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1 SPRING 2013 VOLUME 6 ISSUE 2 A PUBLICATION TO SUPPORT OUR NETWORK OF PHARMACY PROFESSIONALS Independent Health to unveil new claims system Independent Health will begin implementing a new core administrative system in July 2013, which will include a new claims system called HealthRules. A careful, methodical implementation process is in place to ensure a smooth transition to minimize the impact to our external customers and to maintain our award-winning customer service and satisfaction. The implementation timeline is as follows: July 2013: The pilot phase will be implemented, involving approximately 3,000 Independent Health members enrolled into the new core administrative system. Those members include employees of Independent Health, Independent Health Foundation, Reliance Rx and Nova Healthcare Administrators, Inc. January 2014: We will begin full implementation when we will start to transition the remainder of our members into the new system. New Member ID Numbers As a result of the transition to the new claims system, member ID numbers will change, beginning in late June. The new member ID numbers for the pilot phase are all numeric and have 11 numbers, instead of the alphanumeric that most of our members have now. Although we will be reminding our members to always show their ID cards for all services, including prescription fills, we encourage our pharmacies to get into the habit of asking our members if they have new ID cards with new numbers. We will keep our participating pharmacies up-to-date on what you need to know about this new system. Important Medicaid update regarding foster children As part of the changes to the New York State Medicaid program, Independent Health and other Medicaid-managed care insurers took over the administration of the pharmacy benefits for people who received New York State Medicaid benefits in October Typically, children in foster care have had limited participation in managed care. However, New York State recently began moving the foster care children population into managed care. Enrollment of foster care children is phased in at the county level. The county, in consultation with the children s medical consenter, selects the best managed care organization (MCO) for the child. For children currently in foster care, local districts have between two and six months to select an MCO and complete the enrollment. When foster care children are enrolled into MediSource (our MCO) they receive a MediSource ID card and will be following our MediSource managed care drug formulary. Please note: During the first 90 days of coverage, foster care children newly enrolled in this program will be entitled to a one-time override for one 30-day supply of medications they are currently taking that is not covered on the MediSource formulary, requires prior authorization or has other formulary restrictions. The dispensing pharmacist will need to contact our pharmacy help desk for this override. After this one-time override, the doctor will need to submit a prior authorization for additional fills. FEATURED A R T I C L E S HMS TO CONDUCT 2 ON-SITE AUDITS As a reminder, Independent Health has retained Health Management Systems, Inc. (HMS) to conduct on-site and retrospective desktop pharmacy audits. This program is designed to help us ensure that our participating pharmacies are compliant with program policies and regulations, and will allow us to identify billing/data entry errors. OVERRIDING NARCOTIC 3 DUPLICATION RESTRICTION In an effort to reduce and/or avoid narcotic overutilization, Independent Health s Pharmacy Help Desk staff will be asking additional questions before overriding any narcotic duplication restriction. This restriction is intended to prevent early refills as well as duplicate therapies. A prescription claim will now reject if it is for a narcotic medication and at least 25 percent of the first prescription remains. BEERS LIST IS A 5 VALUABLE TOOL The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly called the Beers List, is intended for use by pharmacists and prescribers to improve the care of patients age 65 years and older. The list, which was updated in 2012, lists drugs that have risks that tend to outweigh the benefits, and safer alternatives. 5 Cialis Reminder 6 Formulary changes 7 FDA MedWatch 8 Policies independenthealth.com

