Celebrating 22 years of service with Independent Health. Clarification on our tablet splitting program PHARMACY HELP DESK

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1 SUMMER 2015 VOLUME 8 ISSUE 2 A PUBLICATION TO SUPPORT OUR NETWORK OF PHARMACY PROFESSIONALS Celebrating 22 years of service with Independent Health It is with mixed emotions that we announce the retirement of Cheryl Paul, assistant director, pharmacy operations. Her last day with Independent Health will be September 31, Cheryl began her career at Independent Health in Coming from the pharmacy at Wegmans, she started our Pharmacy Help Desk, which has remained an integral part of her job for the past two decades. During her career she has worn many hats in the pharmacy department, most recently as assistant director, pharmacy operations. Under her direction, the Pharmacy Help Desk grew from one associate to 14. The help desk has received superior customer service ratings of 95 percent and above from our pharmacy network under her management. Cheryl s departure will certainly be felt at Independent Health as she has been diligent in making sure the needs of our pharmacy network are met to ensure we re meeting the highest standards whether it be for servicing, vouchers, payments, or the medication needs of our members. Cheryl will be missed not only by our pharmacy community, but by her Independent Health family as well. Cheryl s skill set and passion for her job is hard to match, but she has left us well-positioned to move forward in the future as she enjoys her retirement with her husband, children and grandchildren. Please join us over the next few months in wishing Cheryl a wonderful and well-deserved retirement! Clarification on our tablet splitting program We want to remind our providers that all Independent Health members are still eligible to participate in our voluntary tablet splitting program. By splitting higher-cost medications, our members can continue to experience the following benefits: Commercial members Receive reduced copayments. Commercial members in high-deductible plans Significantly reduce their overall out-of-pocket prescription costs while paying toward their deductible. Receive reduced copayments once their deductible is met. Medicare Advantage members Reduce their overall prescription costs; however, they are not eligible to receive reduced copayments. There may still be cost savings involved for our Medicare members who split tablets since by splitting higher-cost medications, members may be able to avoid the Medicare Part D Coverage Gap, thus reducing their overall prescription costs. When prescribing medications for patients to split, prescribers should be writing the prescription the way they intend the medication to be taken. The directions provided to the pharmacy and on the label must match the way the patient is instructed to take the medication. We regularly review the utilization patterns of our members to ensure they are taking their medications safely and as prescribed. If you have any questions regarding tablet splitting for any of our members, please contact our Pharmacy Help Desk. PHARMACY HELP DESK If you have questions regarding any of the information in this issue, please call our Pharmacy Help Desk at (716) or , Monday through Friday from 8 a.m. to 11 p.m., and Saturday and Sunday from 8 a.m. to 8 p.m. Additional information regarding when the help desk is closed can be found on page 2.

2 Fraud Prevention Health care fraud can cost the government millions of dollars annually and increase the cost of health care nationwide. Examples of health care fraud range from an individual using someone else s coverage or insurance card to a health care provider billing for services that were not provided. If you become aware of any potentially fraudulent or illegal activity, please contact Independent Health s Integrity Help Line toll-free at Has Your Provider Information Changed? Independent Health is continuously updating its pharmacy information to ensure the most accurate and complete information possible is available for published directory listings, as well as for service remittance addresses, phone and fax numbers, state identification, status and billing. If any of the above listed or any related items should change in your pharmacy, please let us know in writing at: Independent Health Attn.: Pharmacy Department 511 Farber Lakes Drive Buffalo, New York Read Script on the Internet Read Script online at: independenthealth.com/providers. Accessible under the News tab in Newsletters. Script is published