Health&Y O U R O X F O R D G U I D E T O L I V I N G W E L L

WellnessS P R I N G 2 0 0 4

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Beyondclinical careTeamwork eases a

difficult journey

The eyes have it! The real skinny on fats & cholesterol

Participating in a once-a-week program of group exercisecan help you strengthen leg muscles, improve balance and reduce your

risk of falling, according to a recent issue of Age and Aging. In a year-long

study of 163 people over age 65, those who were randomly selected to

participate in the exercise group scored substantially higher on balance

tests and had 40 percent fewer falls than those who did not exercise. O

As we age, the protective cartilage that allows our joints to move

smoothly may wear down faster than it repairs itself, causing some

movements to become painful and arthritic. Glucosamine,

which is produced naturally in the body, is thought to promote the

formation of new cartilage. However, for many years people have taken an

oral supplement similar to human glucosamine to treat various aches and

pains. Now scientific evidence confirms oral glucosamine’s effectiveness

in moderating damage and pain in some joints. Chondroitin, often paired

with glucosamine, has not yet been shown to provide any additional

benefit. Chondroitin raises the cost of supplements considerably, so

sticking with glucosamine-only products is significantly less expensive. O

Oxford has developed a core set of rights and responsibilities for all Oxford Medicare AdvantageSM Members

that can provide you with helpful information about how to access quality

care. Your rights and responsibilities can be found in your Member

Handbook, or you can log on to www.oxfordhealth.com and click on the

Oxford Medicare Advantage box. Next click on Benefits and Services, then

click on Member Rights and Responsibilities to read the online version. O

Did you know?

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Health&Y O U R O X F O R D G U I D E T O L I V I N G W E L L

WellnessS P R I N G 2 0 0 4

C O N T E N T S

President and CEO Charles G. BergChief Medical Officer and EVP Alan M. Muney, MD, MHAVice President, Marketing Chuck GreenDirector, Member Marketing Rebecca MadsenManager, Member Marketing Meg DedmanCopy Editor Starlet ColemanEditor Stephanie Green

Health & Wellness is published exclusively for Oxford Medicare AdvantageSM Members by:Onward Publishing, Inc.10 Lewis Road, Northport, NY 11768Fax 1-631-754-0522

Publisher Jeffrey BaraschCreative Director Melissa BaraschEditorial Director Wendy MurphyArt Director Bruce McGowinDesigner Lisanne SchnellProject Director Tamyra ZieranProject Manager Bret BaraschBusiness Manager Liz Lynch

Oxford Health Plans, Inc. and Onward Publishing,Inc., are not responsible for typographical errors.

The information in this newsletter is intended to be used as a general guide and should not replace the advice of your physician. Always consult your physician for individualized care.

© 2004 Onward Publishing, Inc. All rights reserved.

Health& Wellness, which is designed to give you the latest information on a wide range of health topics and your plan benefits, is now available on our web site. Simply log on to www.oxfordhealth.com and click on the Oxford Medicare Advantage box. Next, click on Innovative Programs and Services, then click on Health and Wellness Magazine to read the online version. As always, we encourage you to e-mail your comments to us at publications@oxfordhealth.com or write to: Oxford Health Plans, c/o Stephanie Green, 55 Corporate Drive,Trumbull, CT 06611.

C O V E R S T O R Y

Beyond clinical careTeamwork eases a difficult journey

W E L L N E S S

The eyes have it!

N E W S Y O U C A N U S E

Oxford benefits update

P R E V E N T I O N

Spring cleaningUpdating your medicine cabinet

S P E C I A L T O P I C

When illness is a family affair

P A T H S T O W E L L N E S S

Is it just indigestion or is it IBS?

N U T R I T I O N

The real skinny on fats & cholesterol

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C O V E R S T O R Y4

Beyond c

Teamwork eases a difficult journeyFor Virginia Gonzales, the year 2003 will always be filled with special

memories, some very happy and some tempered by grief. In the space

of a few months, her son, Carlos, was married in a joyous family

celebration, and Valentin, Carlos’ father and Virginia’s beloved

husband, had a recurrence of the cancer that eventually took his life.

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“Devastated as our family is by Valentin’s loss,” Mrs. Gonzales says, “I am thankful daily that wehad the extraordinary support of Oxford duringthose difficult times. Valentin and I never felt wewere making the difficult journey alone. From the moment we knew that Valentin’s cancer hadreturned and that his long-term prognosis waspoor, Oxford’s doctors, nurses and social workerswere at our side, working as a team. I call them‘our angels’ because they were always there, telling us what we needed to know, giving us theconfidence to get through the hard times, listeningwhen we just needed to talk. They went beyondanything I could have imagined in their caring.”

The compassionate team support that VirginiaGonzales so vividly describes is the hallmark ofOxford’s new and highly successful OncologyProgram. Designed for Members with advancedcancer, the program recognizes that more than just excellent clinical care is needed to keep people going through the latter stages of the disease. The diagnosis can have emotional, socialand financial consequences for the entire family, so Oxford’s support extends well beyond thepatient to assist caregivers in ways not ordinarilycovered by health insurance.

Eligibility for participation in Oxford’s OncologyProgram is based on the specific cancer diagnosis, as well as other health-related considerations thatmight raise the Member’s risk of being hospitalizedfrequently. When Oxford’s case management teamfinds that a Member’s condition can best be servedby the kind of individualized attention the programoffers, a support team is assigned. In the first pilotyear of the program, 1,100 Oxford Members met

the criteria and participated; this year we expect the program to be even larger with an estimated4,000 Members meeting eligibility requirements.

Everyday championsIn the Gonzales’ case, the principle day-to-day leaders were Teresa Walsh, one of Oxford’s 25 registered nurses with special training in oncologyissues, and Sheryl Manasse, one of the program’sfour oncology social workers. As is done with other Members in the Oncology Program, Teresaand Sheryl coordinated the treatment plans of Mr.Gonzales’ various physicians, including his primarycare physician and his oncologist, Dr. AbdulKhuwaja. They also laid out for the Gonzales familywhat benefits and services were available, not onlyfrom Oxford, but also from the community andstate, to assist individuals with advanced disease,and explained how the family might take advantageof these programs as their circumstances changed.

