An Update on COVID-19 Over-the-counter Tests
In today’s environment, a negative COVID-19 test may unlock welcome entry into many places, such as family gatherings, school programs, and some in-person events. Recently, the Biden-Harris Administration expanded coverage for over-the-counter (OTC) COVID-19 tests authorized for use by the U.S. Food and Drug Administration (FDA).
Beginning Jan. 15, 2022, Sutter Health Plus covers COVID-19 screening for members in accordance with state and federal guidelines during this public health emergency. This includes FDA-authorized OTC COVID-19 tests available for purchase directly through pharmacies, retailers or online. Sutter Health Plus limits coverage of OTC COVID-19 tests bought without a prescription or clinical assessment by a provider to eight (8) tests per member, per one-month period. While members can purchase the tests without a prescription or other clinical assessment by a provider, Sutter Health Plus encourages members to contact their primary care physician (PCP) to see if testing is recommended for their particular situation. There are no quantity limits when a treating physician orders a test as part of an individual clinical assessment.
In-person testing capacity is currently limited in many regions due to high demand. While individuals have several options for COVID-19 testing, including licensed retail and community sites, at-home antigen tests are gradually becoming more readily available.
Proof of COVID-19 Vaccination and Test Results
Members who received their COVID-19 vaccination(s) or testing with Sutter can view and share proof of their COVID-19 vaccination(s) or test results easily from My Health Online. After signing in, members can click the Menu button, scroll to My Record and select COVID-19 to view details. Visit Sutter’s COVID-19 Vaccine Resources page for more information.
Additionally, all members can go to California’s Digital COVID-19 Vaccine Record site to get a link to a QR code and digital copy of their COVID-19 vaccination record.
Health and Safety
This current surge in COVID-19 cases is causing concern among many community members. It’s important to remember that the best way for individuals to protect themselves and others from serious illness from COVID-19 is to get vaccinated and boosted. Especially as those that are vaccinated are much less likely to require hospitalization if they become ill with COVID-19. We also encourage everyone to continue to practice good public health practices and wear a mask when in indoor spaces with others.
Additional Resources
For up-to-date information about COVID-19, visit:
- Sutter Health Plus COVID-19 Coverage, Cost and Access to Care for health plan information and FAQs
- Sutter Health COVID-19 Resources for clinical information, a COVID-19 interactive screener, patient information, and more
- Centers for Disease Control and Prevention for federal guidance, U.S. data tracking, and public health information
- California Department of Public Health for California-specific alerts, data tracking, resources, and guidance
An Update on COVID-19 Vaccines
The Centers for Disease Control and Prevention (CDC) expanded Pfizer COVID-19 vaccine recommendations to include moderately or severely immunocompromised children ages five to 11 receive an additional primary dose of vaccine 28 days after their second shot.
Additionally, the CDC updated the Pfizer booster shot recommendation to include individuals ages 12 to 15. The CDC also updated its recommendation for when many people can receive a booster shot, shortening the interval from six months to five months for people who received the Pfizer vaccine. This means that eligible individuals can now receive an mRNA (Pfizer or Moderna) booster shot five months after completing their Pfizer primary vaccine series.
This new guidance will help provide individuals stronger protection against COVID-19, which is especially important given the highly contagious Omicron variant.
Primary Vaccine Series, Additional Shots, and Booster Shots
In addition to the COVID-19 primary vaccine series, there are additional primary shots and booster shots. The terms “additional primary shot” and “booster shot” aren’t interchangeable. Please refer to the following to better understand the differences between the primary vaccine series, an additional primary shot, and a booster shot.
Primary Vaccine Series: Pfizer and Moderna require two doses: the initial vaccine and then a second shot—three weeks later for the Pfizer vaccine or four weeks later for the Moderna vaccine. The second dose stimulates a greater immune response, offering the recipient far more protection from COVID-19. The Janssen/J&J vaccine is administered as a single shot that provides maximum protection 14 days after administration.
Additional Primary Shot: Additional vaccine doses are administered to individuals with moderately to severely compromised immune systems at least 28 days after the initial vaccine series with the intent to improve their immune response.
Booster Shot: Booster shots are given to individuals at varying intervals after their initial series because their immune response to COVID-19 has likely decreased over time.
Booster Shot Guidance
*Although mRNA vaccines are preferred, J&J/Janssen COVID-19 vaccine may be considered in some situations. Updated as of Jan. 7, 2022.