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. Accessible in the Providers section under Publications for Providers. Script is published quarterly for Independent Health s network of pharmacy professionals Director of Pharmacy: Martin Burruano Editors of Script: Cheryl Paul, Keith Page Health Management Systems to conduct audits As a reminder, Independent Health has retained Health Management Systems, Inc. (HMS) to conduct on-site and retrospective desktop pharmacy audits. This program is designed to help us ensure that our participating pharmacies are compliant with program policies and regulations, and will allow us to identify billing/data entry errors. If your pharmacy is selected for a desktop audit, you will be notified via fax by HMS and requested to provide copies of specific prescriptions and/or other substantiating documentation. Upon receipt, HMS will review the documentation against program policies and state/federal regulations. Your pharmacy will be notified of the initial results via fax. If your pharmacy is selected for an on-site audit, you will be notified via fax or phone by HMS of the audit date and time. You will be required to retrieve prescriptions during the course of the audit. Prescriptions will be reviewed against program policies and state/federal regulations. Your pharmacy will be notified of the initial results via fax. You will have the opportunity to appeal the initial results by providing additional supporting documentation of which HMS will perform a subsequent review. Your pharmacy will be notified via fax of the final results. Final results will be reported to Independent Health. If you have any questions about these audits, please contact Cheryl Paul, Assistant Director of Pharmacy Operations at Independent Health, at (716) What to do when you get a rejection and the help desk is closed Our claim processing statistics indicate that our help desk is currently open when approximately 95 percent of Independent Health prescriptions are filled. The normal hours of operation for our help desk are Monday through Friday from 8 a.m. to 11 p.m. and Saturday and Sunday from 8 a.m. to 8 p.m. Unfortunately, there will be some rejects occurring for medically necessary drugs when our help desk is not open. Here s what to do when 1. A claim rejects because the drug is non-formulary, requires prior authorization, and 2. The prescription is urgent, and the patient cannot reasonably wait until the next time the help desk is open to obtain and begin taking the medication, and 3. You are confident of the member s eligibility with Independent Health. A. You can dispense up to a five-day supply of medication to Independent Health members with prescription coverage. You will need to call the next time the help desk is open 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 five-day supply, provided you have made your best effort to confirm that the member is an active member (i.e., holding a valid Independent Health identification card). OR B. You can call our 24-Hour Medical Help Line at (716) or , and press two. A nurse is available 24 hours a day/7 days a week and will be able to page a staff pharmacist or medical director to determine if an override can be given. While you re posting phone numbers by your phone, our 24-Hour Medical Help Line number is a good one to add. If a claim rejects for eligibility reasons, your best option is to have the member pay cash for part or all of the prescription and work out the eligibility issues with our Member Services Department and/or their employer. If they are later determined to have been eligible they will be able to submit their receipts for reimbursement. 2

3 New process for overriding narcotic duplication restriction In an effort to reduce and/or avoid narcotic overutilization, Independent Health s Pharmacy Help Desk staff will now be asking additional questions before overriding any narcotic duplication restriction. This restriction is intended to prevent early refills as well as duplicate therapies. Specifically, a prescription claim will reject if it is for a narcotic medication and, according to the day supply of a previous fill of a narcotic medication, at least 25 percent of the first prescription should remain. We realize that there will be situations where the use of two concurrent narcotic medications is appropriate. We also understand that there is some degree of urgency associated with the use of pain medications. Therefore, we will allow an override of this restriction based on the pharmacist s or physician s judgment. In many cases, two different narcotic medications are prescribed by two different physicians, and/or filled at two different pharmacies. By placing a restriction on these medications, we will help draw your attention to this issue. It will then be up to you, the pharmacist, to determine if the prescription is medically appropriate. This may require that you contact the prescribing physician. If you determine that the prescription is medically appropriate, simply call the Independent Health Pharmacy Help Desk for an override. At that time, you will be asked to provide your rationale for determining SPRING 2013 the appropriateness; here are a few examples of how you can answer this question: The physician was contacted and aware of duplication (you will need to provide our help desk staff with the date and time you contacted the physician), The combination of products is necessary to control patient s pain (you will be asked your rationale so our help desk staff can document the reason) The patient was unable to tolerate the first medication and has changed to this new medication (you will need to provide our help desk staff with the date that the medication was discontinued). In the event a claim rejects for narcotic duplication at a time when our help desk is closed, and you are able to determine that the script is medically appropriate