quarterly for Independent Health s network of pharmacy professionals. Vice President of Pharmacy Services: Martin Burruano Editors of Script: Cheryl Paul, Jennifer Gallardo What to do when the Pharmacy Help Desk is closed According to Independent Health s claims processing statistics, approximately 95 percent of prescriptions are filled while the Pharmacy Help Desk is open. The standard hours of operation for Independent Health s Pharmacy Help Desk are from 8 a.m. to 11 p.m. (EST) Monday Sunday. However, some medically necessary drugs may be rejected when the Pharmacy Help Desk is closed, which could happen if a drug is non-formulary and requires prior authorization. If the prescription is urgent or the patient cannot reasonably wait until the next time the Pharmacy Help Desk is open to obtain medication, and you are confident of the member s eligibility with Independent Health, then there are two options available to you: 1. For Medicare Part D prescriptions or other urgent issues, contact our Pharmacy Help Desk to speak with a nurse. A nurse is always available 24 hours a day, 7 days a week, and will be able to contact a staff pharmacist or medical director to determine if an override can be given. Call (716) or (800) and follow the prompts. 2. For non-medicare Part D prescriptions, you can dispense up to a 5-day supply of medication; however, you must follow-up with the Pharmacy Help Desk to obtain an override for the dispensed amount and to determine how to obtain coverage for the remaining amount. Independent Health will honor your decision for the 5-day supply, provided you have made your best effort to confirm that the patient is an active member (i.e., holds a valid Independent Health member ID card). If a claim rejects for eligibility reasons, you can ask the member to pay cash for part or all of the prescription and work out the eligibility issues with Independent Health s Member Services Department and/or the member s employer. If the member is later determined to be eligible, he or she can submit any receipts regarding that prescription to Independent Health for reimbursement. Mandatory electronic prescribing effective date extended to March 27, 2016 On March 13, 2015, Gov. Andrew M. Cuomo and the New York State Legislature amended the Public Health Law and the Education Law to extend the implementation date for mandatory electronic prescribing to March 27, Although this amendment extends the effective date of mandated e-prescribing, electronic prescribing of both controlled and non-controlled substances is CURRENTLY PERMISSIBLE in New York. Pharmacies should continue to register their certified pharmacy software applications with the Bureau of Narcotic Enforcement. Additional information pertaining to electronic prescribing may be accessed at the following links: 2

3 Opioid overdose deaths disproportionately higher in NYS Medicaid population SUMMER 2015 According to a recent Centers for Disease Control and Prevention (CDC) analysis of drug poisoning deaths in New York state, there was a 23 percent increase in opioid-related deaths between 2003 and Unlike the national trend of a more rapid increase in opioid analgesic-related deaths among women, the rate of increase is slightly higher in men in New York state. The highest rate of mortality from opioid poisoning occurred in white males, ages 45-64, who are non-new York City residents enrolled in Medicaid. Medicaid enrollee mortality from opioid poisoning has increased substantially faster than those not enrolled. From 2003 to 2012, rates in those enrolled in Medicaid increased fivefold while the non-medicaid enrolled counterparts had a fourfold increase in mortality due to opioid poisoning. Even when age and sex of Medicaid enrollees was accounted for, the difference was significant. The CDC cited articles which postulated increased rates of mental illness and substance abuse in the Medicaid population could factor in to the difference in rates. The CDC also concluded that a majority of deaths from opioid poisoning involve more than one drug. In 2012, 624 of 883 deaths (70.7 percent) involved at least one additional drug, most commonly benzodiazepines, cocaine and antidepressants. What providers can do to help curb the trend: Prescribers need to be vigilant of their prescribing and monitor the use of opioids in the populations that are mentioned above as early identification of abuse and addiction should be of the utmost importance. Special attention should be paid to patients with comorbid mental health issues, high-risk substance abuse screenings