“At first we chose to keep outside help to a minimum,” Virginia explains. “Valentin and I have always been there for each other. When I had surgery some years ago, he did everything forme, even tying my shoes. Now I wanted to take care of him as long as I could. So Teresa became my teacher. She coached me on how to prepare hisfavorite foods so that he could eat them even whenhe wasn’t feeling good, how to keep his pain undercontrol, how to prevent dehydration, which couldmake him sicker, and what symptoms I shouldreport to his doctors in case they needed to adjust his treatment plan.” The one thing that theGonzales’ felt personally unequipped to deal withfrom the onset was how to handle the potentially

linical care

C O V E R S T O R Y6

high copayment costs of the cancer drugs, whichwere sure to rise as the disease progressed. Sherylreassured the Gonzales’ that there were severalprograms they were eligible for, beginning withElderly Pharmaceutical Insurance Coverage(EPIC), New York State’s prescription subsidy plan for qualifying senior citizens. She helpedthem apply early on so that they would be readyshould they need it. “We never would have made it financially if we had had to figure out everythingfor ourselves, but I wasable to talk openly toTeresa and Sheryl asthough they were dearfriends I had known all my life.”

A commongoal“From the start,Valentin accepted thathe might not survivethis cancer,” his wifecontinues, “but he was determined to stay strong enough,long enough to attend our son’s wedding, which was to be in Kansas City in May.” Valentin’s goal quickly becameeveryone’s goal. And for the first three months ValentinGonzales responded well enough to treatment tomake the trip seem feasible. He even seemed to beimproving, as Virginia mastered the complex tim-ing of medications and doctor’s appointments, andlearned to monitor and report on symptoms withthe accuracy of a pro. Teresa and Sheryl, whocalled regularly to check on the family’s situation,marveled at how well everyone was managing.

Then in late March, scarcely more than a monthbefore the much-anticipated wedding trip,Valentin’s doctors found that his cancer had spread.Dr. Khuwaja put him back on chemotherapy andradiation therapy; and Teresa and Sheryl increasedthe frequency of their contact with the family. The situation climaxed a few mornings later whenValentin’s medications were no longer controllinghis pain and the intensified treatments made himtoo weak to get out of bed.

“I had been pretty steadythrough everything up untilthat point,” Virginia recalls,“but now I was feeling reallyhelpless and frightened. Ithought I might have to callan ambulance and takeValentin to the hospital,something that I knew wouldprobably put an end to hisdream of attending Carlos’wedding. Instead, I calledTeresa to tell her what wasgoing on. She knew what todo immediately. Within anhour she arranged to have awheelchair delivered; she alsosent a car service that was ableto drive us to Dr. Khuwaja’soffice. Teresa consulted with Dr. Khuwaja on how to orderthe appropriate medicationneeded so that it would becovered under his benefitsand would give Valentin’s

blood the boost to make him stronger. She was areal miracle worker.”

Dr. Khuwaja was also impressed. “This was the firsttime I’ve been involved with Oxford’s OncologyProgram, and I have to say the people there gavetremendous support to the family and to those ofus managing his treatment. It really helped.”

RR E S O U R C E S

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Three weeks later with the blessing of Dr.Khuwaja and a lot of last minute groundwork on the part of Teresa and Sheryl, the Gonzales’made the flight to Kansas City on schedule. Andin one of the happiest and proudest days oftheir life together, Valentin and Virginia walkeddown the aisle with their son at his wedding. “If Valentin felt any pain that weekend, he wasable to rise above it to enjoy what a blessing itwas to be there.”

Passing the torchAs spring gave way to summer, however, Valentinand Virginia realized that his care needs werebecoming more difficult. Talking frankly abouttheir care options with his physicians and withTeresa and Sheryl, they all decided that it was time to seek out hospice services. Hospice is thespecialized healthcare option that provides carefor patients with a terminal illness when the curative care of hospitals is no longer desired.Although day-to-day management of Valentin’scare was now passed to a new team of specially-trained caregivers, Teresa and Sheryl continued to stay in contact with Virginia to be sure thatshe was comfortable with her choice. “Valentin’slife ended peacefully six weeks later,” Virginiarecalls. “Thanks to the wonderful help we had,he was able to leave us the way he wanted to, in the warmth of his home, surrounded by his loving family and knowing that I was secure.” O

American Cancer Society1599 Clifton Road NEAtlanta, GA 303291-800-227-2345www.cancer.org

Cancer Care, Inc.275 Seventh AvenueNew York, NY 100011-800-813-4673www.cancercare.org

Call to reach a social worker who can answer yourquestions, address concerns and provide information,referrals and practical assistance.

Resources for Mind, Body and Spirit

Health Journeys is a multimedia publishing company offering a range of outstanding holistic health tools, contributed orselected by Belleruth Naparstek, LISW, noted complementaryand alternative medicine (CAM) psychotherapist. HealthJourneys’ 22-page catalog includes scores of guided imageryand meditation audio tapes, CDs, videos, games and bookscovering topics from well being and healing to depression,stress, trauma, cancer, heart health, hypnosis, yoga, and weight-loss. Other contributors to Health Journeys’ line-up includeAndrew Weil, MD, Bernie Siegel, MD, David Illig, PhD, andCarolyn Daitch, PhD. Oxford Members may order any of the regularly priced health tools at a 20 percent discount.(Excluded are sale items, special value and popular salepacks.) To learn more about Health Journeys, place an orderor request a catalog, log on to www.healthjourneys.com andenter promotional code Oxford on the check out page orcall 1-800-800-8661 and mention promotional code Oxford.

OOX F O R D I N F O

As part of Oxford’s Oncology Program, we arepleased to promote eCancerAnswers.com as aresource available to Oxford Members.This web site provides timely information on cancer prevention and screenings, as well as resources forcaregivers. Members can complete a confidentialCancer Risk Appraisal and learn more about how to lower their risk of developing many cancers.For Members with cancer, this site also providesinformation and practical solutions to help supportthem through treatment and recovery.

W E L L N E S S8

As your eyes age, they need all the help they can get, and that begins with an annual eye examinationby an ophthalmologist or optometrist. Along withthe familiar tests for changes in your eyeglasses or contact lens prescription, your doctor will also belooking for any early signs of age-related vision lossthat could impair your ability to read, drive (see box on driver safety at right) or carry out other ordinary activities. Cataracts, glaucoma and maculardegeneration are the principle concerns. Althoughyou may not always be able to prevent these condi-tions, early detection and treatment can slow theseimpairments should they occur. Therefore, if youexperience any sudden, significant change in vision,it’s critical that you call your eye doctor immediately.

