Provider Newsletter. Medical director s corner. The Effect of Dose Counters on Asthma Rescue Inhalers on Your PCHP Patients.

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Provider Newsletter Summer 2017 Medical director s corner Dr. Barry Lachman, MD, MPH The Effect of Dose Counters on Asthma Rescue Inhalers on Your PCHP Patients In an earlier newsletter I reviewed the
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Provider Newsletter Summer 2017 Medical director s corner Dr. Barry Lachman, MD, MPH The Effect of Dose Counters on Asthma Rescue Inhalers on Your PCHP Patients In an earlier newsletter I reviewed the literature on the effect of dose counters on asthma exacerbations. That article is reprinted below. However, PCHP now has information about the effect of dose counters on the PCHP members with asthma. Looking at asthma ER visits and hospital admissions for asthma, we found that asthma admissions were 81% higher in patients who used an albuterol inhaler with no dose counter and ER visits were 47% higher in patients who used an albuterol inhaler with no dose counter. Failure to prescribe an inhaler with a dose counter, highly suggests a health risk of asthma ER visit or admission to your patients for children with asthma in your practice. Please consider this information when prescribing rescue inhalers Some asthma inhalers come with dose counters built in to the unit. Dose counters are found on both dry powder and metered dose inhalers. They are found on both controller and rescue medications. The FDA has recommended dose counters since The American College of Asthma, Allergy and Immunology (ACAAI) endorses use of dose counters for asthma. The current literature strongly endorses use of dose counters (Sander, N., Fusco-Walker, S. J., Harder, J. M., & Chipps, B. E. (2006). Dose counting and the use of pressurized metereddose inhalers: running on empty. Annals of Allergy, Asthma & Immunology, 97(1), Conner, J. B., & Buck, P. O. (2013). Improving Asthma Management: The Case for Mandatory Inclusion of Dose Counters on All Rescue Bronchodilators. Journal of Asthma. A recent study presented at the Annual Meeting of the ACAAI shows that asthma related ER visits are reduced 55% by use of asthma medication devices with dose counters (Rigazio A, Buck P, Lepore M, Burden A, Gilchrist A, von Ziegenweidt J, Price DB. Integration of dose-counters into metered-dose rescue inhalers may reduce incidence of respiratory-related emergency room visits. ACAAI Meeting 2013; A5:11. This study has been recently published in a peer reviewed journal (https://www.dovepress.com/historicalcohort-study-examining-comparative-effectiveness-ofalbuter-peer-reviewed-article-jaa) Asthma medications with dose counters include Ventolin, Proair, Asmanex, Qvar, Advair, Symbacort and Pulmocort. Notably, Proventil lacks a dose counter. Table of Contents Medical director s corner...1 The Effect of Dose Counters on Asthma Rescue Inhalers on Your PCHP Patients...1 Pharmacy Corner...2 Mosquito Repellent Additions to Formulary...2 March 2017 Specialty Drug List...3 Prescriber Enrollment Update and Direction...3 Texas Drug Utilization Review (DUR) Board...3 Drug Classes & New Drugs...3 New Drugs / PDL Classes:...3 Texas Pharmacy Association (TPA) Brings Major Changes to the Landscape of Pharmacy in Texas...4 AM-XXXXX Through the Saving Lives Initiative!...4 Drug Recalls:...4 Epaned Addition to Texas Medicaid and CHIP Formularies.. 4 Cytokine-CAM Antagonist Clinical Prior Authorization Update...4 Nuedexta Clinical Prior Authorization Implementation for FFS...4 PCSK9 Inhibitors Prior Authorization and Addition to Formulary...5 Managed care - prescribing...5 Provider requirements...5 Background...5 Additional policy and business requirements...5 Managed care -prescribing provider requirements...7 Background...7 Master provider file...7 Outreach...7 Changes to our website!...8 CM Overview...8 PCHP wants to SWEETEN your day!...8 The Effect of Dose Counters on Asthma Rescue Inhalers on Your PCHP Patients...8 Summer Pharmacy Corner Dr. Nneka Cos-Okpalla, BS, PharmD