and urgent, you may give out a quantity sufficient to last the patient until our help desk reopens. Once the help desk is open, please call and we will enter the necessary override to pay for at least that short-term supply. If you have any questions regarding this process, 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. The Buffalo Museum of Science presents BODY WORLDS Vital BODY WORLDS Vital sponsored by Independent Health - is the latest chapter in the series of BODY WORLDS Human Saga exhibitions. Opening May 31 for a limited engagement, BODY WORLDS Vital presents a special collection of specimens designed to show visitors the essentials for human health and wellness. The Exhibition includes whole-body plastinates, a large arrangement of individual organs, organ and arterial configurations and translucent slices that give a complete picture of how the human body works. BODY WORLDS Vital tells the fascinating story how to best fight, manage and prevent life-threatening diseases -- such as cancer, diabetes, and heart ailments -- through healthy choices and lifestyle changes. Dr. Gunther von Hagens BODY WORLDS exhibitions display authentic human bodies, willed by donors and preserved through plastination. The series is designed to educate the public about the human body and increase health awareness. Learn more at Show your Independent Health member ID card at the Buffalo Museum of Science Box Office to receive a $2 discount on regular exhibit admission. After visiting BODY WORLDS Vital, be sure to check out all the new experiences the museum has to offer, including Explore YOU presented by Independent Health, the first of eight new themed studios the museum will develop as part of an overall renovation and evolution of visitor experience at the Buffalo Museum of Science. In the Explore YOU studio, visitors can explore the human anatomy and learn about important choices they can make to improve and maintain their health. Interactive exhibits provide a hands on approach to health and explore the most recent advances in medical technology. Explore You is part our commitment to create a culture of health in Western New York through programs and opportunities - with community partners - that provide avenues for people to become more engaged in their health. independenthealth.com 3

4 H E L P F U L M E D I C A R E P A R T D I N F O R M A T I O N Beer s List is a valuable tool in ensuring patient safety By Christina Carbone, Pharm D Candidate 2013, and Natalie Edbauer, Pharm D Candidate 2013 Independent Health participates in the UB School of Pharmacy and Pharmaceutical Sciences Professional Experience Program (PEP) and internship programs to provide PharmD students an opportunity to experience managed care pharmacy practice. As students rotate through our site, we periodically ask them to create an article for our pharmacy newsletter, Script. The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly called the Beers List, is intended for use by pharmacists and prescribers to improve the care of patients age 65 years and older. The criteria, which was recently updated in 2012, lists drugs that have risks that tend to outweigh the benefits, and safer alternatives are available. Due to age related physiologic changes, such as decrease renal function and reduced muscle mass, this population is at higher risk of experiencing adverse effects. Around half of hospitalizations in the elderly are due to adverse drug events, many of which can be prevented with your help. As a pharmacist, you have a key role in ensuring the safety of your patients by reviewing the appropriateness of each prescription you fill. It is important that patients are aware of the potentially dangerous side effects that they may experience if they take these medications. Counseling patients prior to dispensing these medications will help to educate patients and allow for an intervention to be made. Below is a list of commonly seen high-risk medications with safer alternatives. Recommending these safer alternatives to prescribers can help to reduce negative patient outcomes. Medication Safety Concern Recommended interventions and safer alternatives Glyburide (Diabeta, Glynase) Prolonged hypoglycemia Change to alternative sulfonylurea: glimepiride (Amaryl) or glipizide (Glucotrol) Please note: one dose conversion when switching a patient from glyburide to glipizide. Avoid Glucotrol XL due to hypoglycemia risk Zolpidem (Ambien) Eszopiclone (Lunesta) Zaleplon (Sonata) Digoxin (Lanoxin) (doses >0.125mg/day in heart failure) Tricyclic antidepressants (amitriptyline, clomipramine, doxepin >6mg/day, imipramine) Estrogen (oral, transdermal) with or without progestin (e.g., Premarin) Muscle relaxants: cyclobenzaprine (Flexaril) carisoprodol (Soma) chlorzoxazone methocarbamol (Robaxin) metaxalone (Skelaxin) orphenadrine (Norflex) Hydroxyzine (Atarax) Minimal benefit with increased risk of cognitive impairment, delirium, unsteady gait, syncope, falls, motor vehicle accidents and fractures No additional efficacy seen with higher doses with added toxicity due to reduced renal clearance Dangerous anticholinergic effects (confusion, dry