As It Relates to You

Use In-Network Providers

Remember to use contracted in-network providers before referring a patient outside our network. You can search a member’s network on Your Health Alliance for providers by attaching to that member.

When our members need services that aren’t available from an in-network provider, they might be able to get those services from a provider in their secondary or tertiary network. You can also access this while attached to a member.

Submit Claims Inquiries and Appeals Online

Please remember to submit claims inquiries and appeals online. Use the New Inquiry form under the Claims tab of Your Health Alliance for providers. Search for a specific claim and submit a Claim Reprocessing Inquiry.

Pharmacy Updates

Formulary Additions

Dermatology

• Qbrexza (glycopyrronium)
• Indicated for the topical treatment of primary axillary hyperhidrosis in adult and pediatric patients age 9 years or older
• Formulary placement
• Medicare—Non-Formulary
• Seysara (sarecycline)
• Indicated for the treatment of moderate to severe acne vulgaris in patients 9 years or older
• Formulary placement
• Medicare—Non-Formulary
• Xepi (ozenoxacin)
• Indicated for the treatment of impetigo due to Staphylococcus aureus or Streptococcus pyogenes in adult and pediatric patients ≥ 2 months of age
• Formulary placement
• Medicare—Non-Formulary
• Ilumya (tildrakizumab-asmn) and Skyrizi (risankizumab)
• Both drugs are indicated for the treatment of moderate-to-severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy
• Formulary placement
• Medicare—Non-Formulary

Pulmonology

• Arikayce (amikacin liposomal)
• Aminoglycoside antibiotic indicated for treatment of Mycobacterium avium complex (MAC)
• Formulary placement
• Medicare—Tier 5 with PA
• Yupelri (revefenacin)
• Long-acting muscarinic antagonist agent indicated for the treatment of COPD
• The first once-daily nebulized bronchodilator approved for COPD
• Formulary placement
• Medicare—Tier 4 with PA and B vs. D determination

Medicare

Mupirocin 2% Cream: Moved from Tier 1 to Non-Formulary

• Mupirocin 2% ointment covered at Tier 1