The chart below\u00a0defines the changes to the Be Healthy\/Medicaid prescription drug coverage, effective 07\/01\/2017. These changes are included in the members\u2019 coverage notice.<\/p>\n
Step Therapy drug changes effective July 1, 2017:<\/strong> 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.<\/em><\/p>\n If it is Medically Necessary for you to use a Step Therapy drug before trying a First Line drug, then your doctor can contact HNE to request a medical review.<\/p>\n All new Step Therapy requirements apply only to new prescriptions.<\/strong><\/p>\n Perforomist<\/td>\n<\/tr>\n Budesonide nasal spray RX<\/p>\n Mometasone nasal spray<\/p>\n Omnaris<\/p>\n Qnasl<\/p>\n Veramyst<\/p>\n Zetonna<\/p>\n Olopatadine nasal spray<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n Quantity Limit Additions<\/strong> (unless otherwise specified)<\/strong><\/td>\n<\/tr>\n <\/p>\n 30 tablets\/capsules<\/td>\n<\/tr>\n New Prior Authorizations (PA) effective July 1, 2017<\/strong><\/p>\n Prior Auth thru Optum<\/em><\/td>\n<\/tr>\n Prior Auth thru Magellan<\/em><\/td>\n<\/tr>\n Effective July 1, 2017, The following medications are Prior Authorized (PA) through Health New England: \u00a0Effective July 1, 2017, The following medications are not covered:<\/strong><\/p>\n If you have any questions about the information in this notice, please contact Health New England Provider Relations at (800) 842-4464, extension 5000. A representative is available Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m.<\/p>\n","protected":false},"excerpt":{"rendered":" The chart below\u00a0defines the changes to the Be Healthy\/Medicaid prescription drug coverage, effective 07\/01\/2017. These changes are included in the members\u2019 coverage notice. Be Healthy\/Medicaid Prescription Drug Coverage Step Therapy drug changes effective July 1, 2017: For Health New England\u00a0(HNE) to cover the Step Therapy drugs listed here, you first must try the corresponding First […]<\/p>\n","protected":false},"author":1,"featured_media":3356,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[2,8],"tags":[],"class_list":["post-3349","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-be-healthymasshealth-plan","category-updates"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/hnetalk.com\/provider\/wp-content\/uploads\/2017\/05\/pharmacy-2-e1496153457327.jpg?fit=800%2C283","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZHB-S1","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/3349","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/comments?post=3349"}],"version-history":[{"count":6,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/3349\/revisions"}],"predecessor-version":[{"id":3357,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/3349\/revisions\/3357"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media\/3356"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=3349"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=3349"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=3349"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\nFor Health New England\u00a0(HNE) to cover the Step Therapy drugs listed here, you first must try the corresponding First Line drugs. If HNE 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.<\/p>\n\n\n
\n You must try: <\/strong><\/td>\n First Line Drug(s):<\/strong><\/td>\n Serevent diskus<\/td>\n<\/tr>\n \n Before HNE will cover: \u00a0<\/strong><\/td>\n Step Therapy Drug(s):<\/strong><\/td>\n Brovana<\/p>\n \n You must try: <\/strong><\/td>\n First Line Drug(s):<\/strong><\/td>\n Nasacort OTC and Azelastine 0.1% nasal spray<\/td>\n<\/tr>\n \n Before HNE will cover:<\/strong><\/td>\n Step Therapy Drug(s):<\/strong><\/td>\n Beconase AQ<\/p>\n
\nStarting July 1, 2017, HNE will add Quantity Limits to the drugs below:<\/p>\n\n\n
\n Drug Name<\/strong><\/td>\n Quantity Limit per 30 day supply <\/strong><\/p>\n \n \n \n
<\/p>\n \n \n \n
250 strips<\/td>\n<\/tr>\n \n \n \n
1bottle<\/td>\n<\/tr>\n \n \n \n
1 therapy pack per lifetime<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n \n\n
\n \n \n
\u00a0<\/em><\/p>\n \n Aldurazyme, Cinqair, Darzalex, Empliciti, Imlygic, Kanuma, Naglazyme, Nucala, Onivyde, Portrazza, Supprelin LA, Yondelis<\/strong><\/td>\n \u00a0<\/em><\/p>\n \n All hemophilia medications<\/strong><\/td>\n Prior Auth thru Magellan<\/em><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
\n<\/strong><\/p>\n\n\n
\n \n \n
\n
\n
\n\n
\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Xenical<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n