Nasonex: The January 2017 recommendation for the HHSC DUR board for the July Bi-Annual change is to move Nasonex to the Non-Preferred Brand (NPD). Available alternative is Fluticasone. Drug Utilization Review - Antihistamine Comparison Antihistamines: Vanahist PD, Histex PD, cetirizine 1mg/ml, loratadine 5mg/ml Drug Condition Pediatric Dosage Vanahist PD Allergic Conjunctivitis, Inflammation of the Nose due to allergy, Vasomotor Rhinitis, Stuffy Nose, Runny Nose, itching, Welt from Pressure of Skin, Hives, Sneezing, Added Medication for Life Threatening Allergic Reaction Allergic rhinitis & Urticaria 4months to under 2 years of age: 0.5ml (0.313mg) 2 to under 4 years age: 1ml (0.626mg) 4 to under 6 to under 12 years of age: 2ml (1.25mg) 6 years of age: 1.5ml (0.938mg) Histex PD Allergic Conjunctivitis, Inflammation of the Nose due to allergy, Vasomotor Rhinitis, Stuffy Nose, Runny Nose, itching, Welt from Pressure of Skin, Hives, Sneezing, Added Medication for Life Threatening Allergic Reaction Allergic rhinitis &Urticaria 2years : Safety and effectiveness unknown 2 years to 6 years: X ml 4 times/day =6 years: X ml orally 4 times/day; depends on formulation Cetirizine Allergic rhinitis & Urticaria 6 months to 2 years: 2.5 mg orally once/day, 12 months and older may be increased to 2.5 mg orally twice a day 2 to 5 years: 2.5mg orally once a day, may be increased to 5 mg/day in 1 to 2 divided doses 6 years or older: 5 to 10mg orally or chewed once a day Loratadine Allergic rhinitis & Urticaria 2 to 5 years: 5mg orally once a day (syrup) 6 years or older: 10mg orally once a day(tablets, capsule, and disintegrating tablets) Sources: package insert where available Mosquito Repellent Additions to Formulary On March 29, 2017, VDP will add the following mosquito repellent products to the formulary for use under the Zika virus prevention benefit. Attached is an updated Zika Products Pharmacy Assistance Chart. Further information regarding Zika virus prevention benefits for the 2017 mosquito season will be distributed once available. NDC Product Name Repel Lemon Eucalyptus 30% spray Off Deep Woods 25% spray Off Deep Woods 25% spray Off Deep Woods 25% spray Off Deep Woods Sportsmen 30% spray NDC Product Name Off Deep Woods Dry 25% spray Off Deep Woods 25% spray Off Deep Woods Sportsmen 25% spray Ultrathon 25% repellent spray Coleman SkinSmart Coleman SkinSmart Coleman High-Dry 25% spray Coleman Botanicals insect spray Cutter Lemon Eucalyptus spray Cutter Backwoods 25% spray 2 Parkland Community Health Plan, Inc. March 2017 Specialty Drug List The March 2017 Specialty Drug List is now available. Only drugs that may be exclusively provided through the managed care organization s specialty pharmacy network are listed on quarterly Specialty Drug List. Prescriber Enrollment Update and Direction Starting on October 16, 2017, MCOs and their PBMs must deny all pharmacy claims when the prescribing provider is not enrolled with Texas Medicaid. Please see the attached document for an update on and direction for the prescriber enrollment requirement. Texas Drug Utilization Review (DUR) Board Each quarter, the Texas DUR Board reviews and makes recommendations regarding clinical prior authorization criteria proposals for certain drugs and drug classes. These drugs and drug classes are then reviewed for preferred drug status at the subsequent quarter s meeting. Proposals should be submitted in the required format as defined in UMCM chapter 3.29 ( MMC/ CHIP MCO Pharmacy Website Required Critical Elements ). A proposal solely based on step therapy will not be reviewed. MCO staff should also prioritize proposals based on the criteria s overall importance to the plan and submit those with the five highest priorities. This includes revisions to previous boardapproved criteria as well as those proposals postponed by the board. Please submit all materials or questions to the following: Your VDP Contract Performance Manager The schedule for forthcoming board meetings, and other boardrelated documents, is available at TxVendorDrug.com/advisory/ Drug Classes & New Drugs Anti-Allergens, Oral Antibiotics, Inhaled Anticoagulants Antidepressants, Other Antidepressants, SSRIs Antihyperuricemics Antiparkinsons Agents Beta-Blockers Bile Salts BPH Treatments Bronchodilators, Beta Agonist COPD Agents Cough and Cold Erythropoiesis Stimulating Proteins Glucocorticoids, Inhaled HAE Treatments Hypoglycemics, SLGT2 Immune Globulins, IV Lincosamides/Oxazolidinones/Streptogramins Lipotropics, Other Lipotropics, Statins PAH Agents, Oral and Inhaled Pancreatic Enzymes Sedative Hypnotics New Drugs / PDL Classes: Namzaric Dose Pack / Alzheimer s Agents PDL Class Restasis Multidose/ Ophthalmics, Anti-Inflammatory/ Immunomodulator PDL class Xultophy / Hypoglycemics, Incretin Mimetics/Enhancers PDL class Basaglar / Hypoglycemics, Insulins PDL class Adlyxin / Hypoglycemics, Incretin Mimetics/Enhancers PDL class Soliqua / Hypoglycemics, Incretin Mimetics/Enhancers PDL class Epaned Solution / Angiotensin Modulators PDL class Eucrisa /Immunomodulators, Atopic Dermatitis PDL class Ticalast / Intranasal Rhinitis, PDL class Summer Texas Pharmacy Association (TPA) Brings Major Changes to the Landscape of Pharmacy in Texas Through the Saving Lives Initiative! HB the new law allowing pharmacists to administer epinephrine, took effect on January 1st. The new law received tremendous media attention not only around the state but nationwide. Dr. Elly Baker, a pharmacist in East Texas, was the first reported instance of pharmacist using the new law to save a life. Since that time more and more pharmacists are becoming aware of the new law and using it to save lives. Utilizing the newly enacted law, TPA created a physician-signed standing order-in essence, a statewide prescription Pharmacists may dispense an opioid antagonist to any patient they believe has a need for the medication. This first of its kind statewide standing order in Texas represents a significant shift in the role pharmacists can play in providing much needed care to their patients. HB allowed authorized medical personnel to prescribe the opioid antagonist Naloxone either directly to a third-party patient (not necessarily the end-user) or through a standing order and pharmacists to dispense to a third-party. Drug Recalls: Date Brand Product/Description Reason/Problem Company Mylan EpiPen (epinephrine injection, USP) and EpiPen Jr (epinephrine injection, USP) Auto- Injectors Failure to activate the device due to a potential defect Mylan N.V. Epaned Addition to Texas Medicaid and CHIP Formularies Epaned 1 mg/ml oral solution (NDC ) has been retroactively added to the Texas Medicaid and CHIP formularies effective April 1, The NDC will be available to MCOs on the daily formulary file beginning April 12. Similar to Epaned (NDC ), the new Epaned product is non-preferred and requires PDL prior authorization for individuals greater than 6 years. Individuals ages 6 years and under do not require PDL prior authorization. Cytokine-CAM Antagonist Clinical Prior Authorization Update VDP added the new Ilaris 150 mg/ml (NDC ) to the Medicaid and CHIP formularies effective April 7, This new Ilaris product was approved by the FDA with additional indications, including: Tumor necrosis factor receptor associated periodic syndrome (TRAPS) in adult and pediatric patients Hyperimmunoglobulin D syndrome (HIDS)/mevalonate kinase deficiency (MKD) in adult and pediatric patients Familial Mediterranean fever (FMF) in adult and pediatric patients VDP will update the Cytokine-CAM Antagonist clinical prior authorization to include the new Ilaris product and indications. Until the criteria guide is updated, VDP authorizes MCOs to apply the current Cytokine-CAM Antagonist clinical prior authorization for Ilaris to the new Ilaris product. MCOs that choose to apply the criteria to the new Ilaris product must allow approval for TRAPS, HIDS/MKD, and FMF in adult and pediatric patients in addition to the criteria currently approved for Ilaris within the clinical prior authorization. VDP will send notice once the revised criteria guide is available. Nuedexta Clinical