and concomitant high-risk drugs when prescribing opioids. Use the prescription registry and urine drug toxicity screening to check patient s medication history and compliance when prescribing opioids. Generally, benzodiazepines should be avoided in patients who are prescribed opioids; however, when necessary, communication between various specialists is crucial and agreements should be made between providers about who will prescribe specific medications. If addiction or abuse is suspected in one of your patient s, seek counsel from an addiction specialist and keep lines of communication open between all health care professionals involved in your patient s care, including the pharmacist. Updates to Healthy New York and NYS Exchange members erectile dysfunction benefit In November 2008, the Amendment to Regulation 62 (Chapter 645 of the Laws of 2005) was adopted to exclude from coverage under Healthy New York and standardized individual enrollee direct payment contracts any drugs, procedures and supplies for the treatment of erectile dysfunction when provided to, or used by, a person who is required to register as a sex offender pursuant to article 6-C of the Correction Law. Therefore, it is the responsibility of Independent Health to determine eligibility for its members to receive such coverage by utilizing a secured Internet portal operated and maintained by the NYS Department of Financial Services (DFS). As a reminder, Independent Health rejects all claims for any erectile dysfunction drugs for our Healthy New York and NYS Exchange members with rejection code 75, Prior Authorization Required. For these members only, you will also receive a secondary message: Please call the help desk for assistance, When you receive this rejection notice, it is important that you contact our help desk and ask one of our help desk representatives to check the NYS DFS Portal to determine if the member is on the sex offender registry. If the member is not on the registry, then our help desk representative will be able to override the prescription in accordance with the member s prescription drug formulary. Proper billing codes for MediSource members Independent Health s Pharmacy adjudication system is configured to apply appropriate copays based on the location code submitted by the pharmacy. Please ensure that you are billing the proper residence code when adjudicating a claim for an Independent Health MediSource member who resides in an adult care facility licensed by the State Department of Health, nursing home, or Intermediate Care Facility for the Developmentally Disabled (ICF/DD). For additional help with submitting patient residence codes, call Independent Health s Pharmacy Help Desk. independenthealth.com 3

4 Zolpidem (Ambien ) fact sheet Zolpidem (Ambien ) is only indicated for short-term treatment of insomnia with difficulty of sleep initiation. According to the American Geriatric Society (AGS) Beers Criteria, the Centers for Medicare and Medicaid Services (CMS) and the Pharmacy Quality Alliance, zolpidem is considered a high-risk medication for people ages 65 or older. Patients taking zolpidem are more than four times as likely to fall as those not taking zolpidem. 1 The number of zolpidem-related emergency room (ER) visits involving adverse reactions increased nearly 220 percent from 6,111 visits in 2005 to 19,487 visits in The side effects of zolpidem (e.g., cognitive impairment, delirium, unsteady gait, syncope, falls, fractures, motor vehicle accidents) can be increased when zolpidem is taken with other CNS depressants, including narcotics and benzodiazepines. Nearly 50 percent of zolpidem-related ER visits in 2010 involved other pharmaceuticals combined with zolpidem, including narcotic pain relievers and other anti-anxiety and insomnia medications. 2 Patients who take zolpidem within 8 hours of driving can be convicted of Driving Under the Influence (DUI) or Driving While Intoxicated (DUI/DWI), even if they do not cause an accident or have not had any alcohol. Zolpidem is proven to impair driving ability to a degree that increases the risk of motor vehicle accidents. 