Drug Formulary Update, July 2013
|
|
|
- Austen Cox
- 8 years ago
- Views:
Transcription
1 Drug Formulary Update, July 2013 Updates to the HealthPartners Drug Formularies are listed below. Updates for the Commercial Drug Formularies and the Minnesota Health Care Programs (Medicaid and Minnesota Care State Programs ) Drug Formulary are listed first, and then changes for the Medicare Drug Formulary. Commercial and Minnesota Health Care Programs These changes are effective July 1, 2013, and apply to PreferredRx, GenericsPlusRx, and HealthPartners Minnesota Health Care Programs (Medicaid and Minnesota Care State Programs ) Drug Formularies. Variations in the formulary status is noted with an asterisk, with details in the notes section Adalimumab (Humira) Prior authorization coverage criteria have been updated, adding coverage for ulcerative colitis. For ulcerative colitis, adalimumab is reserved for prescribing by Gastroenterology, for patients with moderately to severely active ulcerative colitis, who have had an inadequate response or medical contraindications to conventional therapy (such as 6-mercaptopurine, azathioprine or cyclosporine). Initial approvals will be granted for three months. Reauthorizations will be provided for patients who respond to therapy. Reauthorizations are limited to a maximum dose of 40 mg every two weeks. Alogliptin NF Alogliptin products are non-formulary. Alogliptin is the 4 th dipeptidyl peptidase-4 (DPP-4) inhibitor approved by the FDA. Significant clinical advantages have not been shown. Alogliptin is available as a single-ingredient product (Nesina), a combination with metformin (Kazano), and a combination with pioglitazone (Oseni). Amethyst NF Brand oral contraceptives are non-formulary with prior authorization unless they have significant clinical advantages. Current members have been grandfathered allowing them to continue therapy, and this change applies to new starts only. Cabozantinib (Cometriq) Cometriq has been added with prior authorization. Cometriq is reserved for treatment of patients with progressive, metastatic medullary thyroid carcinoma. Approvals will be provided for three months. Reauthorizations will be provided when there is no disease progress. Cometriq is considered a specialty medication by HealthPartners. F, on formulary, prior authorization ST, step-therapy QL, Quantity Limit Age, Age limits NF, non-formulary NF, non-formulary with prior authorization
2 Drug Formulary Update, p. 2 of 6 Canagliflozin (Invokana) ST Canagliflozin has been added with step-therapy, after metformin. Canagliflozin is the first in a new class of diabetes medications called sodium-glucose co-transporter 2 (SGLT2) inhibitors. Codeine Products Age An age-limit of five has been added. Codeine products are not covered for children ages five and younger due to safety concerns. Codeine has a risk of severe respiratory depression in children who are ultra-rapid metabolizers of codeine, and safer alternatives are available. This age-edit will be added on August 1. Coverage for members receiving chronic therapy (two or more recent prescriptions) has been extended through August 31 to allow time to discuss changes. Additional communications are being sent to top providers and to affected members. This change applies to codeine tablets, codeine/ acetaminophen, codeine/ guaifenesin (e.g. Robitussin AC), and codeine/ promethazine. Crofelemer (Fulyzaq) Glycerol Phenylbutyrate (Ravicti) Crofelemer has been added with prior authorization. Crofelemer is reserved for diarrhea in patients with HIV, for patients with inadequate response to first-line therapies such as loperamide and diphenoxylate/ atropine (generic Lomotil). Glycerol Phenylbutyrate has been added with prior authorization. Glycerol Phenylbutyrate is reserved for use in chronic management of adult and pediatric patients two years of age and older with urea cycle disorders (UCDs) that cannot be managed by dietary protein restriction, amino acid supplementation and sodium phenylbutyrate. It must be used in combination with dietary protein restriction. Initial approvals are for one year, with continued coverage available for patients with a significant positive response with attestation of adherence to dietary protein restriction. Glycerol Phenylbutyrate is considered a specialty medication by HealthPartners. Icosapent (Vascepa) Vascepa has been added with prior authorization. Vascepa is reserved for patients with high triglycerides levels > 500 mg/dl, who have an inadequate response to combination therapy with a fibrate (gemfibrozil or fenofibrate) and omega-3-acid ethyl esters (Lovaza). Omega-3-acid ethyl esters (Lovaza) is similar and on formulary with step-therapy, from gemfibrozil or fenofibrate.