Prior Authorization Implementation for FFS VDP will implement the Nuedexta clinical prior authorization for individuals enrolled in traditional Medicaid on May 2, This clinical prior authorization was approved by the Texas Drug Utilization Review Board on January 27, The prior authorization remains optional for MCOs.2 4 Parkland Community Health Plan, Inc. PCSK9 Inhibitors Prior Authorization and Addition to Formulary The PCSK9 Inhibitors Repatha and Praluent were added to the Texas Medicaid and CHIP formularies effective April 11, These products, listed below, are non-preferred on the Texas Preferred Drug List (PDL) and require PDL prior authorization, with the exception of Repatha Pushtronx. Repatha Pushtronx was reviewed at the January 2017 Texas Drug Utilization Review Board meeting. Recommendations from the January 2017 meeting will be incorporated into the July 2017 release of the PDL. NDC Product Name Status Praluent 75 mg/ml pen Non-preferred Praluent 150 mg/ml Non-preferred pen Praluent 75 mg/ml Non-preferred syringe Praluent 150 mg/ml syringe Non-preferred NDC Product Name Status Repatha 140 mg/ml Non-preferred syringe Repatha 140 mg/ml Non-preferred SureClick Repatha 140 mg/ml SureClick Non-preferred Repatha 420 mg/3.5 ml Pushtronx No status until July 2017 The PCSK9 Inhibitors clinical prior authorization is available for use by MCOs. The PSCK9 inhibitors clinical criteria, prior authorization form, and addendum (for use with the Texas Standard Prior Authorization Form). The PCSK9 inhibitors clinical prior authorization was approved by the Texas Drug Utilization Review Board in October 2015, and remains optional for MCOs. Managed care - prescribing Provider requirements HHSC Vendor Drug Program April 5, 2017 Background Below under Additional Policy and Business Requirements are pharmacy claims adjudication requirements and information related to prescriber enrollment. Additionally, outreach templates and the VDP Non-Enrolled Prescriber List are attached. Please use the templates and list to outreach to members and prescribers. If the MCO or PBM alters the member template, you must receive approval from VDP. VDP will provide the Spanish translation in the next several days. The VDP Non-Enrolled Prescriber List includes all providers that prescribed a Medicaid-paid drug from to VDP temporary staff are getting phone numbers for these providers from the NPPES NPI Registry. About half of the providers on this list still do not have phone #s. VDP will provide an updated list to the MCOs with the additional phone #s as soon as it s completed. It s possible some of the phone #s may no longer be accurate if the provider did not update the NPPES NPI Registry. Please see direction VDP provided you on 3/15/17 regarding outreach. Please send any specific questions to state.tx.us and copy your contract compliance manager. If the MCO or PBM needs additional assistance in implementing these requirements, please feel free to request a conference call with VDP staff. Additional policy and business requirements 1. Pharmacy claim adjudication a. Starting on October 16, 2017, MCOs and their PBMs must deny all pharmacy claims when the prescribing provider is not enrolled with Texas Medicaid. b. MCOs must ensure the PBM adjudicates the pharmacy claim based on whether the prescribing provider is enrolled with Texas Medicaid on the adjudication date. The PBM will know if the prescribing provider is enrolled with Texas Medicaid if that provider is on the Master Provider File (MPF) on the adjudication date; the provider may be enrolled as a rendering provider or an ordering/ referring/prescribing provider. If the prescribing provider is not enrolled on the adjudication date, the pharmacy claim is not federally compliant and the PBM must deny the claim. c. The PBM should provide a clear message to the pharmacy explaining that the reason for the denial is related to the prescriber not being enrolled. d. Please see table below for examples: Date RX Written Adjudication Date Date Prescriber is on the Texas Medicaid MPF 3/1/2017 4/15/2017 2/1/2017 No 3/1/2017 4/15/2017 4/1/2017 No 3/1/2017 4/15/2017 5/1/2017 Yes PBM Must Deny the Pharmacy Claim ecause Prescriber Not Enrolled Summer 2. 