3,4,5 For patients with insomnia pharmacists are encouraged to: Make sure the underlying cause of the patient s insomnia is being treated. Co-morbid conditions that contribute to insomnia include chronic pain, depression, anxiety, CHF (paroxysmal nocturnal dyspnea and orthopnea), COPD (dyspnea), GERD (sudden nocturnal awakenings), and diabetes. Reinforce good sleep hygiene habits. Advise patients not to drink caffeine (coffee, tea, soda) after noon, be active and avoid naps during the day, and to avoid drinking fluids or eating large meals within 2 hours of bedtime. Make sure that zolpidem is prescribed at the lowest dose and for the shortest duration possible. Patients who have been using zolpidem regularly should follow a slow a gradual dose reduction when discontinuing use of the drug in order to reduce the likelihood that the patients insomnia persists or recurs. Eszopiclone (Lunesta ) and zaleplon (Sonata ) are generally not considered safer alternatives than zolpidem. Therefore, if continued medication therapy is necessary, recommend alternative options such as: o Low-dose trazodone. o Over-the-counter melatonin mg PO approximately 1 to 2 hours before bedtime (maximum daily dose is 6 mg). o A short acting benzodiazepine, such as lorazepam (maximum daily dose is 2 mg), for short-term treatment of insomnia due to anxiety or transient situational stress. References 1. FDA requires lower dosing of zolpidem. Med Lett Drugs Ther. 2013;55(1408):5. 2. From THE DAWN REPORT: Emergency Department Visits Attributed to Overmedication That Involved the Insomnia Medication Zolpidem. For more information, 3. Farkas RH, Unger EF, Temple R. Zolpidem and driving impairment - identifying persons at risk. N Engl J Med. 2013;369(8): Gunja N. In the zzz zone: the effects of z-drugs on human performance and driving. J Med Toxicol. 2013;9(2): Kuehn BM. FDA warning: driving may be impaired the morning following sleeping pill use. JAMA. 2013;309(7): Update to our Medicaid managed care plans Effective May 10, 2015, our pharmacy claims processing system was updated to reflect a maximum of a 30-day supply per fill for our MediSource and Child Health Plus (Medicaid) members. Prescriptions filled for more than a 30-day supply for our MediSource and Child Health Plus members will now reject at the point of service. If necessary, please contact the member s provider to obtain a new prescription for the medication and rebill with an updated days supply. 4

5 Formulary changes announced SUMMER 2015 Changes to the Independent Health drug formularies resulting from the March 2015 Independent Health Pharmacy and Therapeutics Committee meeting are summarized below and are currently in effect unless otherwise noted. The following medications were added to drug formularies I, II, and III: Cosentyx T3, PA, SP Duopa T3, PA (limited to neurology) Evotaz T3 Farydak T3, PA, SP Glyxambi T3, ST Ibrance T3, PA, SP Kitabis Pak T3, PA, QL, SP Lenvima T3, PA, SP Lynparza T3, PA, SP Namzaric T3, PA Natpara T3, PA, SP Prezcobix T3 Savaysa T3, PA Soolantra T3, PA except dermatology Synribo T3, PA (self-injection only) Viekira Pak T3, PA, SP The following new generic medications are available: desvenlafaxine (Pristiq) esomeprazole (Nexium) miglitol (Glyset) ritonavir (Norvir) The following medications were reviewed and will remain non-formulary for all Independent Health Drug formularies: Prestalia Rytary Xtoro The following changes will be made to the drug formularies effective July 1, 2015: Cambia Remove PA Celebrex Remove step therapy Cephalexin Tabs NF Flonase (fluticasone) NF ipratropium bromide/albuterol sulfate (generic Duoneb) Move to T1 modafanil (generic Provigil) Move to T1 Muti-Source Brand Diabetic Medications NF Oracea NF Prostaglandin Analogs Age restriction does not apply to ophthalmology Relpax NF Vyvanse PA new starts only Zegerid (omeprazole/sodium bicarbonate) NF Lemtrada PA Opdivo PA Rapivab PA Zerbaxa PA except infectious disease The following medications were reviewed and approved as a medical benefit: Blincyto PA Dyloject PA Lemtrada PA Opdivo PA Rapivab PA Zerbaxa PA except infectious disease Key: PA = Prior Authorization Required NF = Non-formulary ST = Step Therapy SP = Specialty Pharmacy Restriction QL = Quantity Limit T1 = First Tier T2 = Second Tier T3 = Third Tier Special DEA number needed for providers treating opioid dependency The Drug Addiction Treatment Act of 2000 (DATA 2000) permits qualified physicians to obtain a waiver through a certification process, which allows that practitioner to treat opioid dependence with medications specifically approved by the FDA for that indication. To date, buprenorphine containing products are the only FDA-approved products for the treatment of opioid dependence. After providers obtain a waiver, a special DEA number that begins with an X is assigned to the physician who intends to practice in this field. This DEA number is required by law to appear on all prescriptions intended for the treatment of opioid dependence. Independent Health also requires the special DEA number to appear on all prescriptions in order to be a valid prescription claim. It is the duty of the provider to obtain this certification prior to providing treatment of opioid dependence. If the prescriber is not certified and does not individually hold a special DEA number intended for use in this treatment, he/she shall not prescribe any medications intended for treatment of addiction. If the practitioner does not have a special DEA number and wishes to obtain one, please refer to the DATA 2000 for guidance on becoming a certified practitioner. independenthealth.com 5