3 Drug Formulary Update, p. 3 of 6 Linaclotide (Linzess) Lomitapide (Juxtapid) Methylphenidate LA (Ritalin LA generic) Mipomersen (Kynamro) QL Linaclotide has been added with prior authorization. Linaclotide is reserved for patients with significant symptoms not responding to OTC medications and lactulose. Linaclotide is FDA-approved for irritable bowel syndrome with constipation, and for chronic idiopathic constipation. Lomitapide has been added with prior authorization. Lomitapide is reserved for patients with homozygous familial Lomitapide is considered a specialty medication by HealthPartners. Ritalin LA generics have been added as a cost-neutral line-extension. Mipomersen has been added with prior authorization. Mipomersen is reserved for patients with homozygous familial Mipomersen is considered a specialty medication by HealthPartners. Opioids QL Limits for opioids have been updated. Quantity limits now allow a maximum of 120mg morphine equivalent dose (MED) per day, and product strengths exceeding 120mg MED per day (e.g., morphine sulfate 200mg tablets) will require prior authorization. Specific limits are listed in the Drug Formulary. These limits will be added on August 1. Coverage for members affected by these changes has been extended through September 30 to allow time to discuss changes. Additional communications are being sent to affected providers and members. Exceptions allowing higher quantities can be requested if medically necessary. Exception requests should include a care plan with longterm goals, and a monitoring plan for addiction, abuse, and diversion. Pasireotide (Signifor) Pasireotide has been added with prior authorization. Pasireotide is reserved for the treatment of adult patients with Cushing s disease for whom pituitary surgery is not an option or has not been curative. Initial approvals will be for three months. Authorizations will be provided annually thereafter for responders (reduction in mean urinary free cortisol). Pasireotide is considered a specialty medication by HealthPartners.
4 Drug Formulary Update, p. 4 of 6 Pomalidomide (Pomalyst) Regorafenib (Stivarga) Pomalidomide has been added with prior authorization. Pomalidomide is reserved for patients with multiple myeloma who have received at least two prior therapies including lenalidomide and bortezomib, have demonstrated disease progression on or within 60 days of completion of the last therapy, and are using dexamethasone concurrently. Initial approvals are for six months. Reauthorizations will be approved for patients with no disease progression. Pomalidomide is considered a specialty medication by HealthPartners. Prior authorization coverage criteria have been updated. Regorafenib is reserved for patients with Metastatic colorectal cancer (CRC) who have been previously treated with fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapy, an anti-vegf therapy, and, if KRAS wild type, an anti-egfr therapy, OR Locally advanced, unresectable or metastatic gastrointestinal stromal tumor (GIST) who have been previously treated with imatinib and sunitinib. Initial approvals are for three months. Reauthorizations will be provided when there is no disease progression. Regorafenib is considered a specialty medication by HealthPartners. Rifaximin (Xifaxan) Prior authorization coverage criteria have been updated, adding coverage for irritable bowel syndrome (IBS). For IBS, rifaximin is reserved for prescribing by Gastroenterology, for patients with moderate to severe IBS without constipation (particularly those with bloating), who have failed to respond to all other therapies, including dietary restrictions. Other therapies include antispasmodic agents such as dicyclomine and hyoscyamine, antidiarrheal agents such as loperamide and diphenoxylate/ atropine, and antidepressants such as SSRIs and tricyclic antidepressants. Approvals are limited to 550mg three times daily for 14 days. Retreatment is limited to patients with a significant positive response, and limited to a maximum of one treatment per year. Sodium Phenylbutyrate (Buphenyl) F Sodium Phenylbutyrate (Buphenyl and generics) have been added to formulary. Sodium Phenylbutyrate is FDA-approved for urea cycle disorders.
5 Drug Formulary Update, p. 5 of 6 Medicare Drug Formulary Cabozantinib (Cometriq) Canagliflozin (Invokana) T4 Cometriq has been added with prior authorization. Cometriq is reserved for treatment of patients with progressive, metastatic medullary thyroid carcinoma. Approvals will be provided for three months. Reauthorizations will be provided when there is no disease progress. T2 ST Canagliflozin has been added with step-therapy, after metformin. Crofelemer (Fulyzaq) T2 Crofelemer has been added with prior authorization. Crofelemer is reserved for diarrhea in patients with HIV, for patients with inadequate response to first-line therapies such as loperamide and diphenoxylate /atropine (generic Lomotil). Glycerol Phenylbutyrate (Ravicti) Icosapent (Vascepa) Linaclotide (Linzess) Lomitapide (Juxtapid) Methylphenidate LA (Ritalin LA generic) T4 Glycerol Phenylbutyrate has been added with prior authorization. Glycerol Phenylbutyrate is reserved for use in chronic management of adult and pediatric patients two years of age and older with urea cycle disorders (UCDs) that cannot be managed by dietary protein restriction, amino acid supplementation and sodium phenylbutyrate. It must be used in combination with dietary protein restriction. Initial approvals are for one year, with continued coverage available for patients with a significant positive response with attestation of adherence to dietary protein restriction. T2 Vascepa has been added with prior authorization. Vascepa is reserved for patients with high triglycerides levels > 500 mg/dl, who have an inadequate response to combination therapy with a fibrate (gemfibrozil or fenofibrate) and omega-3-acid ethyl esters (Lovaza). T2 Linaclotide has been added with prior authorization. Linaclotide is reserved for patients with significant symptoms not responding to polyethylene glycol 3350 and lactulose. T4 Lomitapide has been added with prior authorization. Lomitapide is reserved for patients with homozygous familial T1 QL Ritalin LA generics have been added as a cost-neutral line-extension.
