{"id":4435,"date":"2018-11-26T15:11:33","date_gmt":"2018-11-26T15:11:33","guid":{"rendered":"http:\/\/hnetalk.com\/provider\/?p=4435"},"modified":"2018-11-26T15:15:30","modified_gmt":"2018-11-26T15:15:30","slug":"behealthy-partnership-medicaid-prescription-drug-coverage-effective-1-1-2019","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/behealthy-partnership-medicaid-prescription-drug-coverage-effective-1-1-2019\/","title":{"rendered":"BeHealthy Partnership\/ Medicaid Prescription Drug Coverage, Effective 1\/1\/2019"},"content":{"rendered":"

The following chart defines the changes to the BeHealthy Partnership\/Medicaid prescription drug coverage, effective 1\/1\/2019. These changes are included in members\u2019 coverage notices.<\/p>\n

Step Therapy Drug changes effective January 1, 2019:<\/strong>
\nFor 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.<\/p>\n

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.<\/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 Health New England to request a medical review.<\/p>\n

All new Step Therapy requirements apply only to new prescriptions.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
You must try:<\/td>\nFirst Line Drug(s):<\/td>\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Olopatadine 0.2% and Azelastine<\/td>\n<\/tr>\n
Before HNE will cover:<\/td>\nStep Therapy Drug(s):<\/td>\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pazeo<\/td>\n<\/tr>\n
You must try:<\/td>\nFirst Line Drug(s):<\/td>\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Azelastine<\/td>\n<\/tr>\n
Before HNE will cover:<\/td>\nStep Therapy Drug(s):<\/td>\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Epinastine<\/td>\n<\/tr>\n
You must try:<\/td>\nFirst Line Drug(s):<\/td>\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Azathioprine<\/td>\n<\/tr>\n
Before HNE will cover:<\/td>\nStep Therapy Drug(s):<\/td>\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Azasan<\/td>\n<\/tr>\n
Quantity Limit Additions<\/strong><\/p>\n

Starting January 1, 2019, HNE will add Quantity Limits to the drugs below.<\/td>\n<\/tr>\n

Drug Name<\/td>\nQuantity Limit per 30 day supply<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Belsomra<\/td>\n30 tablets<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Emverm<\/td>\n6 chews per 21 days<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Fluocinonide cream<\/td>\n60 grams<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Lidocaine\/Prilocaine<\/td>\n60 grams<\/td>\n<\/tr>\n
New Prior Authorizations (PA) effective January 1, 2019<\/strong><\/td>\n<\/tr>\n
Durolane, GelSyn-3, Genvisc 850, Hyalagan, Hymovis, Monovisc, Orthovisc, Supartz\/Supartz FX, Synvisc, Synvisc-One, TriVisc, Visco 3, Vpriv<\/td>\nPrior Auth thru MagellanRX<\/em><\/td>\n<\/tr>\n
Doxepin cream<\/td>\nPrior Auth thru Optum<\/em><\/td>\n<\/tr>\n
Humalog and Humalog Mix, Novolog and Novolog Mix<\/td>\nPrior Auth thru Optum<\/em><\/td>\n<\/tr>\n
Effective January 1, 2019, the following medications will require Prior Authorization:<\/strong><\/td>\n<\/tr>\n
\n
    \n
  • Noritate cream. Alternative is metronidazole 0.75% cream<\/em><\/li>\n
  • Rayaldee. Alternative is Calcitriol<\/em><\/li>\n
  • Urelle. Alternative is urin d\/s<\/em><\/li>\n
  • Uro-mp. Alternative is urin d\/s<\/em><\/li>\n
  • \u00a0Ustell. Alternative is urin d\/s<\/em><\/li>\n
  • \u00a0Uribel. Alternative is urin d\/s<\/em><\/li>\n
  • Utopic. Alternative is urea topical cream<\/em><\/li>\n
  • Veregen ointment. Alternative is imiquimod<\/em><\/li>\n
  • Zyclara. Alternative is imiquimod<\/em><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"

    The following chart defines the changes to the BeHealthy Partnership\/Medicaid prescription drug coverage, effective 1\/1\/2019. These changes are included in members\u2019 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 […]<\/p>\n","protected":false},"author":1,"featured_media":2993,"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":[92],"tags":[107,106,104,105,103],"class_list":["post-4435","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-provider-newsletter","tag-aco","tag-behealthy-partnership","tag-ma","tag-massachusetts","tag-medicaid-prescription-drug-coverage"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/hnetalk.com\/provider\/wp-content\/uploads\/2016\/12\/pharmacy-3-e1480954493285.jpg?fit=700%2C247","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZHB-19x","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/4435","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=4435"}],"version-history":[{"count":4,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/4435\/revisions"}],"predecessor-version":[{"id":4439,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/4435\/revisions\/4439"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media\/2993"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=4435"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=4435"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=4435"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}