6 Recent FDA MedWatch updates on safety and efficacy issues The following represents recent alerts or changes made to the package labeling of drugs, where patient safety or efficacy are the primary concern: Testosterone Products: Drug Safety Communication The FDA Cautions About Using Testosterone Products for Low Testosterone Due to Aging; Requires Labeling Change to Inform of Possible Increased Risk of Heart Attack And Stroke The FDA is requiring that the manufacturers of all approved prescription testosterone products change their labeling to clarify that prescription testosterone products are approved only for men who have low testosterone levels caused by certain medical conditions. The benefit and safety of these medications have not been established for the treatment of low testosterone levels due to aging, even if a man s symptoms seem related to low testosterone. The FDA is also requiring manufacturers to update the labeling to include a possible increased risk of heart attacks and strokes in patients taking testosterone. Chantix (varenicline): Drug Safety Communication FDA Updates Label to Include Potential Alcohol Interaction The FDA has approved changes to the Chantix label to warn about interactions between alcohol and Chantix resulting in some patients experiencing increased intoxicating effects of alcohol, sometimes associated with aggressive behavior and/or amnesia. In addition, rare accounts of seizures in patients treated with Chantix have been reported. Treanda (bendamustine hydrochloride) Solution by Teva: FDA Statement Not Compatible with Closed System Transfer Devices, Adapters, and Syringes Containing Polycarbonate or Acrylonitrile-Butadiene-Styrene The FDA is warning health care professionals not to use Treanda Injection (45 mg/0.5 ml or 180 mg/2 ml solution) with closed system transfer devices (CSTD), adapters, and syringes containing polycarbonate or acrylonitrile-butadiene-styrene (ABS). Most marketed CSTDs contain either polycarbonate or ABS and are not compatible with Treanda Injection (45 mg/0.5 ml or 180 mg/2 ml solution). N, N-dimethylacetamide (DMA), an ingredient in Treanda Injection (45 mg/0.5 ml or 180 mg/2 ml solution), is incompatible with polycarbonate or ABS. Devices that contain polycarbonate or ABS dissolve when coming into contact with DMA. This can lead to device failure, possible product contamination, and potential serious adverse health consequences, including skin reactions in health care professionals preparing and administering this product and the risk of small blood vessel blockage in patients. The FDA is requiring label changes for both the solution and the powder formulations of Treanda to reflect safe preparation information. Over-the-Counter Asthma Products Labeled as Homeopathic: FDA Statement Consumer Warning About Potential Health Risks The FDA is warning consumers not to rely on asthma products labeled as homeopathic that are sold over-the-counter (OTC). These products have not been evaluated by the FDA for safety and effectiveness. Many of these products are promoted as natural, safe and effective, and include indications that range from treatment for acute asthma symptoms, to temporary relief of minor asthma symptoms. In general, consumers can identify such products by looking for the word HOMEOPATHIC or HOMŒOPATHIC on a product s label and looking for whether the product s active ingredient(s) are listed in terms of dilution (e.g., LM1 6X or 30C ). There are many prescription asthma treatments approved by the FDA as safe and effective, as well as some products that are marketed OTC in accordance with an FDA monograph. Please advise consumers who think they have asthma or have children with asthma to take an active role in managing their condition by making certain they have appropriate treatments on hand in the event they experience an asthma attack or a worsening of asthma symptoms, and by consulting with a health care provider when