Skip to main content

SCOPE | Provider Update

April 2024

Clinical Matters

Renewed concerns about the neuropsychiatric effects of montelukast use in children

The asthma medication montelukast (sold under the brand name Singulair) has been tied to an increased risk of neuropsychiatric effects. Here's what prescribers can do to help keep their patients safe.

Montelukast (brand name: Singulair) is used in the treatment of asthma. It has a boxed warning from the Food and Drug Administration (FDA) about serious neuropsychiatric (NP) effects since 2020. These NP effects include agitation, insomnia and other sleep disturbances, aggression, depression, suicidal thoughts, and behaviors. These adverse effects have been reported in patients of all ages, with and without pre-existing psychiatric disease, while taking montelukast or rarely after discontinuation. 

Neuropsychiatric events in children
Among younger individuals, particularly those between the ages of 1 and 17 years, many studies have suggested that use of montelukast is significantly associated with an increased risk of NP events. These adverse events typically involve sleep disturbances, insomnia, and nightmares. However, there may be an increased risk of other adverse events as described above. These adverse events led to a rate of discontinuation that, in at least one study, was higher than that associated with inhaled corticosteroids, the gold-standard of asthma treatment. 

Why the renewed concern?
On February 22, 2024, N.Y. Attorney General Letitia James called on the FDA to increase efforts to alert doctors about potential side effects of Singulair (generic montelukast) and to consider discouraging use of the drug for children. An examination by The New York Times, done in January 2024, found that people continued to report that they were not aware of the possible side effects when they took the medication or gave it to their children.

What can prescribers do?
Prescribers should counsel all patients receiving montelukast about mental health side effects and advise them to stop the medicine and contact a health care professional immediately if they develop any symptoms.

Health care professionals should consider the risks and benefits of montelukast when deciding to prescribe or continue patients on the medicine. Montelukast should be used with caution in patients with pre-existing conditions, especially pre-existing depression.

Although these side effects are rare, authorities recommend informing patients and stopping the medication if they note any mood changes. When patients are educated about the possibility of side effects, montelukast is generally well-tolerated and safe. 

Advance Care Planning: starting the conversation with patients

National Healthcare Decisions Day is April 16, the annual reminder to encourage people to share their wishes for care through the end of life.

Making decisions about advance care planning and having uncomfortable, but necessary, conversations with loved ones regarding end-of-life wishes can prove to be invaluable to families when a health crisis strikes.

It’s important for individuals – your patients – to prepare advance directives in an effort to maintain autonomy during periods of incapacity or at the end of life.

Physician barriers to completing an advance directive include lack of time and discomfort with the topic.

On the patient's part, lack of knowledge, fear of burdening family, and a desire to have the physician initiate the discussion are common barriers.

Overcoming these barriers depends on effective communication at multiple visits, including allowing the patient the opportunity to ask questions. Involving the family or a proxy early and over time can help the process.

It may be helpful to begin to integrate advance directive discussions at selected stages of the patient's life, such as when a new diagnosis has been made or as health status changes.

For more information and guidance, please visit: Implementing Advance Directives in Office Practice | AAFP

Patients can also get started by using resources from The Conversation Project by the Institute for Healthcare Improvement.

Two important components of advance care planning include having a living will, which can include written instructions for end-of-life care, and a health care proxy, which allows individuals to appoint a health care agent – someone they trust to make health care decisions for them – if they are incapacitated or unable to do so themselves.

Experts agree no matter the age, people should consider taking the time to have these conversations, designate a health care proxy, and create a living will. It may very well prevent agonizingly difficult decisions down the road.

Preventing and treating STIs using the three Ts

STIs go undetected and can have serious health consequences. The CDC offers up-to-date educational and informative resources for providers and patients alike. 

The Centers for Disease Control and Prevention (CDC) estimates, as of 2022, more than 2.5 million cases of chlamydia, gonorrhea, and syphilis were reported in the United States. According to the 2022 report, while reported cases of gonorrhea declined and chlamydia remained relatively level, syphilis cases increased 80% in the last five years. 

Many of these infections go undetected because they often have no recognizable symptoms. If left untreated, some of these infections can have serious health consequences and severe, adverse effects including:

  • infertility
  • ectopic pregnancy
  • increased HIV transmission

STIs are preventable and treatable, and most are curable and encourage taking three simple actions— Talk. Test. Treat.

  • Talk openly and honestly to your patients about sexual health and sexually transmitted infections, or STIs.
  • Testing is the only way to know for sure if a patient has an STI. Many STIs don’t cause any symptoms, so patients could have one and not know it.
  • Treat if a patient tests positive for an STI, utilizing evidenced based clinical practice guidelines.

