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December Newsletter

December 6, 2013

Help Your Patients Find the Info They Need

Your patients might ask you where to call for information about the health insurance exchanges or to learn more about their coverage. Below is some Illinois contact information to help you direct them to the correct source. Members can also call the number on the back of their ID card if they have questions about their coverage. Our reps are happy to help.

Individuals & Families

1-888-382-9771
TTY/TDD: 711 or 1-800-526-0844
HealthAlliance.org

Health Alliance Medicare

Call toll-free: 1-888-382-9771
TTY/TDD: 711 or 1-800-526-0844
HealthAllianceMedicare.org

Health Alliance Connect (Medicaid)

Integrated Care Program (ICP)/Seniors and Persons with Disabilities (SPD)
Client Services: 1-877-933-8480
TTY/TDD: 711 or 1-800-526-0844

Medicare-Medicaid Alignment Initiative (MMAI)/Medicare-Medicaid Plan (MMP)
Client Services: 1-866-951-0264
TTY/TDD: 711 or 1-800-526-0844

HealthAllianceConnect.org

Health Alliance Medical Plans

1-800-815-3379
TTY/TDD: 711 or 1-800-526-0844
HealthAlliance.org

Federal Health Insurance Marketplace

1-800-318-2596
Healthcare.gov

Pharmacy

Medicare

Medicare Updates

Commercial

Formulary Additions

  • Kynamro (mipomersen) – Tier 6 with preauthorization (PA)
  • Juxtapid (lomitapide) – Tier 6 with PA
  • Sirturo (bedaquiline fumarate) – Tier 5 with PA
  • Pomalyst (pomalidomide) – Tier 5 with PA
  • Ravicti (glycerol phenylbutyrate) – Tier 6 with PA
  • Signifor (pasireotide diaspartate injection) – Tier 6 with PA
  • Aubagio (teriflunomide) – Tier 5 with PA
  • Tecfidera (dimethyl fumarate) – Tier 5 with PA
  • Simbrinza (brinzolamide/brimonidine) – Tier 3
  • Osphena (ospemifene) – Tier 3 with Step Therapy edit
  • Fulyzaq (crofelemer) – Tier 3 with PA

Formulary Exclusions

  • Venlafaxine ER tablets – Excluded, available at Tier 1

Drugs Moving to Tier 3 – Effective 1/1/14

  • Apidra and Apidra Solostar (insulin glulisine)
  • Coreg CR (carvedilol extended release)
  • Lialda (mesalamine)
  • Pentasa (mesalamine)
  • Opana ER (oxymorphone ER)
  • Seroquel XR (quetiapine XR)

Drugs Moving to Tier 4 from Tier 5 – Effective 1/1/14

  • Rebif

Drugs Moving to Tier 5 from Tier 4 – Effective 1/1/14

  • Avonex

Drugs Moving to Specialty Tiers (4, 5, 6) – Effective 1/1/14

  • Botulinum toxins (Botox, Dysport, Xeomin, Myobloc) – Tier 5 (Medical Specialty) with PA
  • Ozurdex and Retisert – Tier 5 (Medical Specialty) with PA
  • Budesonide ER  – Tier 4 with PA
  • Entocort EC – Tier 6 with PA

Preauthorization Criteria Updates

  • Ampyra Criteria Updated
    • Patient must be ambulatory
    • Patient baseline walk speed must be between 8 to 45 sec
    • Patients with RRMS must also have documentation of concurrent disease-modifying therapy
  • Testosterone Criteria Modified
    • Documentation of a single low testosterone level for topical and injectable forms of testosterone (previous requirement was 2 low levels).
  • Long-Acting Brand-Name Opioid Step-Therapy Criteria Modified
    • Require trial and failure of a Tier 1 long-acting opioid (effective 1/1/14)

New Smoking Cessation Program

Starting January 1, 2014, Health Alliance will partner with Quit for Life®, the nation’s leading smoking cessation program. This will replace I Can Quit as the program available to our members.

You will soon receive (or might have already received) script pads for your office. The tear-off pads give an overview and contact information for the program. Please use these pads to encourage your patients,our members, to break tobacco’s hold by signing up for this program. It’s free with their coverage.

With Quit For Life, participants are 8 times more likely to quit than going cold turkey. Program features include:

  • One-on-one coaching
  • A customized quit plan
  • Helpful tools, like Text2Quit
  • Web Coach®, an online learning and support community

Quit for Life participants may also be able to use nicotine replacement therapy, like patches, gum, or medicines at reduced copays. Members can call 1-866-QUIT-4-LIFE (1-866-784-8454) or visit QuitNow.net to get started.

New Medicare Dental Coverage Benefit

To better serve our Medicare members, our HMO and PPO plans now include one dental exam for a $0 copayment each year. Members can see any dentist.

The dental coverage also includes:

  • $40 copay for Medicare-covered dental benefits
  • $15 copay for up to one supplemental oral exam(s) every year

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