COVID-19 Appointments
Sutter Health Plus covers COVID-19 vaccines for our members, including additional primary shots or booster shots, even when administered out-of-network. Vaccinations are offered at multiple locations across the Sutter Health Plus service area. Members can check appointment availability through:
- Network pharmacies
- The Sutter Health COVID-19 Vaccine appointment line at 844-987-6115
- Sutter’s patient portal, My Health Online
- My Turn, California’s COVID-19 vaccine scheduling portal
Proof of COVID-19 Vaccination and Test Results
Members who received their COVID-19 vaccination(s) or testing with Sutter can view and share proof of their COVID-19 vaccination(s) or test results easily from My Health Online. After signing in, members can click the Menu button, scroll to My Record and select COVID-19 to view details. Visit Sutter’s COVID-19 Vaccine Resources page for more information.
Additionally, all members can go to California’s Digital COVID-19 Vaccine Record site to get a link to a QR code and digital copy of their COVID-19 vaccination record.
Vaccination Progress
With the increasing vaccine eligibility and supply, the total number of eligible Californians (age five and older) fully vaccinated against COVID-19 now tops 71%, according to the state. Additionally, 51% of eligible Californians have already received a booster shot.
To maximize protection from COVID-19 and prevent possibly spreading COVID-19 to others, the CDC still recommends wearing a mask indoors in public settings—regardless of vaccination status.
Additional Resources
For up-to-date information about COVID-19, visit:
- Sutter Health Plus COVID-19 Coverage, Cost and Access to Care for health plan information and FAQs
- Sutter Health COVID-19 Resources for clinical information, a COVID-19 interactive screener, patient information, and more
- Centers for Disease Control and Prevention for federal guidance, U.S. data tracking, and public health information
- California Department of Public Health for California-specific alerts, data tracking, resources, and guidance
Planning for a Healthy New Year
It’s common for people to seek ways to improve their health and happiness in the new year. Selecting a few wellness resolutions is the easy part—but staying motivated can be tricky. This year, increase your chances of success by creating a solid plan of action.
Research shows that people who write down their goals are significantly more likely to succeed in accomplishing them than those who do not. By clearly articulating what you’d like to achieve, connecting to the reason why you’re making a resolution, and outlining how you will do it, healthy new habits can become achievable parts of daily life.
Setting Your Health Goals
When setting resolutions and goals, be reasonable about what you can accomplish. Whether it’s improving mental wellness, mood, and resiliency for your well-being or managing weight to feel healthier and more energized, it can also be helpful to take a moment to align with your personal values, needs, and purpose.
Here are a few healthy resolutions to consider:
- Eat a healthier diet, exercise, and sleep – Take small steps, like adding more fruits or vegetables to one daily meal, walking 15 minutes each day, and going to bed 30 minutes earlier.
- Schedule preventive care – Don’t postpone care. Make sure you are up-to-date on health, vision, and dental exams, screenings, and immunizations for yourself and your family. For the latest health screening recommendations, see these Health Maintenance Guidelines and learn more at sutterhealthplus.org/members/preventive-care.
- Care for mental health – Schedule a virtual or in-person visit with a behavioral health provider as a first step toward improving mental wellness or consider using wellness apps like Sanvello.
- Manage stress – Spend time with loved ones, express gratitude, try deep breathing and mediation, exercise, consume less screen time, and focus on the things that make you happy to reduce stress and improve mood.
- Quit smoking – Take advantage of tobacco cessation telephone helplines, mobile apps, and coaching programs to help when you are ready to quit.
- Seek help for substance use – Find support groups, talk to your primary care physician, or reach out to a behavioral health provider for substance use disorder services.
Creating Your Plan
After selecting meaningful goals for the new year, it’s time to outline the steps you will need to take to accomplish them. First, prioritize the ones that can make the greatest positive impact for your health in the short and long term. Then, identify a few strengths, like the tools and resources available to you, and perhaps weaknesses or barriers you might run into, like lack of time or sustainability.
Write down how long it may take to reach your goals and create a schedule of times during the week you will work toward them. Even add a few ideas on how you will stay motivated. It can be difficult to find time for your new habits, but remember it’s okay to say no to obligations and other activities to make space for new, healthier parts of your life.
