FLASH: P & T Changes and HCMD List Changes for December
January 14, 2025Pharmacy Updates
Pharmacy Updates
A Season of Gratitude The end of the year is upon us, with the beauty of the holidays shining all around us. During this season of cheer and gratitude, we want to express our deepest thanks to you. All year long you work hard to keep our members healthy, and it’s your expertise and dedication that keep their bodies, minds and spirits well. We’re grateful for your partnership, and we wish you, your staff and your loved ones a blessed holidays and wonderful start to 2025.
Effective 7/1/24, Health Alliance™ added Omnipod insulin pods to the Medicare Part D formulary. Coverage of Omnipods does require Prior Authorization.
After careful consideration, Health Alliance™ has made the decision to stop covering consultations billed with codes 99242-99245 and 99252-99255. Providers should bill the appropriate evaluation and management code in place of the consultation codes. Health Alliance will continue to cover any add-on codes if additional time is needed to evaluate the patient. This change will be applicable to dates of service starting on January 1, 2025. This new rule will apply to all lines of business, including group, individual and Medicare Advantage.
This is a reminder to register for the Health Alliance™ Fall Education Series that will focus on our provider portal. In our latest provider surveys, you told us that there’s a need for better understanding of our portal and the various functions that can be accomplished in it.