CataractsCataracts are found in 50 percent of people age 65to 74 years; this rate rises to 70 percent or higher in later years. The natural lens of the eye graduallygrows cloudy and becomes less able to focus to seeclear images. Those affected may also begin to seehaloes or a glare around objects in bright lightswhen a cataract is forming. Wearing polarized sunglasses during the day to minimize exposure tosunlight can delay the process, but over months oryears the cataract matures until vision is seriously

impaired. The lens can then be surgically removedor extracted and replaced with an artificial lensimplant to restore the magnifying power of theoriginal lens. Cataract removal is an outpatient procedure, accomplished painlessly in about anhour. A protective patch is usually worn for the first24 hours; improved vision occurs within 24 hours.

GlaucomaGlaucoma is the result of excess pressure within the eyeball. Caused by a narrowing of the drainagetissue that usually carries away fluid build-up, theabnormal pressure damages the optic nerve todecrease peripheral vision (what you see beyondthe center of your focus). The more common form(95 percent) is “open-angle glaucoma,” which hasno early symptoms; “narrow-angle glaucoma” isassociated with pain in the eyes, a rapid loss of visual sharpness and often a haloing effect. Oncediagnosed, glaucoma is treated with daily eye drops that improve drainage; in most cases this simple corrective action averts further damage.Occasionally, laser surgery is also used to open thenarrowed angle at the back of the eye. Any loss ofvision that occurs prior to treatment is permanent,so early diagnosis is critical to preserving sight.

Macular DegenerationAge-related macular degeneration (AMD) is the leading cause of vision loss in people over age65. AMD causes gradual damage to the macula, the area of the retina involved in central vision(activities such as reading, sewing, driving, andidentifying faces). Roughly 85 percent of peoplewith AMD get the “dry” form, which is associatedwith accumulating deposits of debris, known asdrusen, in the macula. The National Eye Institute

Theeyes have it!

OOX F O R D I N F O

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Driver SafetyProgram

An excellent driving refreshercourse, geared to motorists age 50and older, is offered periodically atsenior centers and other community locations in your area.The course,which is sponsored by AARP andcosts just $10, helps drivers refineexisting skills and develop safe,defensive driving techniques,particularly as they impact age-related changes in vision, hearing and reaction time.We encourage you to take the two four-hour classroom sessions. You will not only feel more confident behind the wheel, but you may also be entitled to a multi-year discount on auto insurance premiums. Formore information, including times and locations, call your local seniorservices agency or check current listings at www.aarp.org.

If you are a New York Oxford Medicare AdvantageSM Member…

Your plan includes one of the following vision benefits. Please refer to your Member Handbook for further coverage details:

Standard vision benefit• Visit any optometrist or ophthalmologist without a referral from your

primary care physician (PCP)

• Be reimbursed up to $50 per eye exam every 12 months

• Be reimbursed up to $70 for eyeglasses or contact lenses every 24 months

Enhanced vision benefit• Visit a participating Davis Vision provider without a referral from your

PCP for a vision exam every 12 months, at no charge

• Receive one set of eyeglasses or contact lenses every 24 months,at no charge

• In addition, you are covered for one pair of eyeglasses or contact lenses after each cataract surgery, at no charge

If you are a Connecticut or New Jersey Oxford MedicareAdvantageSM Member…

• For Medicare-covered vision services, your PCP can give you a referral to an Oxford participating ophthalmologist; a $25 copayment applies

• In addition, you are covered for one pair of eyeglasses or contact lenses after each cataract surgery, at no charge

recommends that persons withmoderate dry AMD take high doses of antioxidants and zinc, aformulation known by the acronymAREDS. With treatment, vision lossis typically slow, and progression to the condition known as legalblindness (20/200 in the worst eye) is rare. The “wet” form of AMDinvolves the formation of new, oftenleaky, blood vessels in the macula.The first symptom is frequently having straight lines appear wavy. Anyone who experiences this shouldreport it to his or her doctor immediately. You can easily test this withthe Amsler Grid (see example at right). Laser treatment, as well asphotodynamic therapy, can slow the progress of wet AMD, but theoverall benefit remains slight. Owing to the graying of the population,research into better ways to treat AMD is currently a high priority atthe National Eye Institute. O

The Amsler Grid How the grid may appear if youhave AMD.

N E W S Y O U C A N U S E10

Additional locations forSilverSneakers® fitness benefitWe are pleased to announce that we are adding participating fitness facilities that are locatedbeyond the five boroughs of New York City to our SilverSneakers® program. As part of theSilverSneakers fitness benefit,1 eligible Memberscan now attend SilverSneakers classes and use participating fitness facilities in Arizona, Colorado,Connecticut, Florida, Georgia, Louisiana,Massachusetts, Minnesota, New York, Oregon,Pennsylvania, Texas, and Washington. This added convenience allows Members to enjoy thebenefits of regular exercise while traveling and onvacation. For more information about additionalparticipating locations, call 1-800-234-1228 or visit www.silversneakers.com.

2002 Medicare Member satisfaction survey resultsRecently, the results of the 2002 MedicareConsumer Assessment of Health Plans Study(MMC-CAHPS) were reported by the Centers for Medicare & Medicaid Services (CMS). TheCAHPS program is conducted annually by selecting a random group of Medicare+Choice beneficiaries and administering a survey measuringquality of healthcare provided to them by theMedicare+Choice plans in their area. The resultsare tallied, and each Medicare+Choice plan is compared on a national and regional basis.

Oxford was rated significantly higher than the state(New York) average for Overall Rating of HealthPlan, Rating of Specialists and Personal Doctors

in Oxford’s Network and Customer Service.Significantly improving over our results in 2001,Oxford rated higher for Rating of CustomerService and How Well Doctors Communicate. In addition, Oxford ranked in the top 25 percentof plans nationally for Rating of Specialists andPersonal Doctors for our New York plan.

The survey results also indicate that Oxford performs comparably to other plans in our area on measures such as Getting Needed Care andGetting Care Quickly, as well as Courteous andHelpful Office Staff. We remain committed to offering you quality healthcare by maintaining an outstanding physician network and providingaccess to innovative healthcare programs, such as our Complementary & Alternative Medicine program2 and SilverSneakers Fitness program1.