Create a list of helpful resources you may have, like a support system of loved ones, fitness apps or wearable devices to help you stay on track, or health tools and resources available.
Keep a journal to track and evaluate your progress along the way and celebrate small wins. Remember, you cannot control everything. Sometimes a goal or strategy needs to be refined to be more realistic, like exercising at least three days a week instead of five and working to lose 10 lbs. rather than 20. Be compassionate to yourself along the way and remember that you can always try again the next day.
Getting Help to Reach Your Goals
Reaching out for support can be an important step toward success. Sutter Health Plus members have access to resources to help accomplish their wellness goals.
The Health Coaching program provides one-on-one training with a personal health coach by telephone to uncover barriers to self-management, set goals, and make healthier lifestyle choices for maintaining a healthy weight, managing stress, and tobacco cessation—all at no cost share. Call 866-961-8513 to enroll or learn more.
Members also have access to secure virtual or in-person visits for mental health and substance use disorder services with participating behavioral health providers through U.S. Behavioral Health Plan, California (USBHPC). Call USBHPC at 855-202-0984 or visit liveandworkwell.com.
For more ideas to create your plan for a healthy new year, check out this library of webinars and visit sutterhealthplus.org/wellness.
An Update on COVID-19 Booster Shots
The Centers for Disease Control and Prevention (CDC) expanded Pfizer COVID-19 booster shot recommendations to include individuals ages 16 and 17.
A booster shot is given to individuals when the immune system response to the primary vaccine series has likely decreased over time. This will help provide stronger protection against COVID-19, particularly in light of the new variant.
Read More about An Update on COVID-19 Booster ShotsSutter Health Plus Year in Review 2021
Over the past year, many businesses have successfully reset their “business as usual” operations, from standardizing virtual approaches to retooling organizational structures. One key area that has sharpened across industries is a focus on employee engagement and retention—including offering comprehensive health benefit plans.
Important Information About New Pharmacy Benefit Manager
On January 1, 2022, Sutter Health Plus is changing its pharmacy benefit manager (PBM) to CVS Caremark®. CVS Caremark will manage the pharmacy benefits for our members, including retail, mail order, and specialty prescription drugs, claims processing, and prior authorization requests. This change is pending regulatory approval by the Department of Managed Health Care.
While Sutter Health Plus and CVS Caremark are working to ensure minimal disruptions during this transition, there are a few things members should know.
New Member ID Cards
Sutter Health Plus members will receive new member ID cards with updated prescription benefit information. Members will need to present their new ID card at the pharmacy for any prescriptions filled on or after January 1, 2022. The pharmacist needs the information on the back of the card, including Rx Group, Rx BIN, and Rx PCN to process prescriptions and submit claims for coverage. Member ID cards will also be available through the Member Portal on or before January 1, 2022.
Current Retail Prescriptions
Sutter Health Plus is transferring members’ prescription history, including claims information and any active prior authorizations, to CVS Caremark. This will allow our members to continue their current retail prescriptions with minimal disruption.
The CVS Caremark retail pharmacy network includes most major pharmacy retail chains and independent pharmacies, including CVS, Rite Aid, Walgreens, Bel Air, Raley’s, and Safeway.
Mail Order Pharmacy
Sutter Health Plus members will have their active and refillable prescriptions transferred to the CVS Caremark mail order provider, CVS Caremark Mail Service Pharmacy. CVS Caremark Mail Service Pharmacy will not mail the first refill automatically. Members must call 1-844-740-0635 or visit caremark.com (registration required) on or after January 1, 2022, to provide their billing information.
CVS Caremark Member Portal
In January, members can create an account on the CVS Caremark member portal at caremark.com, allowing them access to:
- View order and drug history
- Order refills online
- Automatic refill reminders for all of prescriptions (retail, mail order, specialty)
- Set communication preferences, for example email or text
- Check order status and track shipments
- Delivery of drugs within the United States, Monday through Friday, at no additional charge with most supplies provided, e.g., needles and syringes
- Safety checks to help prevent interactions with other drugs and products
- Access to specialty-trained pharmacists and nurses 24 hours a day, 7 days a week
- View claims information
For questions, call Sutter Health Plus Member Services weekdays from 8 a.m. to 7 p.m. at 1-855-315-5800. CVS Caremark Customer Care is also available 24 hours a day, 7 days a week, including holidays by calling 1-844-740-0635.