6 Drug Formulary Update, p. 6 of 6 Mipomersen (Kynamro) T4 Mipomersen has been added with prior authorization. Mipomersen is reserved for patients with homozygous familial Pasireotide (Signifor) T4 Pasireotide has been added with prior authorization. Pasireotide is reserved for the treatment of adult patients with Cushing s disease for whom pituitary surgery is not an option or has not been curative. Initial approvals will be for three months. Authorizations will be provided annually thereafter for responders (reduction in mean urinary free cortisol). Pomalidomide (Pomalyst) T4 Pomalidomide has been added with prior authorization. Pomalidomide is reserved for patients with multiple myeloma who have received at least two prior therapies including lenalidomide and bortezomib, have demonstrated disease progression on or within 60 days of completion of the last therapy, and are using dexamethasone concurrently. Initial approvals are for six months. Reauthorizations will be approved for patients with no disease progression. For Medicare: T1, covered generic T2, covered Brand T3, covered Brand T4, specialty Formulary Information and Requests Formulary Information is available at HealthPartners.com/ Provider/ Pharmacy Services, including the Drug Formularies. Pharmacy Customer Service is available to providers (physicians and pharmacies) from 8AM - 6PM CST, Monday through Friday. After hours calls are answered by our Pharmacy Benefit Manager. Fax or Telephone or Mail - HealthPartners Pharmacy Services, rd Avenue S, PO Box 1309, Mpls, MN
PHARMACY BENEFIT UPDATE Summer/Fall 2013 Issue. Preferred Drug List (PDL) News
PHARMACY BENEFIT UPDATE Summer/Fall 2013 Issue Preferred Drug List (PDL) News A._PDL Changes This issue of the Pharmacy Benefit Updates contains recent changes to the Preferred Drug List as well as updates
Pharmacy and Therapeutics Committee Policies and Procedures
Pharmacy and Therapeutics Committee Policies and Procedures I. Charter... p 2 II. Formulary Principles... p 3 III. Drug Review Process... p 4 7 A. When are Medications Reviewed B. How Are Medications Reviewed
Millions of Americans suffer from abdominal pain, bloating, constipation and diarrhea. Now new treatments can relieve your pain and discomfort.
3888-IBS Consumer Bro 5/8/03 10:38 AM Page 1 TAKE THE IBS TEST Do you have recurrent abdominal pain or discomfort? YES NO UNDERSTANDING IRRITABLE BOWEL SYNDROME A Consumer Education Brochure Do you often
Why are antidepressants used to treat IBS? Some medicines can have more than one action (benefit) in treating medical problems.
The Use of Antidepressants in the Treatment of Irritable Bowel Syndrome and Other Functional GI Disorders Christine B. Dalton, PA-C Douglas A. Drossman, MD What are functional GI disorders? There are more
Omega-3 Fatty Acid Products
Omega-3 Fatty Acid Products Policy Number: 5.01.563 Last Review: 7/2016 Origination: 6/2014 Next Review: 7/2017 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage for the
American Gastroenterological Association Institute Guideline on the Use of Pharmacological Therapies in the Treatment of Irritable Bowel Syndrome
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 American Gastroenterological Association Institute Guideline on the Use of Pharmacological Therapies in the Treatment of Irritable
Original Policy Date
MP 5.01.20 Tysabri (natalizumab) Medical Policy Section Prescription Drug Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Local Policy/12:2013 Return to Medical Policy Index Disclaimer
Paramount Elite Standard Medical and Drug (HMO) offered by Paramount Care, Inc.
Paramount Elite Standard Medical and Drug (HMO) offered by Paramount Care, Inc. Annual Notice of Changes for 2016 You are currently enrolled as a member of Paramount Elite Standard Medical and Drug (HMO).