To learn more and view resources for healthcare providers, please visit the CDC’s STD webpages.


NYSDOH issues guidance on NYS law regarding syphilis testing effective May 3, 2024

Testing will now be required during third trimester.

Please note that effective May 3, 2024, NYS law will require a syphilis test during the third trimester of pregnancy in addition to syphilis testing at the time of first examination. Prior to this change, syphilis testing was required at the time of first examination and again at delivery (as per 10 NYCRR section 69-2.2).

Please click HERE for complete reference to this new testing requirement and for interim guidance on syphilis testing during pregnancy in light of this change in the law.

As noted in the release, though the law expansion effectively requires at least three syphilis screens during pregnancy, additional screening may be warranted. 

For questions or inquiries on syphilis screening and/or reporting requirements of same during pregnancy, please contact the NYSDOH Office of Sexual Health and Epidemiology (OSHE) at

Routine Foot care coverage update - important reminder

Benefits vary by plan; verify coverage before rendering podiatry services

Effective June 1, 2024, Independent Health will be following Medicare guidelines from Local Coverage Article A57759 regarding routine foot care for Commercial, Medicare and Self-funded lines of business.

Please note: We have identified instances of members who were receiving coverage for routine foot care that will no longer be covered. We will be notifying those members.  Benefits vary by plan, so please contact Independent Health to ensure coverage before rendering services.

The Routine Foot Care policy and all other Independent Health policies are posted in our provider portal. 

If you have questions, please contact our Provider Relations Department by calling (716) 631-3282 or    1-800-736-5771 Monday through Friday from 8 a.m. to 6 p.m.

Office Matters

Contraception coverage can be as low as $0 for your patients

Benefits cover contraceptive drugs, devices, methods and counseling

Independent Health offers more than sixty $0 cost preventive services to our commercial and FEHB members. (Self-funded plan members should check their plan documents for details.) Included on this comprehensive list are all FDA-approved contraceptive drugs, devices, methods, and counseling services.

Health care providers may find the FDA’s birth control chart a helpful tool. The chart is not meant to be a complete list of all available or covered items, but it does include many of the products covered under this benefit. View the chart on the FDA’s website.  

Covered contraceptive drugs & devices 
Prescription drugs and devices: Our drug formulary covers most generic formulations of contraceptive items, and brand name drugs and devices when no generic alterative exists. The $0 cost prescription covers up to a one-year fill. Find our drug formularies here.

Over-the-counter drugs and devices: Many over-the-counter contraceptive drugs and devices are also covered at $0 cost, including male and female condoms, spermicides, and sponges. Patients need a prescription for these over-the-counter items to take advantage of the $0 cost benefit.

Thank you for your continued partnership as we work together to keep our community healthy and safe.


Now open: 2024 Required Compliance Training and Attestation

Independent Health is required by state and federal agencies to ensure our participating providers complete this annual compliance training.

The 2024 training modules for our participating providers to complete their annual required training are now available on our website.

Independent Health is required by state and federal agencies to ensure our participating providers complete this annual compliance training.  

Staff members of practices required to complete this training include physicians, mid-levels, ancillary providers, registered nurses, licensed practical nurses, administrative and office staff, technicians, coders and others.

 Once again, participating practices have to attest to completing each of the following by December 31, 2024:

1. Cultural Competency Training 
All providers who treat Independent Health’s commercial and state program must attest annually that they have completed cultural competency training for all staff who have regular and substantial contact with Independent Health members.

In addition, the New York State Department of Health requires that all providers annually attest to completion of cultural competency training for all staff who have regular and substantial contact with Independent Health Medicaid and HARP members. 

To satisfy this training requirement, staff must complete the U.S. Department of Health & Human Services  online module, “The Guide to Providing Effective Communication and Language Assistance Services,” or the comparable Think Cultural Health training that corresponds with the provider’s scope of practice, and submit the electronic attestation to confirm completion.
This cultural competency training and attestation is available online.
2. Fraud, Waste & Abuse Training 
Independent Health requires each of its participating provider groups or practices to complete Fraud, Waste & Abuse Training and submit an electronic attestation to confirm completion of this training by each of their staff members. 
Staff members of practices required to complete this training includes physicians, mid-levels, ancillary providers, registered nurses, licensed practical nurses, administrative and office staff, technicians, coders and others.
If your practice has already completed the 2024 Fraud, Waste & Abuse training and attestation through Independent Health, it is not necessary to attest to doing so again. 
All related details, the downloadable training modules for your staff, and an attestation to verify with Independent Health that this training has been completed are available online.
Who must submit each attestation?
 Each of the above attestations should be submitted by an authorized representative on behalf of all individuals under a practice’s Tax Identification Number (TIN). Therefore, each individual staff member who completes each training does not need to submit the attestation.
If your practice has already completed this 2024 training through another source and has a roster or spreadsheet with the dates the training was completed, you may submit the attestation through each of Independent Health’s public provider portal pages above.
If you have questions, please call Independent Health Provider Relations Department at (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m.


