BeHealthy Partnership/ Medicaid Prescription Drug Coverage, Effective 1/1/2019
Posted on November 26, 2018
The following chart defines the changes to the BeHealthy Partnership/Medicaid prescription drug coverage, effective 1/1/2019. These changes are included in members’ coverage notices.
Step Therapy Drug changes effective January 1, 2019:
For Health New England to cover the Step Therapy drugs listed here, you first must try the corresponding First Line drugs. If Health New England has paid a claim for the First Line drug within the previous 180 or 360 days (depending on the First Line drug), then you are eligible for coverage of the Step Therapy drug.
The use of samples does not satisfy the requirements of documented usage of a First Line drug or medical necessity for a Step Therapy drug.
If it is Medically Necessary for you to use a Step Therapy drug before trying a First Line drug, then your doctor can contact Health New England to request a medical review.
All new Step Therapy requirements apply only to new prescriptions.
| You must try: | First Line Drug(s): | · Olopatadine 0.2% and Azelastine | ||
| Before HNE will cover: | Step Therapy Drug(s): | · Pazeo | ||
| You must try: | First Line Drug(s): | · Azelastine | ||
| Before HNE will cover: | Step Therapy Drug(s): | · Epinastine | ||
| You must try: | First Line Drug(s): | · Azathioprine | ||
| Before HNE will cover: | Step Therapy Drug(s): | · Azasan | ||
| Quantity Limit Additions
Starting January 1, 2019, HNE will add Quantity Limits to the drugs below. |
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| Drug Name | Quantity Limit per 30 day supply | |||
| · Belsomra | 30 tablets | |||
| · Emverm | 6 chews per 21 days | |||
| · Fluocinonide cream | 60 grams | |||
| · Lidocaine/Prilocaine | 60 grams | |||
| New Prior Authorizations (PA) effective January 1, 2019 | ||||
| Durolane, GelSyn-3, Genvisc 850, Hyalagan, Hymovis, Monovisc, Orthovisc, Supartz/Supartz FX, Synvisc, Synvisc-One, TriVisc, Visco 3, Vpriv | Prior Auth thru MagellanRX | |||
| Doxepin cream | Prior Auth thru Optum | |||
| Humalog and Humalog Mix, Novolog and Novolog Mix | Prior Auth thru Optum | |||
| Effective January 1, 2019, the following medications will require Prior Authorization: | ||||
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