OO X F O R D | B E N E F I T S U P D A T E

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1 This program is available to Oxford Medicare AdvantageSM

Members living in Brooklyn, Queens, Staten Island, Manhattan,and Bronx counties.

2 The products and services of the referenced program are neither offered nor guaranteed under our contract with theMedicare program. In addition, they are not subject to theMedicare appeals process.Any disputes regarding these productsand services may be subject to Oxford’s grievance process.

Privacy notice concerning financial informationAt Oxford, protecting the privacy of the personalinformation we have about our customers andMembers is of paramount importance, and we takethis responsibility very seriously. This informationmust be maintained in a manner that protects the privacy rights of those individuals. The following notice describes our policy regarding the confidentiality and disclosure of customer and Member personal financial information thatOxford collects in the course of conducting its business. Our policy applies to both current and former customers and Members.

The information Oxford collectsWe collect non-public, personal financial information about Members from the following sources:

• Information we receive from you on applications

or other forms (e.g., name, address, Social Security number, and date of birth)

• Information about your transactions with us, our affiliates (companies controlled or owned by Oxford) or others

• Information we receive from consumer reportingagencies concerning large group customers

The information Oxford disclosesWe do not disclose any non-public, personal financial information about our current and former customers and Members to anyone except as permitted by law. For example, we may discloseinformation to affiliates and other third parties to service or process an insurance transaction, orprovide information to insurance regulators or law enforcement authorities upon request.

N E W S Y O U C A N U S E12

Oxford security practices We emphasize the importance of confidentialitythrough employee training, the implementation ofprocedures designed to protect the security of ourrecords, and our privacy policy. We restrict accessto personal financial information of our customersand Members to those employees who need toknow that information to perform their jobresponsibilities. We maintain physical, electronicand procedural safeguards that comply with federal and state regulations to guard your non-public, personal financial information.

This notice is being provided on behalf of the following Oxford affiliates: Oxford Health Plans,Inc., Oxford Health Plans (CT), Inc., OxfordHealth Plans (NJ), Inc., Oxford Health Plans (NY), Inc., Oxford Health Insurance, Inc.,Investors Guaranty Life Insurance Company, and Oxford Benefits Management, Inc.

Please note: A copy of Oxford’s Notice of Privacy Practices can be obtained by logging on to www.oxfordmedicare.com. To request a written copy, please call Customer Service at 1-800-234-1228.You can also contact us by mail at:

Oxford Health PlansHIPAA Member Rights Unit48 Monroe TurnpikeTrumbull, CT 06611

Promoting appropriate careThrough the media or your own research, you may have become aware that some managed careorganizations offer rewards or bonuses to providerswho limit and/or deny care. Please note that utilization management decision-making is basedonly on appropriateness of care and service, andexistence of coverage. Oxford Health Plans doesnot compensate providers for denials of service,

nor do we offer incentives to encourage denials.Oxford encourages the use of appropriate careand services to prevent and/or treat illnesses. For details about your specific benefit coverage,please refer to your Member Handbook.

Oxford cares about qualityOxford Health Plans’ Quality Management (QM)Program is devoted to making sure that you receive access to quality healthcare. Our QM Program is led by an Executive QualityManagement Committee and consists of variousregional committees in which QM staff and network providers participate.

Functions include:

• Identifying the scope of care and services available through Oxford

• Developing clinical practice guidelines (e.g.,guidelines regarding treating depression) andservice standards (e.g., customer service timeframes for answering incoming calls) by whichperformance is measured

• Verifying the medical qualifications of providerswho participate in Oxford’s network

• Monitoring and evaluating the quality and appropriateness of the services and medical care received by Oxford Members (i.e., via ongoing Member satisfaction surveys)

• Pursuing opportunities to improve patient safetyand customer service

• Resolving identified quality issues or concerns

If you would like to request more informationabout Oxford’s QM Program and goals, please call Customer Service at 1-800-234-1228.

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Adopting the latest technologiesNew treatment methods are constantly being developed for conditions ranging from asthma toskin cancer. In light of this, you may wonder howOxford evaluates these new medical technologiesand how decisions are made regarding their use.The following information will help you understandhow the process works.

What is new medical technology? New medical technology is defined as a newly approveddrug or medication, a new surgical procedure or new medical equipment. Oxford continuallyassesses new medical technologies to make sure that Members have appropriate access to the latestand most effective medical treatment available. Two examples of new medical technologies thatwere recently approved by Oxford are IntranasalInfluenza Vaccine (Flu Mist™) and Essure™ System.

What is the evaluation process? Oxford’sHealthcare Services Department, led by experienced physicians representing multiple specialties, is responsible for evaluating new medical technology. The process begins with a review of the medical literature and other technical research. The clinical staff also seeksopinions from leading physicians and specialists in the community — providers who have knowledge and expertise regarding how new medical technology will be used on a day-to-daybasis. Once a thorough review of the availableinformation has been conducted, Oxford’s seniormedical staff meets to decide whether or not tocover the new medical technology. They base theirdecision on the strength of the scientific evidencepublished in the medical journals. Representativesfrom all department areas then meet to create a policy, which outlines the conditions for whichthe technology will be covered.

Once the policy is finalized, front-line Oxfordemployees are trained regarding precertification,review, benefit application, and claims payment.When a new policy is implemented, Oxford notifiesphysicians through a quarterly publication calledthe Provider Program and Policy Update (PPU).

As a Member, you are notified of important newpolicies through this News You Can Use section in Health & Wellness magazine. All policies are re-evaluated on an annual basis.

Access to careWe recognize that timely access to physician services is important — whether you need a physical, a colonoscopy, or an appointment to be treated for an unexpected illness. That’s why we’ve developed physician service standardsand regularly monitor our provider network forcompliance with these standards.

As an Oxford Member, you can expect to see aprovider for urgent care within 24 hours, routine

N E W S Y O U C A N U S E14

symptomatic care (non-urgent, but in need of attention) within 72 hours or for a regular physicalexam within six weeks. Your wait in a provider’soffice or for a response to an after-hours urgentphone call should be no more than 30 minutes.We also set standards for the maximum number of appointments a primary care physician shouldhave scheduled per hour, and how many patientshe or she can care for in the practice. Naturally,measures like these are designed to help promotequality care in the event that illness strikes.