needed. Zyprexa Relprevv (olanzapine pamoate): Drug Safety Communication FDA Review of Study Sheds Light on Two Deaths Associated with the Injectable Schizophrenia Drug The FDA has concluded its review to determine the cause of elevated levels of the injectable schizophrenia drug Zyprexa Relprevv (olanzapine pamoate) in two patients who died. On the basis of all of the information reviewed (refer to the Drug Safety Communication for a full data summary), the FDA is not recommending any changes to the current prescribing or use of Zyprexa Relprevv injection at this time. Patients should not stop receiving treatment without first talking to their health care professionals. Hepatitis C Treatments Containing Sofosbuvir in Combination With Another Direct Acting Antiviral Drug: Drug Safety Communication Serious Slowing of Heart Rate When Used With Antiarrhythmic Drug Amiodarone The FDA is warning that symptomatic bradycardia can occur when amiodarone is taken together with either Harvoni (ledipasvir/ sofosbuvir) or with Sovaldi (sofosbuvir) taken in combination with another direct acting antiviral such as the investigational drug, daclatasvir or Olysio. The FDA is adding this information to the Harvoni and Sovaldi labels and recommending that health care professionals should not prescribe this combination of medications. In cases where alternative treatment options are unavailable, the FDA recommends heart monitoring in an inpatient hospital setting for the first 48 hours. Subsequently, monitoring in a doctor s office or self-monitoring of the heart rate should be done every day through at least the first 2 weeks of treatment. Due to the long half-life of amiodarone, patients discontinuing amiodarone just prior to starting Harvoni, or Sovaldi in combination with another direct-acting antiviral should also undergo similar cardiac monitoring as outlined above. 6

7 SUMMER 2015 Feraheme (ferumoxytol): Drug Safety Communication Warnings Strengthened and Prescribing Instructions Changed All IV iron products carry a risk of potentially life-threatening allergic reactions. Since Feraheme s approval in 2009, serious reactions, including deaths, have occurred despite the proper use of therapies to treat these reactions and emergency resuscitation measures. The FDA evaluated this risk further and has identified ways to reduce the risk of serious allergic reactions with Feraheme: Only administer IV iron products to patients who require IV iron therapy. o Do not administer Feraheme to patients with a history of allergic reaction to Feraheme or other IV iron products. o Only administer diluted Feraheme as an IV infusion over a minimum of 15 minutes. Feraheme should not be given as an undiluted IV injection. o Closely monitor patients for signs and symptoms of serious allergic reactions, including monitoring blood pressure and pulse during Feraheme administration and for at least 30 minutes following each infusion. o Carefully consider the potential risks and benefits of Feraheme administration in elderly patients with multiple or serious medical conditions, as these patients may experience more severe reactions. o Carefully consider the potential risks and benefits of Feraheme administration in patients with a history of multiple drug allergies. Patients with multiple drug allergies may also be at higher risk. Flurbiprofen-Containing Topical Pain Medications: FDA Alert Illnesses and Deaths in Pets Exposed to Prescription Topical Pain Medication The FDA recommends that people who use topical medications containing flurbiprofen take care to prevent their pets from being exposed to them, even in ways that may seem unlikely to cause problems. Health care providers who prescribe topical pain medications containing flurbiprofen, and pharmacists who fill these prescriptions, should advise patients with pets to take care to prevent exposure of the pet to the medication. SGLT2 inhibitors: Drug Safety Communication FDA Warns Medicines May Result in Ketoacidosis The FDA is investigating whether the SGLT2 inhibitors, canagliflozin, dapagliflozin, and empagliflozin may lead to diabetic ketoacidosis (DKA). DKA is a subset of ketoacidosis in diabetic patients that usually develops when insulin levels are too low or during prolonged fasting. DKA most commonly occurs in patients with type 1 diabetes and is usually accompanied by high blood sugar levels. These cases were not typical for DKA because the patients had type 2 diabetes and their blood sugar levels were only slightly increased. Factors identified in some reports as having potentially triggered