mouth, constipation), cognitiveimpairment, delirium, sedation, orthostatic hypotension Increased risk of breast cancer and endometrial cancer, worsening of incontinence; lack of cardio and cognitive protection Dangerous anticholinergic effects (confusion, dry mouth, constipation, urinary retention), cognitive impairment, delirium, clearance reduced in elderly Change to alternative therapy: low-dose trazodone, low-dose doxepin or ramelteon OR use lowest effective dose possible due to hypoglycemia risk Dose reduction, with monitoring of renal function (SrCr) Change to alternative tricyclic: nortriptyline, desipramine, low-dose doxepin, trazodone Alternatives for treatment of hot flashes: non-drug therapy, SSRIs, gabapentin, venlafaxine Alternatives for bone density treatment: calcium, vitamin D, bisphosphonates, raloxifene (Evista) Treatment of vaginal symptoms and recurrent UTI: vaginal estrogen cream Change to alternative therapy: treat underlying problem with non-pharmacologic treatment physiotherapy, heat or cold application; correct seating and footwear For spasticity: antispasmodics like baclofen, nerve blocks Consider an alternative antihistamine: cetirizine (Zyrtec), fexofenadine (Allegra), loratadine (Claritin), desloratadine (Clarinex), levocetirizine (Xyzal) 4

5 Just the facts: Lovaza/Vascepa vs. OTC Fish Oil Products By Natalie Edbauer, Pharm D Candidate 2013 SPRING 2013 Independent Health participates in the UB School of Pharmacy and Pharmaceutical Sciences Professional Experience Program (PEP) and internship programs to provide PharmD students an opportunity to experience managed care pharmacy practice. As students rotate through our site, we periodically ask them to create an article for our pharmacy newsletter, Script. A new omega-3 product has been approved by the U.S. Food and Drug Administration (FDA) named Vascepa. The products are currently available as both prescription and over-the-counter medications. Efficacy of these products (omega-3 s) has come into question for long-term cardiovascular outcomes. Therefore, the following is some helpful information that may be used in counseling or recommending these products to your patients: Omega-3 fatty acids include the long chain entities of Eicosapentaenoic acid (EPA) and docasahexaenoic acid (DHA). Lovaza contains 375 mg DHA and 465 mg EPA for a total of 840mg omega-3 fatty acids. Vascepa contains only EPA, a total of about 1G of omega-3 s per capsule. Most OTC 1000mg fish oil supplements contain mg of EPA and DHA (omega-3 s) and dosing recommendations are usually based on the grams of omega-3 s, not the fish oil mg concentrate (e.g., Nature Made 1200mg Fish Oil (OTC) has 360mg of omega-3 s in each capsule vs. 840mg omega-3 s per 1 Lovaza capsule). Omega-3 fatty acids and alpha-linolenic acid can be found in fish, soy, canola oil, flaxseed and English walnuts. American Heart Association recommends: o General population 500mg/day of combined EPA and DHA o Coronary heart disease 1g/day of omega-3 fatty acids (EPA and DHA) o High triglycerides 2-4g/day of omega-3 fatty acids (EPA and DHA) References: 1. Choosing a Fish Oil Product. Pharmacist s Letter/Prescriber s Letter 2008; 24: Omega-3 fatty acids: an update. Updated November Pharmacist s Letter/Prescriber s Letter 2007; 23(8): Non-Statin Lipid-Lowering Agents. Pharmacist s Letter/Prescriber s Letter. January 2013: Reminder: ICD-9 diagnosis codes required for certain Cialis claims As of January 1, 2013, Medicare now provides coverage of Cialis 2.5 mg and 5mg under Part D when used for the treatment of benign prostatic hyperplasia (BPH). In order to process these claims appropriately,independent Health now requires the dispensing pharmacy to include the ICD-9 diagnosis code on all Cialis 2.5 mg and 5mg claims. The ICD-9 diagnosis code can be populated in NCPDP field 424-DO. For the purpose of adjudication, only the following ICD-9 codes listed are currently being accepted: Benign Prostatic Hyperplasia (BPH) or Erectile Dysfunction (ED) or EPA alone doesn t increase LDL like EPA/DHA combos can, but it may be a little less effective for lowering triglycerides (TGs). Newest data shows Vascepa 4 g/d lowers TGs about 27 percent compared to baseline in patients with very high triglycerides. Lovaza 4 g/d lowers TGs about 45 percent; however, LDL can increase by 45 percent. This increased LDL particle is suggested to be different -larger, more buoyant and less athlerogenic ( fluffy LDL ). For OTC s, look for a product that is USP Verified Mark, which means it usually contains lower amounts of mercury and other heavy metals than a non-verified OTC version. Although controversial, it is thought that omega-3 s decrease risk of coronary heart disease, reduce total stroke risk, slow atherosclerotic progression, and decrease in overall mortality by 23 percent and cardiovascular mortality by 32 percent. They are also known to decrease heart rate, reduce inflammation, reduce thrombosis, and inhibit atherosclerosis. More recently, a meta-analysis of secondary prevention studies found no benefit of omega-3 fatty acids on cardiovascular events, mortality, sudden death, myocardial infarction, angina, heart failure, or stroke. As opposed to previous analyses, this analysis excluded open-label design studies. Use of cardioprotective agents (e.g., statins, antiplatelets, antihypertensives) in the newer, included studies may have reduced the impact of omega-3 fatty acids on heart health. Please note: Claims submitted without a valid ICD-9 code(s) will reject. If you have any questions about any of these important reminders, please contact 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. independenthealth.com 5