2004 Drug Formulary Update The following is an update to the preferred druglist for Oxford Medicare AdvantageSM Members whohave a three-tier prescription drug benefit. Pleasenote that under your plan, different copaymentsmay apply to non-preferred brand, preferred brandand generic drugs. Alternatively, coinsurance mayapply. Oxford reviews new drug products approvedby the Food and Drug Administration (FDA) andreviews current products when new informationbecomes available. The following medicationswere reviewed by the Pharmacy and TherapeuticsCommittee in October 2003 and January 2004.Coverage for the listed items may be limited orexcluded based on your eligibility or plan design.

Additions:The following drugs have been added to Oxford’spreferred drug list. This means that if you have a three-tier prescription drug plan, you may pay a lower cost share as a result of the change to preferred (2nd tier) status.

D r u g T h e r a p e u t i c U s e

Benicar HCT Antihypertensive therapy

Emend Antiemetic

Emtriva HIV/AIDS therapy

Fuzeon HIV/AIDS therapy

Humira Rheumatoid arthritis

Reyataz HIV/AIDS therapy

Deletions:The following drugs have been deleted from Oxford’s preferred drug list. This means that if you have a three-tier prescription drug plan, you may pay a higher cost share as a result of the change to non-preferred brand (3rd tier) status. A listing of generic and preferred brand alternatives is provided. Unless otherwise noted, all changes went into effect January 1, 2004.

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D r u g T h e r a p e u t i c U s e G e n e r i c a n d P r e f e r r e dB r a n d A l t e r n a t i v e s*

Accutane Acne therapy isotretinoin (generic)

Alphagan (effective 04/01/04) Glaucoma brimonidine (generic)

Amicar syrup Hemostatic aminocaproic acid (generic)

Amoxil Antibiotic — penicillin amoxicillin (generic)

Aygestin Progestin norethindrone acetate (generic)

Azmacort (effective 04/01/04) Asthma Flovent

Bactroban ointment Topical antibacterial mupirocin ointment (generic)(effective 04/01/04)

Children’s Advil Suspension Non-steroidal anti-inflammatory ibuprofen (generic)

CoLyte Bowel evacuant sodium sulfate/sodium/sodiumbicarbonate/potassium chloride polyethyleneglycols (generic)

DDAVP Solution/Spray Misc. hormones desmopressin (generic)

DesOwen Lotion Topical corticosteroid desonide (generic)

Desquam-X Acne therapy benzoyl peroxide (generic)

Dilaudid tablet/liquid Narcotic analgesic hydromorphone (generic)

Drysol/Drysol Dab-O-Matic Astringent aluminum chloride (generic)

Eldopaque Forte Misc. dermatological agent hydroquinone/ferric oxide (generic)

Eldoquin Forte Misc. dermatological agent hydroquinone (generic)

Endep Antidepressant amitriptyline (generic)

Estratest/Estratest HS Estrogen combination methyltestosterone/estrogens,esterified (generic)

Florinef Acetate Adrenal hormone fludrocortisone (generic)

Glucophage XR (effective 04/01/04) Diabetes therapy metformin, extended release (generic)

Glucotrol XL (effective 04/01/04) Diabetes therapy glipizide, extended release (generic)

Lotrisone Cream Topical antifungal clotrimazole/betamethasone (generic)

Mestinon tablet Myasthenia gravis pyridostigmine (generic)

Myambutol Antimycobacterial ethambutol (generic)

Nexium Ulcer therapy omeprazole (generic)

Paxil Antidepressant paroxetine (generic)

Pediapred Adrenal hormone prednisolone sodium phosphate (generic)

Permax Antiparkinsonism agent pergolide (generic)

ProctoCream-HC 2.5 percent Misc. gastrointestinal agent hydrocortisone (generic)

Rythmol Antiarrhythmic propafenone (generic)

Spectazole Topical antifungal econazole (generic)

Tambocor Antiarrhythmic flecainide (generic)

Zarontin Anticonvant ethosuximide (generic)

Zaroxolyn (effective 04/01/04) Diuretic metolazone (generic)

*Please make sure you speak with your physician about whether these drugs may be appropriate alternatives for treatment.

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Medications requiring precertificationFor most Members with pharmacy benefit coverage through Oxford, the medications on the following list (including their generic equivalent, if available) generally require precertification through Medco Health, based on Oxford’s coverage criteria. Precertification, also known as prior authorization, requires thatyour physician formally submit a request to, andreceive approval from Medco Health in order toreceive coverage for a prescription for certain medications. If you have any questions regardingthe medications on this list or any additional medication, please call Pharmacy Customer Serviceat 1-800-905-0201 (24 hours a day, seven days aweek — except Thanksgiving and Christmas). Please note: Precertification requirements may vary

depending on the Member’s benefit.

To obtain precertification, please have your physi-cian call Medco Health directly at 1-800-753-2851,Monday through Friday from 8 AM to 9 PM (EasternStandard Time).

This list is subject to change without notice. For themost up-to-date information, please call PharmacyCustomer Service at 1-800-905-0201.

Acne drugs• Avita2

• Differin2

• Retin-A2

Arthritis drugs• Enbrel• Humira• Kineret

CNS stimulants• Adderall1

• Concerta1

• Desoxyn1

• Dexedrine1

• Dextrostat1

• Provigil

Specialized OB/GYNdrugs• Lupron (3.75 mg

& 11.25 mg)

Miscellaneous drugs• Forteo• Serostim• Strattera• Vitamin D

Preparations (i.e. Hectorol, Rocaltrol, etc)

1 Applies only to Membersage 19 or older.

2 Applies only to Membersage 40 or older.

No Change:There has been no change in the formulary status of the following drugs. This means that if you have a three-tier prescription drug plan, you will continue to pay a higher cost share as a result of the non-preferred (3rd tier) brand status. A listing of generic and preferred brand alternatives is provided.

D r u g T h e r a p e u t i c G e n e r i c a n d P r e f e r r e d U s e B r a n d A l t e r n a t i v e s *

Acular LS Non-steroidal anti-inflammatory diclofenac (generic), flurbiprofen (generic)agent — ophthalmic

Ciprodex Otic steroid/antibiotic neomycin sulfate/polymyxin B sulfate/hydrocortisone (generic)

Clobex Topical corticosteroid clobetasol propionate (generic)

Femring Estrogen estradiol (generic), Climara, Estring, Premarin,Vivelle

Finacea Acne therapy azelaic acid (generic), Metrocream, Metrogel

Innopran XL Antihypertensive therapy propranolol (generic), Inderal LA

Oxytrol Anticholinergic & antispasmodic oxybutynin (generic)

Striant Androgen testosterone (generic),Androgel,Androderm

Uroxatral Benign prostatic hyperplasia doxazosin (generic), terazosin (generic)

Vigamox Antibiotic — ophthalmic Ocuflox

Zymar Antibiotic — ophthalmic Ocuflox

* Please make sure you speak with your physician about whether these drugs may be appropriate alternatives for treatment.