72 Hours Supply a) In accordance with federal law, the MCO and PBM must deny a claim for a 72 hour supply when the prescribing provider is not on the MPF on the adjudication date. 3. National Provider Identifiers (NPIs) a) The MCO and PBM must confirm that the prescribing provider NPI on the claim matches an NPI on the MPF that is eligible to write prescriptions on the adjudication date. If the information does not match, the PBM must deny the claim. Federal regulation requires the NPI of the prescriber who wrote the prescription to be on the claim in the prescribing provider field. The pharmacy may not substitute this NPI with another NPI in order to make the claim payable. HHSC assumes PBMs will not be able to verify at point of sale that the provider whwrote the prescription is the prescribing provider the pharmacy submits on the claim. Therefore, pharmacies must ensure they are adhering to this requirement, and MCOs should include this in the scope of their pharmacy audits. MCOs should educate their pharmacies about this requirement. b) If the NPI in the prescribing provider field is an organizational NPI, such as a hospital NPI, the MCO and PBM must deny the claim. The NPI on the pharmacy claim must be an individual s NPI. If the pharmacy submits the claim with an organizational NPI in the prescribing provider field, the MCO and PBM should direct the pharmacy to contact the organization and obtain the name and NPI of the prescribing provider prior to re-submitting the claim. If the pharmacy is unable to obtain the NPI of the prescribing provider or their NPI is not on the MPF, the MCO and PBM must deny the claim. For example, if a pharmacy submits a claim with a hospital s NPI in the prescribing field, that claim is not compliant and must be denied. The PBM should direct the pharmacy to obtain the NPI of the hospitalist, intern, resident, or other prescribing provider who treated the member and wrote the prescription. c) The NPI requirement also applies to prescribing providers who are authorized to prescribe under a supervising provider s license, such as nurse practitioners, interns, prescribing pharmacists, etc. Pharmacies may not use the NPI of the supervising provider in place of the NPI of the provider who wrote the prescription on a claim. Again, HHSC assumes PBMs will not be able to verify at point of sale that the provider who wrote the prescription is the prescribing provider the pharmacy submits on the claim. Therefore, pharmacies must ensure they are adhering to this requirement, and MCOs should include this in the scope of their pharmacy audits. 4. Master provider file (MPF) a) HHSC will continue to provide the MPF to the MCOs using the current process. Beginning in late April 2017, the MPF will include providers with ordering and referring privileges only (i.e. prescribing providers). b) Both the COMBMPF-yyyy-mm-dd (MPF), and the excluded file (PVEXLjjj where jjj in the Julian date) - will be updated to include the new ORP. See attached MPF image. c) MCOs should be using the MPF on TexMedCentral as the source for provider data. d) Accenture is targeting a completion date of April 28, e) If an MCO wishes to test, they can do so in TXMedReg. The files are available for them to extract and apply to their systems for testing, and Accenture is available to answer questions. However, Accenture has completed official trading partner testing. MCOs should be testing the MPF file changes with their PBM. 6 Parkland Community Health Plan, Inc. Managed care -prescribing provider requirements HHSC Vendor Drug Program April 12, 2017 BACK Background Please see additional questions and responses. Please send any other specific questions to hhsc.state.tx.us and copy your contract compliance manager. If the MCO or PBM needs additional assistance in implementing these requirements, please feel free to request a conference ca
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