6 SPRING 2013 Latest formulary changes made by P&T Committee Changes to the commercial formulary resulting from the March 2013 Individual Practice Association of Western New York Pharmacy and Therapeutics (P&T) Committee are summarized below and are currently in effect unless otherwise noted. CATEGORY DRUG ACTION COMMENTS Chapter 20 Stomach/Intestinal Anti-Hepatitis Agents Cystaran Addition - Tier 2 Prior authorization applies Ilevro Addition - Tier 2 Prior authorization applies, except ophthalmology; maximum two fills per year Ophthalmic Corticosteroids Lotemax gel Addition - Tier 2 QL applies Chapter 20 Stomach/Intestinal GI Drugs Delzicol Addition Tier 2 Chapter 22 Womens Health Estrogen-Related Products Minivelle Addition Tier 2 Chapter 1 Allergy/ Cough and Cold Allergy Drugs Auvi-Q Addition - Tier 2 QL applies The following changes in restrictions were made: Caprelsa Add limited to medical and hematology prescribers in PA Gleevec Add limited to medical and hematology prescribers in PA Benzaclin/Benzaclin pump Add ST Methylphenidate ER cap Add to Tier 1 from Tier 3 Cefdinir Add to Tier 1 from Tier 3 ODT atypicals Remove maintenance status ondansetron 4mg, 8mg Remove QL for oncology The following new generics have been added to the commercial formulary: methylphenidate CD Metadate CD quinine sulfate Qualaquin griseofulvin Gris-Peg clindamycin granules Cleocin Ped methylphenidate ER Concerta betamethasone Luxiq glimepiride/pioglitazone Duetact abacavir Ziagen The following medications will remain non-preferred on the commercial formulary at this time: Gattex Tier 3, PA, SP Cometriq Tier 3, PA limited to oncology and medical hematology prescribers, SP Eliquis Tier 3 Fulyzaq Tier 3, PA except Infectious Disease Sirturo Tier 3, PA except Infectious Disease Juxtapid Tier 3, PA, SP Iclusig Tier 3, PA limited to oncology and medical hematology prescribers, SP Adasuve Restrict to institutional use Nesina Tier 3 Oseni Tier 3 Kazano Tier 3 Pomalyst Tier 3, PA limited to oncology and medical hematology prescribers, SP Uceris Tier 3, PA Signifor Tier 3, PA V-Go Cover as medical benefit Zecuity Tier 3, QL, ST Onmel Non-formulary Oxtellar XR Tier 3, ST Giazo Tier 3, male restriction For updated versions of our drug formularies, please visit 6

7 Recent FDA MedWatch updates on safety and efficacy issues The following are recent U.S. Food and Drug Administration (FDA) alerts or changes that were made to the package labeling of drugs, based on concerns for patient safety or efficacy: Zolpidem Containing Products: Drug Safety Communication The FDA Requires Lower Recommended Doses for Ambien, Ambien CR, Edluar, and Zolpimist: The FDA is recommending lower bedtime doses because new data shows that blood levels in some patients may be high enough to impair activities that require alertness the morning after use. The recommended dose of zolpidem for women should be lowered from 10 mg to 5 mg for immediate-release products (e.g. Ambien, Edluar, and Zolpimist) and from 12.5 mg to 6.25 mg for extended-release products (e.g., Ambien CR). The recommended doses of Intermezzo are not changing. At the time of Intermezzo s approval in November 2011, the label already recommended a lower dosage for women than for men. Samsca (tolvaptan): Drug Warning - Potential Risk of Liver Injury: Healthcare providers should perform liver tests promptly in patients who report symptoms that may indicate liver injury. In its open-label extension trial, several patients developed significant increases in alanine aminotransferase and total bilirubin. In the trials, the maximum daily dose of Samsca administered (90 mg in the morning and 30 mg in the afternoon) was higher than the maximum 60 mg daily dose approved for the treatment of hyponatremia. Most of the liver enzyme abnormalities were observed within the first 18 months of therapy. Following discontinuation of treatment all 3 patients improved. Azithromycin (Zithromax or Zmax): Drug Safety Communication - Risk of Potentially Fatal Heart Rhythms: Patients at particular risk for developing potentially fatal arrhythmias with azithromycin include those with known risk factors such as existing QT interval prolongation, low blood levels of potassium or magnesium, a slower than normal heart rate, or use of certain drugs used to treat arrhythmias. Azithromycin may have been chosen in the past as a safer macrolide alternative in patients at risk for arrhythmias but that may not be the case. Keep in mind that other macrolides and non-macrolides such as levofloxacin also have the potential for QT prolongation when choosing an antibacterial drug. Incretin