Spring cleaning is one the season’s most rewardingrituals — time to sort through the papers on yourdesk, toss out old or unused clothing, and organizeyour closet shelves. But more importantly, spring is an excellent time to clean out your medicinecabinet and any other areas where you store med-ications. Too often, we hold onto medicines thatare outdated or otherwise harmful or ineffective.The result is hundreds of unnecessary poisoningsand other health emergencies each year.

The first step to safeguard your medicine cabinet is to examine every container and dispose of thosethat fit the following criteria:

• Any prescription drug, over-the-counter (OTC)medication or vitamin/food supplement that has expired according to the date printed on the container

• Any medication not in its original container or lacking a legible set of instructions

• Any leftover antibiotics, regardless of expirationdate (antibiotics are highly specific to the condition for which they are prescribed andshould be used according to instructions and in their entirety at the time of infection)

• Any medication that you no longer use or thatyour physician has told you to discontinue using

• Pills with a powdery appearance, an indicationthat medications may have been affected bychanges in humidity or temperature

• Any medication that has a noticeable change in color or smell

• Cough syrups that have separated or become cloudy

• Sterile bandages and adhesives that have becomediscolored or whose packaging is torn or open

Never dispose of medicines in the household trash,where children, pets or someone who may misusethem could find them. Instead, empty containers intothe toilet and flush medications away. And before you restock your medicine cabinet, ask yourself if it’s a good place to store them. Medicines keep bestin cool, dry spaces, quite the opposite of what mostbathrooms and kitchens offer. A secure place in your bedroom might be a better spot.

Lastly, when you take any medication, includingcommon OTC medicines, read the label and followthe instructions carefully. If you are doubtful aboutthe appropriateness of any drug, do not experi-ment. Instead, call your physician to double check.Even something as commonplace as aspirin canhave serious consequences in certain situations. O

Spring cleaningUpdating your medicine cabinet

P R E V E N T I O N 17

• Acetaminophen, aspirinand/or non-aspirin pain reliever

• Fever reducer

• Decongestant

• Cough expectorant

• Antacid or other stomach remedy to treat indigestion,heartburn or gas

• Antihistamine for allergic reactions and itching

• Antidiarrheal

• Laxative

• Eye wash

• A variety of sterile bandages, adhesive tapes, gauze, and cotton swabs

• Antiseptic solution

• Antibiotic cream

• Scissors and tweezers

• A digital (not mercury)thermometer

T h e w e l l - s t o c k e d h o m e h e a l t h c a r e k i t

S P E C I A L T O P I C18

When illnessis afamily

affair

19

Such transitions are something that all of usneed to think about and prepare for, should the time come. Statistics indicate that the care-giver-care recipient relationship is on the rise. In a recent year, more than one quarter (26.6percent) of American adults reported that theyprovided care for a chronically disabled or agedfamily member or friend either in their ownhome or through regular visits to the recipient’shome. The typical caregiver is a woman caringfor an elder parent while also caring for one ormore children of her own, but caregivers comein every description with nearly as many beingolder spouses (13 percent wives, 10 percent husbands) who must balance their own healthconcerns with those of an ill partner.

Most people involved in these caring relation-ships say they would not forego the experience

however difficult. But even under the best condi-tions, everyone involved is likely to experienceongoing emotional and physical stresses.

The care recipient’s perspectiveIf you are a caregiver, expect the person receiving your care to exhibit a range of feelingand behaviors that will make your job harder, particularly in the beginning. Some of the feelings most frequently displayed by an individual in need of your help are:

• Anger and frustration over a growing inability to do familiar things

• Denial that the disabling condition is serious or that it has lasting effects

• Sadness at a changed self-image

One of the most difficult issues we face as we grow

older is the possibility that we or someone we love

will become disabled and need long-term care. For

most of us, the idea of becoming a burden on

another is almost more frightening than death itself.

Nobody wants to surrender personal privacy and

independence, nor does the caregiver want to take

over roles that once belonged to a mate, a parent,

a beloved friend, or relative.

S P E C I A L T O P I C20

• Fear of becoming dependent or isolated from the world

• Emotional depression and physical withdrawal

Struggling to adapt, the cared-for family member may vent these fears and losses byrejecting not only the care provided, but also the loving caregiver. Take heart in the fact thatwith time and support, most recipients adjust to their new dependent situation. Together you and your loved one can find ways to makehim or her feel less alone and less helpless. Try to preserve as many of the care recipient’sold ways of doing things as possible. Attending a weekly support group or an adult daycare center may aid the adjustment. Perhaps findinga suitable recreation or hobby or talking to acounselor will also bring some comfort. And if serious depression is a component of the care recipient’s state of mind, seek treatmentfrom a physician. Many kinds of depression inolder people can be lifted with medication.

The caregiver’s perspectiveWhether you are a care recipient, a family observer or a new caregiver yourself, it’s important to recognize that anyone taking onthis role also goes through major adjustment difficulties, however sincere their desire to help.Some examples include:

• For younger caregivers with families and jobs of their own, the time and financial commitment of caregiving may pose tremendous challenges

• Where several siblings are concerned over the care of an elderly parent, jealousies and disagreements about sharing responsibilities may surface

• Managing a loved one’s assets can be a source of friction, particularly when the

caregiver has no prior knowledge of what the loved one’s situation is

• Spousal caregivers can feel understandably sad over the loss of aspects of a loved one’s companionship and intimacy; despite the best intentions they can feel angry and abandoned as they take on new roles

Navigating in uncharted territoryIt’s critical that family members on both sides of the equation practice good communicationand exercise patience and understanding. Don’t be afraid to talk about and accept yourfears and emotions honestly. Feelings of anger, resentment, love, hate, sadness, and impatience are all normal and shared by others in the same circumstance.

Look for the occasional bright spots in your new situation; it’s not uncommon for adult children and their older parents to build newand stronger bridges between them as they discover previously untapped strengths in each other. Reach out to old friends by phone or the Internet and make a point of talkingabout topics that take you out of your situation.And if you are the caregiver, make it a priority to take care of your own health and morale, too, because without your strength you cannot provide strength to another.

