MMO: 4/30/25 Broker Update

Updated Fully Insured Group Contracts Now on MyBrokerLink

Topic: Broker Relations | Companies: Medical Mutual | Applies to: Small Group and 51-99

New contracts for groups with fully insured plans can be found on MyBrokerLink

While only a small number of revisions were made (e.g., No Surprise Act updates, incorporation of prior amendments, etc.), please be sure to utilize the most recent versions immediately.

Prior versions will no longer be accepted after May 31, 2025.

Please contact your ExpressLink representative with any questions.

Paramount Members’ Telehealth Options to Change May 1

Topic: Network Updates | Companies: Paramount | Applies to: All

Paramount’s telehealth services will transfer from ProMedica OnDemand to MinuteClinic (medical) and SonderMind (behavioral) effective May 1, 2025.

To inform Paramount members of their current telehealth options, commercial and Medicare members will receive a mailer. For more information for you or your clients, there’s also a telehealth flyer available here.

Please contact your ExpressLink representative with any questions.

Network Updates for East Ohio, PA and NJ

Topic: Network Updates | Companies: Medical Mutual, Mutual Health Services | Applies to: All

Some recent network updates that Medical Mutual would like to make you aware of:

• Jefferson Health Returns to the Cigna Healthcare PPO Network: An agreement has been reached and Jefferson Health (PA/NJ) is back in the Cigna Healthcare network effective immediately. Impacted members will receive a notice via mail.
• East Ohio Regional Hospital in Belmont County Closed: Medical Mutual was recently notified that East Ohio Regional Hospital in Belmont County is closed. Impacted members will receive a letter alerting them to changes and providing new care options.

If you’d like to see a group email template or the impact list for either network change, please reach out to your ExpressLink Representative.

Commercial Group Pharmacy Benefit Changes Effective July 1

Topic: Product News | Companies: Medical Mutual, Mutual Health Services | Applies to: All Except Medicare

Twice each year, adjustments may be made to prescription drug formularies and drug lists based on changes in the market.

Beginning on July 1, 2025, the following changes will become effective:

• Humira will be non-formulary for the National Preferred Formulary and nonpreferred with a step therapy requirement for the Basic Plus and ACA Advantage formularies. (These changes have already been in effect since January 1, 2025, for new utilizers.)
• Updates were made to the Express Scripts National Preferred formulary. Medications on the list below will change categories as noted (i.e., moving costshare tiers, being excluded from coverage):
  • National Preferred Formulary Exclusion List Changes
  • National Preferred Formulary Exclusions (Full List)
• Though minimal, SaveOnSP will see changes to their drug lists
  • MedMutual Basic Public SaveOnSP Drug List for 07.01.25
  • MedMutual Basic Standard SaveOnSP Drug List for 07.01.25
  • MedMutual National Preferred Public SaveOnSP Drug List for 07.01.25
  • MedMutual National Preferred Standard SaveOnSP Drug List for 07.01.25
  • MedMutual Exclusive Public SaveOnSP Drug List for 07.01.25
  • MedMutual Exclusive Standard SaveOnSP Drug List for 07.01.25

Members affected by these changes will receive a mailer alerting them to changes and any additional steps they need to take. If you would like to see any of the three letters or need a list of those affected, please contact your ExpressLink Representative.