Coventry Health Care of Georgia, Inc. Coventry Health and Life Insurance Company
Coventry Health Care of Georgia, Inc. Coventry Health and Life Insurance Company PRESCRIPTION DRUG RIDER This Prescription Drug Rider is an attachment to the Coventry Health Care of Georgia, Inc. ( Health
Benefit Summary - A, G, C, E, Y, J and M
Benefit Summary - A, G, C, E, Y, J and M Benefit Year: Calendar Year Payment for Services Deductible Individual $600 $1,200 Family (Embedded*) $1,200 $2,400 Coinsurance (the percentage amount the Covered
New York City Office of Labor Relations Employee Benefits Program/Municipal Labor Committee
New York City Office of Labor Relations Employee Benefits Program/Municipal Labor Committee PICA PRESCRIPTION DRUG PROGRAM Self-Injectable Medications Chemotherapy Medications Questions & Answers Last
Ultram (tramadol), Ultram ER (tramadol extended-release tablets); Conzip (tramadol extended-release capsules), Ultracet (tramadol / acetaminophen)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.02.35 Subject: Tramadol Acetaminophen Page: 1 of 8 Last Review Date: September 18, 2015 Tramadol Acetaminophen
RIDER ADDING PRESCRIPTION DRUG COVERAGE
Group Health Incorporated (hereinafter referred to as GHI ) 441 Ninth Avenue New York, NY 10001 RIDER ADDING PRESCRIPTION DRUG COVERAGE RETAIL DRUG PROGRAM Deductible: Generic Drugs: Brand Name Preferred
MOH Policy for dispensing NEOPLASTIC DISEASES DRUGS
MOH Policy for dispensing NEOPLASTIC DISEASES DRUGS All prescriptions for antineoplastic drugs must be accompanied by the MOH special form. All the attachments mentioned on this form shall be submitted
Managed Care Pharmacy. Objectives. Health Plans Some Background 4/7/2015. Kim Moon, PharmD Spring 2015
Managed Care Pharmacy Kim Moon, PharmD Spring 2015 Objectives Describe the role of pharmacists in managed care plans Discuss the role of quality ratings systems in managed care pharmacy Explain some of
2015 Medicare Part D Step Therapy Requirements. Effective: November 01, 2015
2015 Medicare Part D Step Therapy Requirements Effective: November 01, 2015 Formulary ID 15293, Version 17 Last Updated: 10/27/2015 BISPHOSPHONATE THERAPY ACTONEL 30 MG TABLET ACTONEL 35 MG TABLET ACTONEL
Cost Sharing Definitions
SU Pro ( and ) Annual Deductible 1 Coinsurance Cost Sharing Definitions $200 per individual with a maximum of $400 for a family 5% of allowable amount for inpatient hospitalization - or - 50% of allowable
UnitedHealthcare Injectable Chemotherapy Prior Authorization (PA) Program Frequently Asked Questions
UnitedHealthcare Injectable Chemotherapy Prior Authorization (PA) Program Frequently Asked Questions Q1. What members are impacted by the UnitedHealthcare Injectable Chemotherapy PA Program? A. Beginning
PRESCRIPTION DRUG PLAN
PRESCRIPTION DRUG PLAN The Plan Administrator will pay a portion of the cost of covered prescriptions. Maximum benefits are paid when prescriptions are filled through the CVS Caremark network pharmacies.
Harmony Clinical Trial Medical Media Factsheet
Overview Harmony is the global Phase III clinical trial program for Tanzeum (albiglutide), a product developed by GSK for the treatment of type 2 diabetes. The comprehensive program comprised eight individual
NUVIGIL (armodafinil) oral tablet
NUVIGIL (armodafinil) oral tablet Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy Coverage
PROTOCOL SYNOPSIS Evaluation of long-term opioid efficacy for chronic pain
P a g e 1 PROTOCOL SYNOPSIS Evaluation of long-term opioid efficacy for chronic pain Clinical Phase 4 Study Centers Study Period 25 U.S. sites identified and reviewed by the Steering Committee and Contract
New York State Auto Dealers Association Group Insurance Trust (GIT) Prescription Drug Coverage Summary
New York State Auto Dealers Association Group Insurance Trust (GIT) Prescription Drug Coverage Summary Effective January 1, 2014, all pharmacy coverage will be administered by Express Scripts and its affiliates.
HMO and PPO Updates May 2013- Commercial Results
HMO and PPO Updates May 2013- Commercial Results ELIQUIS Non Triple Tier Formular y 4th Tier Applicable Traditional Alternatives warfarin, Xarelto, Pradaxa TAMIFLU - EXPANDED INDICATION 2 No 2 No No None
RMIP Prescription Plan FAQ's
RMIP Prescription Plan FAQ's A new U.S. Pharmacy Benefit Manager has been selected for January 1, 2015 - CVS/caremark. 1) Why is the RMIP changing to CVS/caremark? The Express Scripts contract ends on
Questions and answers on breast cancer Guideline 10: The management of persistent pain after breast cancer treatment
Questions and answers on breast cancer Guideline 10: The management of persistent pain after breast cancer treatment I ve had breast cancer treatment, and now I m having pain. Does this mean the cancer