Equally important, whether you are a caregiver now or anticipate needing or givingsome kind of help in the future, familiarizeyourself with the many community resources— social service agencies, clergy, hospital support groups, home care, respite services,and legal advisors — that are out there.Teaming up with these wonderful people can make homebound care and caregiving a whole lot smoother for everyone. O

P A T H S T O W E L L N E S S 21

A

Alan M. Muney, MD, MHA, Is the ChiefMedical Officer and an Executive Vice Presidentfor Oxford Health Plans. Dr. Muney receivedhis bachelor of science in biology and medicaldegree from Brown University in Providence,RI. He also received a master’s in health admin-

istration from University of La Verne, California.

James Dillard, MD, DC, CAc, Is theFounding Medical Director of Oxford’sComplementary & Alternative Medicine program and is Chairman of the OxfordChiropractic Advisory Board. He is a board-certified medical doctor, a doctor

of chiropractic, and a certified medical acupuncturist.

AConventional ResponseAfter taking a thorough history, your doctor will perform a physical exam and very likely blood and stool tests. He or she may also order an intestinal x-ray and an endoscopic (sigmoidoscopy or colonoscopy) exam. Once tests rule out more serious disorders and IBS is diagnosed, managementof the condition can begin.

Eliminating or reducing certain foods from yourdiet is a basic first step. You may be asked to keep a diary to track whether symptoms are related to par-ticular foods — fatty foods, milk products, chocolate,caffeine, alcohol, and carbonated drinks are commontriggers of IBS. You may also be urged to increasedietary fiber; most people can tolerate raw apples,peaches, cabbage, and carrots, as well as kidney andlima beans, whole grain cereals and breads.

Medications may be appropriate, although onlyunder a doctor’s supervision as overuse can lead to dependency. Antispasmodic drugs reduce thepropulsive contractions of the intestinal muscles, lessening painful cramping as well as the frequencyand volume of bowel movements. Ordinary laxativescan treat short-term constipation.

Lifestyle and exercise should also be examined.While stress does not cause IBS, constant anxiety can intensify symptoms in anyone with a highly reactive digestive system. Increasing low-stress physical activity may help.

Complementary & Alternative ResponseAfter being diagnosed with IBS, there are several complementary and alternative (CAM) approaches you can integrate into your medical treatment.

Among mind-body techniques, controlled breathing, guided imagery and meditation can be helpful. Yoga is a proven stress-reducer, and some postures may provide relief from gas and bloating. Massage therapy and acupuncture promote healing, reduce pain and induce physicalrelaxation to smooth the flow of bodily functions.

Nutritional programs can go beyond eliminatingfood triggers and increasing fiber. For example, 1/2ounce of lemon juice in an 8-oz glass of warm wateror two to three prunes daily may relieve constipation;if you have bloating, spasms and diarrhea, try a short-term diet of dry toast, bananas, applesauce, and rice. Acidophilus and Bifidus bacteria replacementtablets work to supplement normal healthy intestinal bacteria. And powdered psyllium or flaxseed, two natural laxatives, can relieve or prevent constipation.Food triggers, such as fermented foods, milk sugar(lactose) and wheat products or excess carbohydrates,may vary from person to person, so trial-and-errorchanges in your diet may be needed.

Herbal teas, particularly chamomile, spearmint and peppermint, can calm an upset stomach. Take time out to really enjoy the tea and you will get the double benefit of relaxation, too. O

Persistent indigestion, gas, belching, painful bloating and cramps, diarrheaand/or constipation may be related to irritable bowel syndrome (IBS), a disorder associated with extra sensitivity of the digestive muscles and nerves.

Although IBS cannot be cured, symptoms can be relieved with treatment.

QIs it just indigestion or is it IBS?

The real skinny onfats& cholesterol

By now, everyone knows that eating too much fat is unhealthy.

Study after study has linked a high-fat diet to heart disease and a

host of other chronic illnesses. But ask most Americans how much

fat is too much or which kinds are “good fats,” or what any of it has

to do with cholesterol, and you’re likely to get a look of uncertainty

and confusion. Since knowing about dietary fats and cholesterol is

key to better health — it’s time for a little tutorial.

What are fats?Fats, carbohydrates and proteins are the body’s basic nutrients, supplying us with nearly all of thechemicals needed to sustain growth, maintain andrepair tissue, and fuel bodily processes. Dietary fats,in particular, provide the raw materials for hormone-like compounds needed to regulate such functionsas blood pressure, inflammation and blood clotting.Fats help absorb and transport fat-soluble vitamins(A, D, E, and K) through the bloodstream, and contribute to maintaining healthy skin and hair. Inyoung children, dietary fats also provide buildingblocks for critical brain, nerve and cell growth.Lastly, fats are the most concentrated source of energy among the foods we eat, providing twice the calories (nine calories per gram) found in carbohydrates and proteins. Because we need energy in reserve, our bodies are designed to storeexcess calories as body fat. While this is meant to be a survival factor, it has led to expanding waistlines.

Saturated and unsaturatedDietary fats are categorized as saturated, unsaturatedand trans-fats (hydrogenated).

N U T R I T I O N22

23

Saturated fats are largely supplied by the animalfoods we eat — dairy products, fat-laced meats andlard — as well as saturated coconut and palm oils. All are loaded (or saturated) with hydrogen atoms,linking them to high levels of low-density lipoprotein(LDL) or “bad cholesterol” in the body, a major riskfactor for heart disease and stroke.

Unsaturated fats are a group of relatively harmlessoils that are missing hydrogen atoms. These liquefiedfats are further identified as monounsaturated (missing one atom, as in olive, canola, peanut, andavocado oils) or polyunsaturated (missing severalhydrogen atoms, as in corn, safflower and sesameoils). Cold-water fish such as salmon, mackerel andsardines contain an unsaturated fish oil known asOmega-3 fatty acid. Unsaturated fats in their naturalstate have a heart-protective effect because they raise high-density lipoprotein (HDL) or “good cholesterol” levels.