Mimetic Drugs for Type 2 Diabetes: Early Communication - Reports of Possible Increased Risk of Pancreatitis and Pre-cancerous Findings of the Pancreas: Exenatide (Byetta, Bydureon), liraglutide (Victoza), sitagliptin (Januvia, Janumet, Janumet XR, Juvisync), saxagliptin (Onglyza, Kombiglyze XR), alogliptin (Nesina, Kazano, Oseni), and linagliptin (Tradjenta, Jentadueto): The FDA is evaluating unpublished new findings that suggest an increased risk of pancreatitis and pre-cancerous cellular changes called pancreatic duct metaplasia in patients with type 2 diabetes treated with incretin mimetics. These findings were based on examination of a small number of pancreatic tissue specimens taken from patients after they died from unspecified causes. The FDA continues to investigate the potential pancreatic toxicity associated with the incretin mimetics. Codeine Use in Certain Children After Tonsillectomy and/or Adenoidectomy: Drug Safety Communication Risk of Rare, But Life-Threatening Adverse Events or Death: Some children have a genetic ability to convert codeine into life-threatening or fatal amounts of morphine in the body. All children were 2-5 years old who experienced these adverse events and had received doses of codeine that were within the typical dose range. Over-The-Counter Topical Muscle and Joint Pain Relievers: Drug Safety Communication Rare Cases of Serious Burns: Consumers using an OTC topical muscle and joint pain reliever containing menthol, methyl salicylate, or capsaicin, who experience signs of skin injury where the product was applied, such as pain, swelling, or blistering of the skin, should stop using the product and seek medical attention immediately. When recommending OTC topical muscle and joint pain relievers to patients, healthcare professionals should counsel patients about how to use the products appropriately and inform them about the risk of serious burns. For a complete summary of all alerts, please visit the FDA website at Make sure prescriptions are filled under the correct physician name Independent Health provides our physician network with periodic reports on prescribing practices. Several times a year we send these reports to physicians, including primary care physicians as well as specialists. These reports are pulled from pharmacy claims using the prescribing physician s NPI number. Physicians will often contact Independent Health if a name appears on their report that is not associated with his or her practice. Although we recognize that some physicians may have names that look or sound alike, it is easy to use an incorrect physician identifier when filling prescriptions. However, New York State requires that labels and records reflect the correct prescribing physician. In addition, an error of this type may impact a patient s health in an emergency, a physician s risk arrangement, and provide Independent Health with incorrect patient history information. If a claim is filled under the incorrect physician, it may be considered invalid and the pharmacy will be asked to reverse and reprocess the claims under the correct physician identifier. This can be a time consuming process and can be avoided by using the correct physician name and identifier each time a prescription is filled. Please take the time to ensure that the prescription you are selecting the correct physician and that your files contain the correct identifiers when processing claims for patients. 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 guidelines: 1. Log in to the Providers page on the home page of our website at independenthealth.com using partners as both the user name and password. 2. Go to the box entitled Reference and Policies 3. Click on the Pharmacy Policies link If you have any questions, please call the Provider Relations Department at (716) or , Monday through Friday from 8 a.m. to 6 p.m. The following drug specific policies have been reviewed without any changes made: Azasite Bexxar Blood Glucose Meters Ciprodex Daliresp EGFR Enteral Formula Ilaris Increlex LABA Makena Maprotiline Modified solid food products Noxafil Nplate Oral antiemetics Oral contraceptives for medical reasons Restasis Sedative Hypnotics Tysabri The following drug specific policies have been reviewed and revised: Actemra Adcirca Clomiphene Direct Renin Inhib Duexis Exjade Ferriprox Fourth Generation Quinolone Hectorol Infergen Krystexxa Lamisil Lovenox Ultracet Xolair Zevalin Zolinza Zyflo Multiple Sclerosis Disease Modifying Therapies Mycamine Onychomycosis Orencia Promacta Provigil Remicade Sancuso Patch Stelara Tracleer TZD Policy Vfend Xalkori The following drug specific policies are new: Abilify Aubagio Bosulif Stivarga Xeljanz Xtandi The following existing administrative policies have been reviewed and revised: Drug Formulary Use Application of Closed Formulary InterRater MD InterRater RPH Retail Maintenance Med Potential Fraud and Abuse of Controlled Substance Specialty Pharmacy-Any Willing Provider Requirements The following existing administrative policies have been reviewed without any changes made: Diabetes Supply Maintenance Drug Oncology Med Management P&T Committee Integrity