Medical Plan Comparison - Retirees Age 65 or Over
* Plan Type Medicare Cost Plan with Prescription Coordinates with Medicare and includes Medicare prescription drug program Medicare Cost Plan with Prescription Medicare Advantage Plan with Prescription
SECTION 3. Criteria for Special Authorization of Select Drug Products. Section 3 Criteria for Special Authorization of Select Drug Products
SECTION 3 Criteria for Special Authorization of Select Drug Products Section 3 Criteria for Special Authorization of Select Drug Products CRITERIA FOR SPECIAL AUTHORIZATION OF SELECT DRUG PRODUCTS The
www.oxfordhealth.com
www.oxfordhealth.com Oxford s HMO products are underwritten by Oxford Health Plans (NY), Inc., Oxford Health Plans (NJ), Inc., and Oxford Health Plans (CT), Inc., and insurance products are underwritten
MEDICATION GUIDE JUXTAPID (JUKS-tuh-pid) (lomitapide) capsules
MEDICATION GUIDE JUXTAPID (JUKS-tuh-pid) (lomitapide) capsules Read this Medication Guide before your treatment. What is the most important information I should know about JUXTAPID? JUXTAPID is available
Type 2 Diabetes Medicines: What You Need to Know
Type 2 Diabetes Medicines: What You Need to Know Managing diabetes is complex because many hormones and body processes are at work controlling blood sugar (glucose). Medicines for diabetes include oral
The TIRF REMS Access program is a Food and Drug Administration (FDA) required risk management program
Subject: Important Drug Warning Announcement of a single shared REMS (Risk Evaluation and Mitigation Strategy) program for all Transmucosal Immediate Release Fentanyl (TIRF) products due to the potential
Outpatient Prescription Drug Benefit
Outpatient Prescription Drug Benefit GENERAL INFORMATION This supplemental Evidence of Coverage and Disclosure Form is provided in addition to your Member Handbook and Health Plan Benefits and Coverage
Office of Medical Assistance (OMA) P&T Committee Meeting Minutes
Office of Medical Assistance (OMA) P&T Committee Meeting Minutes January 9, 2013 Lazarus Building, 50 W. Town St., Columbus, OH 43215 Committee members present: Susan Baker, CNS; Suzanne Eastman, RPh;
MEDICATION(S) SUBJECT TO STEP THERAPY
ACE/ARB COMBO AZOR 5-20 MG TABLET, AZOR 5-40 MG TABLET, BENICAR HCT, MICARDIS HCT, TARKA, TEKTURNA HCT, TELMISARTAN-HYDROCHLOROTHIAZID, TRIBENZOR Claims for formulary step 2 ACE Inhibitor combination products
Formulary Management
Formulary Management Formulary management is an integrated patient care process which enables physicians, pharmacists and other health care professionals to work together to promote clinically sound, cost-effective
Employee + 2 Dependents
FUND FEATURES HealthFund Amount $500 Individual $1,000 Employee + 1 Dependent $1,000 Employee + 2 Dependents $1,000 Family Amount contributed to the Fund by the employer Fund Coinsurance Percentage at
POST-TEST Pain Resource Professional Training Program University of Wisconsin Hospital & Clinics
POST-TEST University of Wisconsin Hospital & Clinics True/False/Don't Know - Circle the correct answer T F D 1. Changes in vital signs are reliable indicators of pain severity. T F D 2. Because of an underdeveloped
Opioid Addiction and Methadone: Myths and Misconceptions. Nicole Nakatsu WRHA Practice Development Pharmacist
Opioid Addiction and Methadone: Myths and Misconceptions Nicole Nakatsu WRHA Practice Development Pharmacist Learning Objectives By the end of this presentation you should be able to: Understand how opioids
MOVEMENT BEYOND LAXATIVES: EVOLVING PHARMACOLOGIC OPTIONS FOR IBS-C AND CIC PETE KRECKEL, RPH
MOVEMENT BEYOND LAXATIVES: EVOLVING PHARMACOLOGIC OPTIONS FOR IBS-C AND CIC PETE KRECKEL, RPH MOVEMENT BEYOND LAXATIVES: EVOLVING PHARMACOLOGIC OPTIONS FOR IBS-C AND CIC ACTIVITY DESCRIPTION IBS-C and
2015 Plan Guide ALLEGIAN ADVANTAGE (HMO) H8554_013-2015 Accepted
2015 Plan Guide ALLEGIAN ADVANTAGE (HMO) H8554_013-2015 Accepted Allegian Advantage is an HMO plan. We proudly serve Texas residents in Cameron, Hidalgo and Willacy counties, offering doctor, hospital
Clock Hours I General Concepts of Pharmacy 1-4 80. III Pharmacy Billing, Repacking and Compounding 9-12 80
PHARMACY TECHNICIAN (PHT) 720 clock hours/ 9 months (Total time to complete the program may vary based on school holidays and breaks) 28 weeks Theory/Lab (20 hours per week) + 8 weeks externship (20 hours
Overview of Mental Health Medication Trends
America s State of Mind Report is a Medco Health Solutions, Inc. analysis examining trends in the utilization of mental health related medications among the insured population. The research reviewed prescription
How To Get A Tirf