Trans-fats (hydrogenated fats or trans-fatty acids)are polyunsaturated vegetable oils that have beentransformed into more stable, more solid saturated fatsthrough a synthetic process known as hydrogenation.Many margarines and shortenings are made spread-able with hydrogenated vegetable oils. Also, manystore-bought fried foods, cream fillings, potato chips,bottled salad dressings, crackers, and other bakedgoods rely on trans-fats, as do most of the fast foodssold at roadside restaurants. While trans-fats are comparable to naturally saturated fats, they tend to slip into our diets unnoticed. The result is that we consume these unhealthy fats in far greater quantitiesthan we know. (By 2006, manufacturers will berequired to list trans-fats separately on food labels; nowthey are often included with polyunsaturated fats.)

The company fats keepCholesterol is another piece of the fats puzzle. Notprecisely a fat itself, cholesterol is a natural substanceproduced in the body and found in many foods weeat, including egg yolks, full-fat dairy products andmeats. White, waxy cholesterol in the bloodstreamtravels aboard LDL and protective HDL clusters alike.And here’s where it gets interesting.

LDL clusters, when present in great concentrations,tend to bunch up and stick to arterial walls, becomingthe plaque that gradually restricts blood flow and/orbreaks free to cause arterial blockage and stroke.HDLs work to moderate LDL damage by picking upplaque clusters and carrying them away for disposal,so the more HDLs the better. An optimum total cho-lesterol reading is typically 200mg/dL* or lower, withthe ratio of LDLs to HDLs no greater than 3:1.

Although your genes, age and gender play a role inhow your body handles cholesterol, excessive levels of LDLs are usually traced to a diet high in saturatedand trans-fats. Every adult should have a blood profile done periodically. Scores that fall outside the recommended limits are a signal to change your eating habits and make other lifestyle modifications.A reasonable dietary model consists of consuming no more than 30 percent of total calories from fats of any kind. Choosing leaner meats and fish, eatingnaturally low-fat, high-fiber vegetables and grains, andlimiting consumption of fried foods, will go a longway to putting you on a heart-healthy track. O

* Cholesterol levels are measured in milligrams (mg) per deciliter(dL) of blood

1 medium yellow squash1 medium zucchini1 large red pepper1 large yellow pepper1 medium red onion1 medium eggplant

1-2 fresh garlic cloves,thinly sliced

1-2 tablespoons olive oil (“pure” or extra virgin)

1 tablespoon balsamicvinegar

1 teaspoon black pepper1/4 teaspoon salt (optional)

Preheat oven to 400degrees F. Cut vegetablesinto small pieces andarrange in large roastingpan with thinly sliced garlic.Drizzle with olive oil andvinegar; sprinkle with pepper and salt.Toss to coat. Roast vegetables,turning often, until edges are browned andvegetables are tender,approximately 30 minutes.

Serves 4 — Per serving: 130calories; 7g fat; 3g protein; 16gcarbohydrate; 2.9g fiber; 0mgcholesterol; 141mg sodium.

Recipe from the North American Olive Oil Association(NAOOA). For more olive oil recipes, visit the NAOOAat www.aboutoliveoil.org.

Roasted vegetables with olive oil

P.O. Box 7081, Bridgeport, CT 06601

HWSP04/6974

PRESORTED STANDARD

U.S. POSTAGE

PAID

ONWARD PUBLISHING INC.

OCUSTOMER SERVICE 1-800-234-1228(8 AM - 6 PM, Mon to Fri) For Members who have questions ranging from covered benefits to claims issues.For a hearing impaired interpreter, you may contactOxford’s TTY/TDD at 1-800-201-4874.Please call 1-800-303-6719 for assistance in Chinese,1-888-201-4746 for assistance in Korean,1-800-449-4390 para ayuda en Español, or 1-800-234-1228 for assistance in other languages.

PHARMACY CUSTOMER SERVICE

1-800-905-0201 (24 hours a day, 7 days a week)*Receive answers to your questions about pharmacybenefits, claims, prescriptions, and participating pharmacies in your area.

DAVIS VISION MEMBER SERVICES

1-800-999-5431 (8 AM - 8 PM, Mon to Fri; 9 AM - 4 PM, Sat) Find Davis Vision locations near you.

MEDCO HEALTH HOME DELIVERY

PHARMACY SERVICE™ (MAIL-ORDER

SERVICE) 1-800-905-0201 (24 hours a day,7 days a week)* This mail-order pharmacy service provides a cost-effective, convenient way for Memberswith a mail-order prescription benefit to order certain maintenance medications.

QUEST LABORATORIES 1-800-225-7483(24 hours a day, 7 days a week) To find Oxford participating labs in your area.

MEDICARE TELESALES 1-800-303-6720(8 AM - 6 PM, Mon to Fri) To use when referring friends to Oxford Medicare Advantage.

*Except Thanksgiving Day and Christmas Day.

NAT’L. SUPPORT ORGANIZATIONS

Advocates for the Disabled 1-800-522-4369Alzheimer’s Association 1-800-272-3900Asthma and Allergy Foundation 1-800-727-8462American Cancer Society 1-800-227-2345American Diabetes Association 1-800-342-2383American Dietetic Association 1-800-366-1655American Heart Association 1-800-242-8721American Kidney Foundation 1-800-638-8299American Lung Association 1-800-586-4872Arthritis Foundation Information 1-800-283-7800Cancer Care, Inc. 1-800-813-4673Elder Care Locator 1-800-677-1116Grief Recovery Institute 1-800-445-4808Medicare Information Line 1-800-633-4227Multiple Sclerosis Foundation 1-800-441-7055National Osteoporosis Foundation 1-800-223-9994National Parkinson’s Foundation 1-800-327-4545Social Security Information Line 1-800-772-1213

LOCAL COM M U N ITY RESOURCES

New York City Department for the Aging 1-212-442-1000Access-a-Ride (NYC paratransit system) 1-877-337-2017EPIC (NY prescription assistance) 1-800-332-3742Nassau County Department for the Aging 1-516-571-5814Able-Ride 1-516-853-3712Richmond County Department for the Aging 1-212-442-1000New York Dental Clinic (dental assistance) 1-212-998-9800New Jersey Department for the Aging 1-877-222-3737New Jersey Dental Society (dental assistance) 1-732-821-2977PAAD (NJ prescription assistance) 1-800-792-9745SHARE (NY & NJ nutritional assistance) 1-800-708-4667Connecticut Agency for the Aging 1-203-933-5431ConnPACE (prescription assistance) 1-800-423-5026West Haven Elderly Services Department 1-203-937-3507

O X F O R D C O N T A C T I N F O