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SCOPE | Provider Update

March 2024

Clinical Matters

It's Colorectal Cancer Awareness Month: time to review screening guidelines

While colorectal cancer remains a leading cause of death, the survival rate is high if the cancer is found and treated early enough. 

In recognition of Colorectal Cancer Awareness Month in March, it’s timely to review some statistics about this preventable and treatable disease:

  • According to the Centers for Disease Control and Prevention (CDC), colorectal cancer is a leading cause of cancer death in the United States.
  • The National Cancer Institute estimates that more than 150,000 people in the U.S. were diagnosed with cancer of the colon or rectum in 2023, and roughly 52,000 people died from colorectal cancer.

Now for some good news: about nine out of every 10 people whose colorectal cancers are found early and treated appropriately are still alive five years later.

As a reminder, the U.S. Preventive Services Task Force (USPSTF) Prevention Guidelines - Grade A and B Screening recommendations are below:

Adults aged 45 to 85

People should get screened starting at age 45 and continue until age 75. The decision to screen for colorectal cancer in adults ages 76 to 85 should be an individual one.

Available testing options:

  • Guaiac-based fecal occult blood test (gFOBT) every year
  • Fecal immunochemical test (FIT) every year
  • Stool DNA-FIT test every one or three years
  • Flexible sigmoidoscopy every five years
  • Flexible sigmoidoscopy every 10 years plus FIT every year
  • Colonoscopy every 10 years


Independent Health covers colorectal cancer screening for members with $0 cost share.

For more information and additional guidance, visit the USPSTF website

Talking to patients about keeping their kidneys healthy

Early-stage kidney disease usually has no symptoms. This article discusses how to speak to patients about maintaining good kidney help. 

According to the National Institute of Diabetes, Digestive & Kidney Disease (NIH), chronic kidney disease (CKD) affects more than one in seven U.S. adults - an estimated 37 million Americans. CKD is the presence of "an abnormality in kidney structure or function persisting for more than three months." 

For those with diabetes or high blood pressure—the two most common causes of kidney disease—the risk for CKD is even greater.

Early-stage kidney disease usually has no symptoms, and many people don’t know they have CKD until it is very advanced. Kidney disease often gets worse over time and may lead to kidney failure and other health problems, such as stroke or heart attack.

Talking points to help keep your patients' kidneys healthy:

Patients may be unfamiliar or unaware of CKD or ways to maintain kidney health. Generally, practicing healthy habits can keep patients' healthy:

  • Keep active! Regular exercise is good for your body and your kidneys. It can lower the risk of chronic kidney disease.
  • Manage your blood sugar. People with diabetes, or a condition that causes high blood sugar, may develop into kidney damage.
  • Monitor blood pressure. High blood pressure can cause kidney damage. If high blood pressure occurs with other health issues like diabetes, heart disease, or high cholesterol, the impact on the body can be significant.
  • Monitor weight and eat a balanced diet
  • Don’t smoke. Smoking damages the body’s blood vessels. This may lead to slower blood flow throughout the body and to the kidneys.

Kidney function tests for those at high risk

The following people may benefit from regular screening:

  • people who are over 60 years old
  • people who have cardiovascular disease or have family members with it.
  • people who have or have a family history of high blood pressure.
  • people who are obese.

For those diagnosed with chronic kidney disease (CKD), talk with your patients about the possible need to see a kidney specialist.

To learn more about Kidney Health, visit these following resources:

For more information about quitting smoking, please visit How To Quit - NY SmokeFree

Office Matters

Coming soon: Behavioral health coordination of care survey

Independent Health wants to make sure we are meeting your needs and ask for your help by completing this important survey. 

As part of Independent Health’s ongoing effort to support patient needs, we are seeking feedback regarding the exchange of information and coordination of care between behavioral health clinicians and primary care providers so we may help better facilitate patient care. 

On March 4, primary care providers and behavioral health clinicians will receive a survey. By completing it, you will help us to comply with accreditation standards set by the National Committee for Quality Assurance (NCQA).

The NCQA accreditation period spans over three years, with 2024 being our last reporting period in the current three-year cycle.  Independent Health uses the feedback received from these surveys to develop our strategies to improve the integration of care and information-sharing across the physical and behavioral health continuums to ensure our tactics align with the needs of our provider partners and members. 

Over the last three years we have used your feedback to build interventions to benefit our members.  This last survey is for us to monitor the results only; however, if significant concerns are identified in in the survey results additional actions may be taken to address information will be used if there are any significant trends identified in the survey results.

We will be sending the survey to primary care providers and behavioral health providers, so we ask that you please be on the lookout for it. It is encouraged to have each provider at your practice complete a survey, so please make sure to share the link with them. 

As always, we appreciate your assistance in improving the quality care patients receive.

Pharmacy Updates

COVID-19 antiviral drugs added to formularies

Paxlovid and Lagevrio have been added to the Medicare and commercial formularies.

Paxlovid and Lagevrio, now commercially available, were added to the Medicare and commercial formularies effective February 1.

The FDA recently announced guidelines for transitioning away from the government-managed distribution of the drugs to traditional commercial distribution. Therefore, it was important we made this coverage change to ensure these medications are accessible to our members. 

Patient drug costs for these antivirals

Independent Health members enrolled in a Medicare Advantage plan have a $0 cost share for either drug.

Our members enrolled in a Commercial (Employer and Individual/Family), Essential, or a Child Health Plus Plan will see the drugs added in Tier 2.

If you have patients concerned about drug costs, the manufacturer of Paxlovid is offering a Patient Assistance Program. Details are available online.  


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

Independent Health ranked number 1 out of 79 FEHB plans in 2023 for our Clinical Quality, Customer Service, and Resource Use score, calculated using commercial Quality Compass benchmarks from NCQA. Independent Health received the highest score in 15 categories out of 23 categories, including cancer screenings, blood pressure control, overall health plan rating, and diabetes care.