Connection supplemental articles and policies – November 2011
Supplemental articles
Payment policies
New policy – effective January 1, 2012
Revised policies – effective January 1, 2012
The following polices have been updated; details about the changes are indicated on the policies.
Back to top
Let’s connect
Taiese Bingham, M.S., Ph.D.; Stephen Feldman, R.Ph., F.A.S.C.P., Beacon Health Strategies
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common chronic conditions in children, with an overall prevalence estimated at 8% to 10%.
According to the American Academy of Pediatrics Clinical Practice Guidelines for the treatment of ADHD:
- In children who present with inattention, hyperactivity, impulsivity, academic underachievement or behavior problems, clinicians should initiate an evaluation for ADHD.
- Once a child is diagnosed with ADHD, clinicians should begin a trial of medication as part of a treatment plan. Selecting a starting dose and times of administration is crucial to a child’s medication management plan. Once-daily dosing is helpful for school-aged children and prevents the need to send a medication supply to the school nurse. Titrate the dose upward every 1 to 3 weeks until there is adequate response, maximum dose is achieved or side effects preclude a further dose increase.
- In order to assess for side effects and symptom improvement, initial follow-up should be initiated within one month or less of medication therapy initiation. Common side effects associated with ADHD medications include:
- Headache
- Insomnia
- Decreases in appetite or weight loss
- Tics
- Emotional lability/irritability.
NCQA’s HEDIS 2010 Quality Performance Measurement, Follow-Up Care for Children Prescribed ADHD Medication, defines recommended follow-up member visit intervals to be:
- Within 30 days or less from the initial medication dispensing date; and
- At least two or more visits with their practitioner during the next 9-month period.
Check out Beacon’s easy-to-follow ADHD Medication Treatment Algorithm as a good reference tool.
Beacon Health Strategies, FCHP’s behavioral health partner, promotes increased collaboration and coordination between clinicians and behavioral health specialists for the treatment of ADHD. Beacon offers the following support to clinicians:
-
Decision Support line (1-877-249-6659), a free service available to all physicians seeking consultation and advice about ADHD
-
Clinical tools to assist providers (beaconhealthstrategies.com)
For more information about the ADHD Program at Beacon Health Strategies, contact Beacon at 1-888-421-8861.
Back to top
Script Alert
Healthwise® Knowledgebase is one of the nation’s leading online health resources—and it’s available freethrough FCHP’s Web site, fchp.org . A special Healthwise feature we offer through their site is the Drug Interaction Checker. We hope you’ll tell your patients about it.
You know that prescribed medications can be affected by other prescriptions or over-the-counter drugs your patients take, by foods they eat, or by vitamins, herbal supplements or other medicines. Some of these interactions can be dangerous. It’s difficult to keep track of the potential risks.
Now, your patients can go to the Healthwise Drug Interaction Checker, create their personal drug list and check for drug-to-drug and other interactions. It’s an easy way to confirm that the medicines and supplements they are taking together and with certain foods are safe. You can encourage your patients to talk with you about interactions that might be flagged by the checker.
To find the Drug Interaction Checker, go to fchp.org, click on Healthwise® Knowledgebase, under “Helpful tools” at the bottom. Then, on the Healthwise home page, look under Quick Links for the Drug Interaction Checker. Please pass on information about this great safety tool.
Back to top
Fallon Community Health Plan often makes changes to its formularies, including changing prior authorization requirements and adding new medications. See the latest changes below to our commercial plan and Medicare Part D formularies.
Commercial plan formulary |
Additions |
|
Altavera (eth estradiol/levonorgestrel) |
Tier 1 |
Amethyst (eth estradiol/levonorgestrel) |
Tier 1 |
Atelvia (risedronate DR) |
Tier 3, QL 4 per month |
Azurette (desogestrel/eth estradiol) |
Tier 1 |
Budesonide SR |
Tier 1 |
Butrans (buprenorphine ptch) |
Tier 3, PA required |
Carbaglu (carglumic acid) |
Tier 3, PA required |
Caziant (desogestrel/eth estradiol) |
Tier 1 |
Cuvposa (glycopyrrolate) |
Tier 3, PA required |
Cycloset (bromocriptine) |
Tier 3, PA required |
Jevantique (eth estradiol/norethindrone) |
Tier 1 |
Kapvay (clonidine ADHD) |
Tier 3, PA required |
Levofloxacin (oral and ophth) |
Tier 1 |
Methylergonovine Tab |
Tier 1 |
Phoslyra (calcium acetate) |
Tier 3 |
Pramcort (pramoxine-HC) |
Tier 1 |
Syeda (drospirenone/eth estradiol) |
Tier 1 |
Trianex (triamcinolone) |
Tier 3 |
Vimovo (naproxen/esomeprazole) |
Tier 3, PA required |
Zarah (drospirenone/eth estradiol) |
Tier 1 |
New to Market Policy*
Arcapta (indacaterol)
Brilinta (ticagrelor)
Naproderm (naproxen, topical)
Xarelto (rivaroxaban)
* FCHP’s New to Market Policy was enacted to ensure patient safety and to allow for adequate time for the development, review and approval of clinical criteria. When a new medication first becomes available, it will fall under this policy and be excluded from coverage. A process is in place that allows for the quick review of provider requests for non-covered pharmaceuticals.
Back to top