImpact Direct or through multiple retail pharmacies nationwide, including CVS, Walgreens, and Wal-Mart, through MedImpact’s Choice90 program. To avoid surprises at the pharmacy, you can search the formulary using the Formulary Look-Up Tool. This tool will show you if the medication is covered, what tier it falls within, any therapeutic alternatives, and any restrictions. You can also review drug coverage, get an estimate of how much it will cost, and find the lowest-priced pharmacy in your area by logging into the MedImpact portal.

Online Resources

LSU First puts access at your fingertips. WebTPA, medical claims administrator, and MedImpact, pharmacy benefit manager, both have secure online portals and mobile apps that allow you to manage your healthcare. Due to HIPAA (Health Insurance Portability and Accountability Act) that protects health information, both portals require that any spouse and/or dependent over age 18 will need to create their own account to view claims information.

lsufirst.webtpa.com– Members can create an online account with WebTPA. Once registered, the WebTPA portal allows members to track their HRA, deductible, and out-of-pocket balances, view claims, and print ID cards. Note that any spouse and/or dependents over the age of 18 will need to have their own account to view claims information.

medimpact.com – Members can create an online account with MedImpact. Once registered, members can look on prescription drug coverage, drug costs, compare prices for medications, view medication history, and find an in-network pharmacy.