Transmucosal Immediate Release Fentanyl (TIRF) Products Risk Evaluation and Mitigation Strategy (REMS) Education Program for Prescribers and Pharmacists Products Covered Under This Program Abstral (fentanyl)
Welchol (colesevelam HCl) Receives FDA Approval to Reduce Blood Glucose in Adults with Type 2 Diabetes
For Immediate Release Company name: DAIICHI SANKYO COMPANY, LIMITED Representative: Takashi Shoda, President and Representative Director (Code no.: 4568, First Section, Tokyo, Osaka and Nagoya Stock Exchanges)
GIC Medicare Enrolled Retirees
GIC Medicare Enrolled Retirees HMO Summary of Benefits Chart This chart provides a summary of key services offered by your HNE plan. Consult your Member Handbook for a full description of your plan s benefits
First Health Part D Prescription Drug Plan (PDP) S5768 S5674
2011 SUMMARY OF BENEFITS First Health Part D Prescription Drug Plan (PDP) S5768 S5674 Y0022_2011_1001_046_25 CMS Approval Date: 09/23/2010 FH11SB25 Section I Introduction to Summary of Benefits Thank you
SCHEDULE OF BENEFITS
SCHEDULE OF BENEFITS Premier HealthOne Bronze 5500 Health Maintenance Organization (HMO) Individual Certificate of Coverage This schedule of benefits (SOB) is part of your Certificate of Coverage (COC)
EXPLORING NALOXONE UPTAKE AND USE PUBLIC MEETING July 01 02, 2015 Fred Wells Brason II fbrason@projectlazarus.org
EXPLORING NALOXONE UPTAKE AND USE PUBLIC MEETING July 01 02, 2015 Fred Wells Brason II fbrason@projectlazarus.org Disclosures Project Lazarus Zogenix Charitable Contribution 2015 Kaléo Charitable Contribution
Annual Notice of Changes for 2015
First Health Part D Value Plus (PDP) Plan offered by First Health Life & Health Insurance Company Annual Notice of Changes for 2015 You are currently enrolled as a member of First Health Part D Essentials
Prior Authorization Guideline
Prior Authorization Guideline Guideline: PS Inj - Alimta Therapeutic Class: Antineoplastic Agents Therapeutic Sub-Class: Antifolates Client: PS Inj Approval Date: 8/2/2004 Revision Date: 12/5/2006 I. BENEFIT
Optimum HealthCare Sales Video Script - H5594_14SalesVideo_CMS Approved
Optimum HealthCare Sales Video Script - H5594_14SalesVideo_CMS Approved Thank you for joining us for this special presentation on Optimum HealthCare s Medicare Advantage Plans. Today we will explain the
Oral Zinc Supplementation as an Adjunct Therapy in the Management of Hepatic Encephalopathy: A Randomized Controlled Trial
Oral Zinc Supplementation as an Adjunct Therapy in the Management of Hepatic Encephalopathy: A Randomized Controlled Trial Marcus R. Pereira A. Study Purpose Hepatic encephalopathy is a common complication
Department of Vermont Health Access Pharmacy Benefit Management Program DUR Board Meeting Minutes: 05/14/2013
Department of Vermont Health Access Pharmacy Benefit Management Program DUR Board Meeting Minutes: 05/14/2013 Board Members: Present: Jaskanwar Batra, MD Gary Starecheski, RPh Mark Pasanen, MD Jeanne Greenblatt,
NOVARTIS SERVICE REQUEST FORM FOR PATIENT SUPPORT
NOVARTIS SERVICE REQUEST FORM FOR PATIENT SUPPORT Please complete the Fax Cover Sheet and Service Request Form, and fax all pages to the number specified below. Dear Health Care Professional: The Novartis
Essentials Choice Rx 25 (HMO-POS) offered by PacificSource Medicare
Essentials Choice Rx 25 (HMO-POS) offered by PacificSource Medicare Annual Notice of Changes for 2016 You are currently enrolled as a member of Essentials Choice Rx 25 (HMO-POS). Next year, there will
A Patient s Guide to Medicare Part D
Keeping up with all the changes in Medicare can leave you with questions. We ve got the answers... A Patient s Guide to Medicare Part D A Message from the President As lawmakers continue to take a look
PDS Tech, Inc Proposed Effective Date: 01-01-2012 Aetna HealthFund Aetna Choice POS ll - ASC
FUND FEATURES HealthFund Amount $500 Individual $1,000 Employee + 1 Dependent $1,000 Employee + 2 Dependents $1,000 Family Amount contributed to the Fund by the employer Fund Coinsurance 100% Percentage
Multiple sclerosis and health insurance: How to choose a plan that is right for you
Multiple sclerosis and health insurance: How to choose a plan that is right for you What are the different types of health insurance? Choosing a health insurance plan is important, especially if you have
From the Text. Definitions. Definitions. Definitions. Definitions. RSPT 2217 Basic Concepts & Principles. RSPT 2217-01 Basic Concepts
RSPT 2217 & Principles Gardenhire Chapter 1; p. 1-10 From the Text Key Terms and page 2 Orphan Drugs Table 1-1; page 6 Abbreviations Table 1-2; page 8 Aerosolized Agents Table 1-3; page 9 Drug: Pharmacology:
HEALTH SAVINGS PPO PLAN (WITH HSA) - COLUMBUS PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2016 AETNA INC.
