{"id":4706,"date":"2019-05-28T19:08:53","date_gmt":"2019-05-28T19:08:53","guid":{"rendered":"http:\/\/hnetalk.com\/provider\/?p=4706"},"modified":"2019-05-28T19:18:30","modified_gmt":"2019-05-28T19:18:30","slug":"prescription-drug-coverage-medicaid","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/prescription-drug-coverage-medicaid\/","title":{"rendered":"Prescription Drug Coverage – Medicaid"},"content":{"rendered":"

Step Therapy Drug changes effective
\nJuly 1, 2019:<\/h3>\n

For BeHealthy Partnership to cover the Step Therapy drugs listed here, you first must try the corresponding First Line\u00a0drugs. If BeHealthy Partnership has paid a claim for the First Line drug within the previous 180 or 360 days (depending\u00a0on the First Line drug), then you are eligible for coverage of the Step Therapy drug.\u00a0The use of samples does not satisfy the requirements of documented usage of a First Line drug or medical necessity for a Step\u00a0Therapy 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\u00a0contact BeHealthy Partnership to request a medical review.<\/p>\n

All new Step Therapy requirements apply only to new prescriptions.<\/h3>\n\n\n\n\n\n\n
You must try:<\/td>\nFirst Line Drug(s):<\/td>\n\n
    \n
  • Anoro and Stiolto<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Before BEHEALTHY PARTNERSHIP will cover:<\/td>\nStep Therapy Drug(s):<\/td>\n\n
    \n
  • Bevespi<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
You must try:<\/td>\nFirst Line Drug(s):<\/td>\n\n
    \n
  • Spiriva and Incruse<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Before BEHEALTHY PARTNERSHIP will cover:<\/td>\nStep Therapy Drug(s):<\/td>\n\n
    \n
  • Tudorza<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Quantity Limit Additions<\/h3>\n

    Starting July 1, 2019, BEHEALTHY PARTNERSHIP will add Quantity Limits to the drugs below.<\/p>\n\n\n\n\n\n\n
    Drug Name<\/strong><\/td>\nQuantity Limit per 30 day supply<\/strong> (unless otherwise specified)<\/td>\n<\/tr>\n
    \n
      \n
    • Adapalene cream and gel<\/li>\n
    • Soolantra<\/li>\n<\/ul>\n<\/td>\n
    		45 grams<\/td>\n<\/tr>\n
    \n
      \n
    • Arepitant<\/li>\n<\/ul>\n<\/td>\n
    		6 tablets<\/td>\n<\/tr>\n
    \n
      \n
    • Estradiol patches<\/li>\n<\/ul>\n<\/td>\n
    		8 patches<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    New Prior Authorizations (PA) effective July 1, 2019:<\/h3>\n\n\n\n
    \n
      \n
    • Advair HFA, Advair diskus generic<\/li>\n<\/ul>\n<\/td>\n
    		Prior Auth thru Optum<\/em><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Effective July 1, 2019, the following medications will require Prior Authorization:<\/h3>\n\n\n\n
    \n
      \n
    • Lorzone: Alternative is cyclobenzaprine<\/li>\n
    • Tizanidine capsules. Alternative is tizanidine tablets<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"

      Step Therapy Drug changes effective July 1, 2019: For BeHealthy Partnership to cover the Step Therapy drugs listed here, you first must try the corresponding First Line\u00a0drugs. If BeHealthy Partnership has paid a claim for the First Line drug within the previous 180 or 360 days (depending\u00a0on the First Line drug), then you are eligible […]<\/p>\n","protected":false},"author":1,"featured_media":4101,"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":[],"class_list":["post-4706","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-provider-newsletter"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/hnetalk.com\/provider\/wp-content\/uploads\/2018\/05\/GettyImages-669895608-e1525891036603.jpg?fit=800%2C533","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZHB-1dU","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/4706","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=4706"}],"version-history":[{"count":4,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/4706\/revisions"}],"predecessor-version":[{"id":4710,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/4706\/revisions\/4710"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media\/4101"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=4706"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=4706"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=4706"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}