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.<\/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.
\nIf it is medically necessary for you to use a step therapy drug before trying a first line drug, then your provider 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 \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Travoprost<\/td>\n<\/tr>\n Quantity Limit Additions<\/strong><\/p>\n Starting July 1, 2020, Health New England will add Quantity Limits to the drugs below.<\/p>\n (unless otherwise specified)<\/td>\n<\/tr>\n New Prior Authorizations (PA) Effective July 1, 2020<\/strong> New Prior Authorizations (PA) Effective July 1, 2020<\/strong> Step Therapy Drug changes effective July 1, 2020: 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), […]<\/p>\n","protected":false},"author":1,"featured_media":4950,"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-5417","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\/2019\/11\/GettyImages-1015267018.jpg?fit=813%2C430","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZHB-1pn","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/5417","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=5417"}],"version-history":[{"count":1,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/5417\/revisions"}],"predecessor-version":[{"id":5418,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/5417\/revisions\/5418"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media\/4950"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=5417"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=5417"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=5417"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n\n
\n You must try:<\/td>\n First Line Drugs:<\/td>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Clobazam<\/td>\n<\/tr>\n \n Before HNE will cover:<\/td>\n Step Therapy Drug(s):<\/td>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Banzel<\/td>\n<\/tr>\n \n You must try:<\/td>\n First Line Drug(s):<\/td>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dorzolomide<\/td>\n<\/tr>\n \n Before HNE will cover:<\/td>\n Step Therapy Drug(s):<\/td>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Azopt<\/td>\n<\/tr>\n \n You must try both<\/u>:<\/td>\n First Line Drug(s):<\/td>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Latanoprost<\/p>\n \n Before HNE will cover:<\/td>\n Step Therapy Drug(s):<\/td>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zioptan<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n \n\n
\n Drug Name<\/td>\n Quantity Limit per 30-day supply<\/p>\n \n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Banzel<\/td>\n 240 ML<\/td>\n<\/tr>\n \n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zioptan<\/td>\n 30 ML<\/td>\n<\/tr>\n \n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Azopt<\/td>\n 10 ML<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
\n\u2022 Nuplazid: PA thru Optum
\n\u2022 Eylea, Lucentis, Macugen: PA thru Magellan<\/p>\n
\n\u2022 Betoptic S. Alternative is timolol
\n\u2022 Brimonidine 0.15%. Alternative is brimonidine 0.2%
\n\u2022 Calcitriol ointment. Alternative is calcipotriene
\n\u2022 Cephalexin 750mg. Alternative is cephalexin 250mg
\n\u2022 Cyclobenzaprine 7.5mg. Alternative is cyclobenzaprine 5mg or 10mg
\n\u2022 Desloratadine ODT. Alternative is desloratadine tablets
\n\u2022 Desonate gel. Alternative is desonide cream
\n\u2022 Evzio. Alternative is generic Evzio (naloxone injector)
\n\u2022 Fenoprofen. Alternative is ibuprofen
\n\u2022 Gralise. Alternative is gabapentin
\n\u2022 Horizant. Alternative is gabapentin
\n\u2022 Imiquimod 3.75%. Alternative is imiquimod 5%
\n\u2022 Indocin suppository. Alternative is indomethacin
\n\u2022 Lidocaine\/hydrocortisone rectal kit. Alternative is lidocaine 5% ointment and hydrocortisone separately
\n\u2022 Lyrica CR. Alternative is pregabalin
\n\u2022 Urea 41%. Alternative is urea 40%<\/p>\n","protected":false},"excerpt":{"rendered":"