HEALTH SAVINGS PPO PLAN (WITH HSA) - COLUMBUS PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2016 AETNA INC. CPOS II DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS and Aligned Deductible
ANNUAL NOTICE OF CHANGES FOR 2016
Cigna-HealthSpring Preferred (HMO) offered by Cigna-HealthSpring ANNUAL NOTICE OF CHANGES FOR 2016 You are currently enrolled as a member of Cigna-HealthSpring Preferred (HMO). Next year, there will be
Annual Notice of Changes for 2016
Central Health Focus Plan (HMO SNP) offered by Central Health Plan of California Annual Notice of Changes for 2016 You are currently enrolled as a member of Central Health Focus Plan. Next year, there
Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis
Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis Methodology: 8 respondents The measures are incorporated into one of four sections: Highly
18% Role of Pharmacist-Provided Medication Reviews in Workers Compensation Claims Management. Introduction. Role of the Pharmacist
Role of Pharmacist-Provided Medication Reviews in Workers Compensation Claims Management Benjamin Link, PharmD, RPh Introduction According to information from the National Council on Compensation Insurance
Pain and Symptom Management in the Pancreatic Cancer Patient. Objectives:
Pain and Symptom Management in the Pancreatic Cancer Patient Michael D. Harrington, M.D. Division of Geriatrics and Palliative Care MetroHealth Medical Center April 25, 2012 Objectives: Understand palliative
Lesser of $200 or 20% (surgery) $10 per visit. $35 $100/trip $50/trip $75/trip $50/trip
HOSPITAL SERVICES Hospital Inpatient : Paid in full, Non-network: Hospital charges subject to 10% of billed charges up to coinsurance maximum. Non-participating provider charges subject to Basic Medical
DISEASE-MODIFYING ANTIRHEUMATIC DRUG THERAPY FOR RHEUMATOID ARTHRITIS
DISEASE-MODIFYING ANTIRHEUMATIC DRUG THERAPY FOR RHEUMATOID ARTHRITIS APPLICATIONS OBJECTIVE Purpose of Measure: ELIGIBLE POPULATION Which members are included? STANDARD OF CARE NCQA APPROVED CODES HEDIS
January 1, 2015 December 31, 2015 Summary of Benefits. Advantra (HMO) H3928-001 80.06.360.1-LA1
January, 205 December 3, 205 Summary of Benefits H3928-00 80.06.360.-LA Y0022_205_H3928_00_LA Accepted 9/204 Summary of Benefits January, 205 December 3, 205 This booklet gives you a summary of what we
IRRITABLE BOWEL SYNDROME (IBS)
IRRITABLE BOWEL SYNDROME (IBS) INTRODUCTION IBS is the most commonly diagnosed gastrointestinal condition and is second only to the common cold as a cause of absence from work. An estimated 10 to 20 percent
Minnesota Comprehensive Health Association. Summary of Benefits and Plan Options
Minnesota Comprehensive Health Association Summary of Benefits and Options www.mchamn.com MCHA Customer Service 1-866-894-8053 TTY: 952-992-3190 or toll-free at 1-800-841-6753 Monday Friday: 7 a.m. 6 p.m.
POLICY A. INDICATIONS
Alimta (pemetrexed) Line(s) of Business: HMO; PPO; QUEST Integration Akamai Advantage Original Effective Date: 09/01/2007 Current Effective Date: 10/01/2015 POLICY A. INDICATIONS The indications below
PRESCRIPTION DRUG RIDER. Beechcraft
PRESCRIPTION DRUG RIDER Beechcraft If You have Medicare or will become Eligible for Medicare in the next twelve (12) months, Federal law gives You choices about Your prescription drug coverage. Please
Protecting your employees, physicians and you.
Protecting your employees, physicians and you. Opioid abuse is being talked about every day. Modern Medical has a solution - now with real outcomes. Opioids are the most common drugs prescribed in workers
MEDICATION GUIDE. What is Morphine Sulfate Oral Solution?
MEDICATION GUIDE Morphine Sulfate (mor-pheen) (CII) Oral Solution IMPORTANT: Keep Morphine Sulfate Oral Solution in a safe place away from children. Accidental use by a child is a medical emergency and
Management of Constipation in Adults
Hull and East Riding Prescribing Committee Management of Constipation in Adults Definition Constipation is defecation that is unsatisfactory because of infrequent stools, difficult stool passage, or seemingly
MANAGEMENT OF CHRONIC NON MALIGNANT PAIN
MANAGEMENT OF CHRONIC NON MALIGNANT PAIN Introduction The Manitoba Prescribing Practices Program (MPPP) recognizes the important role served by physicians in relieving pain and suffering and acknowledges
ANNUAL NOTICE OF CHANGES FOR 2016
Cigna-HealthSpring Preferred (HMO) offered by Cigna-HealthSpring ANNUAL NOTICE OF CHANGES FOR 2016 You are currently enrolled as a member of Cigna-HealthSpring Preferred (HMO). Next year, there will be
Unlimited except where otherwise indicated.