Take note: Phone survey about NYS standards for access & availability coming soon

Representatives will begin conducting the annual phone survey about appointment access and availability for Independent Health members to ensure compliance with requirements.

To ensure compliance with standards established by New York State for our participating providers, Independent Health has partnered with an outside vendor, SPH Analytics, to conduct brief surveys by phone regarding appointment access and availability for our members.

Over the next several weeks your office may receive a phone call from a surveyor from SPH Analytics to ask questions pertaining to your practice’s appointment availability times for both routine and after hours care as outlined in our Appointment Accessibility and After Hours Access policy.

This survey will be directed to specific types of providers, including primary care,  medical oncologists, OB/GYNs, clinical neuropsychologists, psychiatrists, psychologists, and certified social workers.

As an example, a surveyor identifying themself as from SPH Analytics would call a primary care office to discuss the scenario of a patient who calls to ask for the timeframe to schedule an appointment.   Each discussion with an SPH Analytics surveyor is recorded and shared back to Independent Health. 

All scenarios presented are based on the following types of care: 

  • Emergent
  • Urgent
  • Sick visits (routine non-urgent/emergent)
  • Routine, non-urgent or preventive care
  • Adult baseline and routine physicals

Please make your staff aware of this possible call to your practice so it may be responded to appropriately.

Thank you for your efforts to help us adhere to the New York standards for appointment access and availability.

Upcoming member campaigns to encourage our members to take greater control of their health

Throughout the year, the Health Care Services and Population Health Management Departments deploy various tactics to encourage members to take a more active role in their health.

During the month of April, Independent Health will be conducting the following member engagement/outreach campaigns:

Healthy IDEAS Intervention for Members with Heart Failure
This intervention targets Medicare HMO/PPO members with Heart Failure who have a depression diagnosis.  The goal is to link the member to the WNYICC Healthy IDEAS program to help manage their depression symptoms.

This campaign includes member letters with education around the Healthy IDEAS program and encourages members to call the Behavioral Health Case Management team to complete a referral.

  • Targeted Cohort: Medicare HMO & PPO members who have a diagnosis of Heart Failure and Depression
  • Launch Date: Conducted monthly throughout 2024

Pharmacy Updates

Novo Nordisk discontinuing Levemir insulin

Cost-effective alternatives are available on Independent Health's drug formularies

The drug manufacturer Novo Nordisk recently announced the decision to permanently discontinue the production of Levemir insulin in the United States.

The Levemir® FlexPen® will be discontinued by April 2024, and the Levemir® vials will be discontinued by December 2024. However, Levemir is expected to have supply shortages starting early in the year. To avoid therapy disruptions, Independent Health is encouraging providers to discuss alternative treatment options with their patients as soon as possible.

Affordable Care 

Independent Health remains committed to optimizing the use of safe, effective, and affordable treatment options for our members. The accessibility and cost of anti-glycemic therapy has become a common concern for patients who are managing diabetes.

Our drug formulary covers numerous anti-glycemic agents, both oral and injectable. The long-acting insulin products below are currently the most cost-effective options for our members and our health care system.

  • Lantus Solostar® Solution Pen-Injector 100 unit/ml
  • Lantus® Solution 100 unit/ml

A complete list of covered products can be found on our drug formularies.

Formulary and Policy Changes

Stay up-to-date on Independent Health's pharmacy policies and formulary updates.

Formulary Deletions
The following documents are available in PDF. Please download them, as they contain important information and updates.

Magellan Rx, administered by Magellan Rx Management, reviews select specialty drug prior authorization requests on Independent Health’s behalf. To view Magellan Rx policies for the drugs that they review, click here.


Independent Health's drug formularies
Access Independent Health's drug formularies here.

To obtain a hard copy, please contact Independent Health Provider Relations by calling (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m.


In the News

Getting to know Independent Health's newly appointed president Jim Dunlop - Healthy Vision blog, Feb. 27, 2024

As part of Independent Health's recently announced leadership succession planning process, longtime President and CEO, Michael W. Cropp, M.D., will remain CEO of Independent Health, and will be supported by Jim Dunlop, who was elevated from Chief Financial Officer to the role of President on February 26. 



Top Takeaways this Month

Office Matters for Adult PCP Practices: Behavioral Health: Join us on April 24. View the agenda and register here

Need a quick refresher on which plan pays first and how insurance plans coordinate benefits? Check out this brief article