the ketoacidosis included major illness, reduced food and fluid intake, and reduced insulin dose. Patients should be advised to pay close attention for any signs of ketoacidosis and seek medical attention immediately if they experience symptoms such as difficulty breathing, nausea, vomiting, abdominal pain, confusion, and unusual fatigue or sleepiness. Patients should not stop or change their diabetes medicines without first talking to their prescriber. Health care professionals should evaluate for the presence of acidosis, including ketoacidosis, in patients experiencing these signs or symptoms; discontinue SGLT2 inhibitors if acidosis is confirmed; and take appropriate measures to correct the acidosis and monitor sugar levels. Script does not publish all FDA alerts. For a complete summary of all alerts, please visit the FDA website at Health care professionals are encouraged to report adverse events, product problems and errors to MedWatch by calling FDA Medicare Part D Reminder: Compound Clarification Code National Council for Prescription Drug Programs (NCPDP) implementation guide states that a claim submitted with a clarification code of 8 on a multiple ingredient compound should result in the individual failed ingredients to be set to rejected but the claim should continue to be payable. For Medicare Part D claims only, if the submitted Clarification Code is 8, then the claim processes each ingredient, determining if it is payable or rejected. At the end of processing, all of the payable ingredients are priced. The rejected ingredients do not go through pricing and their status is set to reject with their applicable rejection code. After pricing the payable ingredients, the claim is set as a payable claim and the response is sent. If all of the ingredients are in a rejected state, then the claim will reject. Currently, if one or more ingredients in a multi-ingredient compound rejects, the whole claim rejects. If you receive a rejection for a multiple ingredient compound, you should either: Contact the prescriber to switch the non-covered ingredient to a covered ingredient; or For Medicare Part D claims only, resubmit the claim with the Clarification Code 8 in NCPDP Field 420-DK to accept non-payment for the non-covered ingredient(s). Please Note: Independent Health allows Clarification Code 8 for Medicare Part D claims only. Do not use Clarification Code 8 for our other lines of business. independenthealth.com 7

8 511 Farber Lakes Drive, Buffalo, New York PRSRT STD U.S. POSTAGE PAID PERMIT NO. 757 BUFFALO, NY update P H A R M A C Y P O L I C I E S All of Independent Health s policies and clinical practice guidelines are available on our website. To access these policies and guidelines: 1. Log in to the Independent Health Providers website at independenthealth.com/providers using partners as both the username and password. 2. Click on Policies. 3. Click on the Pharmacy Department AdministrativePolicies & Drug Specific Policies link. The following drug-specific policies are new (effective 7/1/15): Afrezza Keytruda Aveed Movantik Esbriet Ofev HyQvia Trulicity The following existing administrative policy has been reviewed and revised (effective 7/1/15): Drug Formulary Use Maintenance Drug Spec Pharm Any Willing Provider The following policy is being archived: Bexxaar Fourth Gen Quinolones Proton Pump Inhibitor The following drug-specific policies have been reviewed and revised (effective 7/1/15): Abilify Blood Glucose Meters Bosulif Cimzia Diabetes Supply Epaned Imbruvica Jakafi Kalydeco Migraine Oral Antiemetics Promacta Revatio Testosterone Implantable Testosterone Intramuscular Testosterone Oral Testosterone Topical Tysabri Velcade Vfend Xtandi Zyflo The following existing administrative policies have been reviewed without any changes made: Inter-Rater Reliability MD Inter-Rater Reliability RPh Mandatory Generic Copay Differential Oncology med management P&T Committee Integrity Potential Fraud and Abuse Retail Maintenance Med Improperly Filed Pre-service Claim Form Mandatory Generic Policy The following drug-specific policies have been reviewed without any changes made: Actemra Mirvaso Gel Adcirca Mycamine Adempas Nplate Azasite Onychomycosis Bethkis Opsumit Ciprodex Oral Contraceptives Clomiphene for Medical Reasons Daliresp Orencia Direct Renin Inhib Otrexup Duexis Provigil EGFR inhibitor Remicade Exjade Restasis Ferriprox Sancuso Patch Granix Stivarga Hectorol Tracleer Increlex Trokendi XR Infergen TZD Krystexxa Ultracet LABA Valchlor Gel Lamisil Xalkori Letairis Zevalin Lovenox Zolinza maprotiline