PLAN FEATURES Deductible (per calendar year) $1,250 Individual $5,000 Individual $2,500 Family $10,000 Family All covered expenses including prescription drugs accumulate separately toward both the preferred
Contents General Information... 1. General Information
Contents General Information... 1 Preferred Drug List... 2 Pharmacies... 3 Prescriptions... 4 Generic and Preferred Drugs... 5 Express Scripts Website and Mobile App... 5 Specialty Medicines... 5 Prior
Schedule of Benefits Summary. Health Plan. Out-of-network Provider
Schedule of Benefits Summary University Name: University of Nebraska - Student Plan Health Plan : 2014/2015 Academic Year (see attached) Payment for Services Covered Services are reimbursed based on the
Patient Assistance Application for HUMIRA (adalimumab)
The AbbVie Patient Assistance Foundation provides AbbVie medicines at no cost to patients experiencing financial difficulties. Eligible patients typically have no healthcare coverage for the requested
PLAN DESIGN AND BENEFITS Georgia 2-100 HNOption 13-1000-80
Georgia Health Network Option (POS Open Access) PLAN DESIGN AND BENEFITS Georgia 2-100 HNOption 13-1000-80 PLAN FEATURES PARTICIPATING PROVIDERS NON-PARTICIPATING PROVIDERS Deductible (per calendar year)
Prescription Drug Rider
Prescription Drug Rider This Rider is part of the Evidence of Coverage and is effective on the date Your group is effective or renews its coverage with Southern Health Services, Inc. Benefits are available
HEALTH INSURANCE FOR INDIVIDUALS AND FAMILIES. Insuring Minnesota One Life At A Time. www.preferredone.com
foreveryone HEALTH INSURANCE FOR INDIVIDUALS AND FAMILIES Insuring Minnesota One Life At A Time www.preferredone.com for EveryOne Insuring Minnesota One Life At A Time Thank you for your interest in the
Opioids and the Injured Worker Tools for Successful Outcomes
Opioids and the Injured Worker Tools for Successful Outcomes Tim Pokorney, RPh Director, Clinical Express Scripts Workers' Compensation Division Goals and Objectives Alarming statistics for narcotic utilization,
Introduction of a Standard Drug Formulary in Hospital Authority
Introduction of a Standard Drug Formulary in Hospital Authority PURPOSE This paper seeks Members views on the introduction of a Standard Hospital Authority Drug Formulary ( ) ( Standard Drug Formulary
Medications for chronic pain
Medications for chronic pain When it comes to treating chronic pain with medications, there are many to choose from. Different types of pain medications are used for different pain conditions. You may
Depression is a common biological brain disorder and occurs in 7-12% of all individuals over
Depression is a common biological brain disorder and occurs in 7-12% of all individuals over the age of 65. Specific groups have a much higher rate of depression including the seriously medically ill (20-40%),
Clinical Criteria for Hepatitis C (HCV) Therapy
Diagnosis Clinical Criteria for Hepatitis C (HCV) Therapy Must have chronic hepatitis C (HCV infection > 6 months), genotype and sub-genotype specified to determine the length of therapy; Liver biopsy
Irritable Bowel Syndrome
Irritable Bowel Syndrome National Digestive Diseases Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What is irritable bowel syndrome (IBS)? Irritable
2015 Travelers Prescription Drug Plan Blue Cross Blue Shield Plan and United Healthcare Choice Plus Plan
2015 Travelers Prescription Drug Plan Blue Cross Blue Shield Plan and United Healthcare Choice Plus Plan Plan Details, Programs, and Policies Table of Contents Click on the links below to be taken to that
First Health Part D Value Plus (PDP) offered by First Health Life & Health Insurance Company
First Health Part D Value Plus (PDP) offered by First Health Life & Health Insurance Company Annual Notice of Changes for 2016 You are currently enrolled as a member of First Health Part D Value Plus (PDP).
Do more of what you love. HealthPartners Wisconsin Freedom (Cost) 2016 Plan Comparison Guide
Do more of what you love. HealthPartners Wisconsin Freedom (Cost) 2016 Plan Comparison Guide H2462_ 82767 Accepted 9/14/2014 H2462_91699_01 Accepted 8/30/2015 WIPlanComp Table of contents Introducing HealthPartners...................................
Reimbursement Billing and Coding Guide
Reimbursement Billing and Coding Guide Please see Indication and Important Safety Information on page 2 and 3 This billing guide is intended to provide healthcare providers with an overview of coding,
Ever wish you could... Quit using heroin? Protect yourself from HIV infection? Get healthier?
Ever wish you could... Quit using heroin? Protect yourself from HIV infection? Get healthier? Good News: Medical treatments called opioid (oh-pee-oyd) maintenance can help you! Injecting heroin puts you
Frequently Asked Questions (FAQ s): Medication-Assisted Treatment for Opiate Addiction
Frequently Asked Questions (FAQ s): Medication-Assisted Treatment for Opiate Addiction March 3, 2008 By: David Rinaldo, Ph.D., Managing Partner, The Avisa Group In this FAQ What medications are currently
Annual Notice of Changes for 2016
Healthy Advantage Plus HMO offered by Molina Healthcare of Utah Annual Notice of Changes for 2016 You are currently enrolled as a member of Healthy Advantage Plus HMO. Next year, there will be some changes
Essentials Choice Rx 24 (HMO-POS) offered by PacificSource Medicare
Essentials Choice Rx 24 (HMO-POS) offered by PacificSource Medicare Annual Notice of Changes for 2016 You are currently enrolled as a member of Essentials Choice Rx 24 (HMO-POS). Next year, there will
AUBAGIO. Step Therapy Criteria Health Choice Generations Formulary ID: 15179 Version 19 Effective Date: 11/1/2015. PRODUCT(s) AFFECTED AUBAGIO
AUBAGIO AUBAGIO Claim will pay automatically for AUBAGIO if enrollee has a paid claim for at least a 1 days supply of COPAXONE, REBIF, TYSABRI, BETASERON OR EXTAVIA in the past 365 days. Otherwise, AUBAGIO