SCOPE | Provider Update
June 2025
Clinical Matters
Proactive management of pregnancy/postpartum emergencies improves outcomes
The risk of pregnancy-related complications continues for one year after a pregnancy ends. It's important to be aware of the urgent maternal warning signs from complications.
As a health care provider, you play a critical role in eliminating preventable maternal morbidity and mortality.
That’s why Independent Health has created an evidence-based online Maternity toolkit to assist you with educational content, tools, and resources.
The risk of pregnancy-related complications continues for one year after a pregnancy ends. It’s crucial for any health care professional to identify patients who are pregnant or who were pregnant in the last year and to be aware of the urgent maternal warning signs from complications.
Always Ask if Your Patient Is Pregnant or Was Pregnant in the Last Year
Pregnancy or postpartum status may not be something your patient or their support thinks about sharing, particularly with their primary care physician, but it could be the difference in making an accurate and timely diagnosis.
According to the Centers for Disease Control and Prevention (CDC), some warning signs that could signal a medical emergency include:
- Severe headache
- Dizziness or fainting
- Changes in vision
- Fever
- Trouble breathing
- Overwhelming tiredness
- Chest pain
- Severe belly pain
- Severe nausea and vomiting
- Severe swelling
- Thoughts about harming self or baby
Immunizations
The Advisory Committee on Immunization Practices (ACIP) clinical guidelines recommend that all women who are pregnant or who might be pregnant in the upcoming influenza season receive inactivated influenza vaccines.
ACIP also recommends that pregnant women receive one dose of Tdap during each pregnancy, preferably during the early part of gestational weeks 27 to 36, regardless of prior history of receiving Tdap.
Important reminders
- Always discuss immunization status.
- Screen patients for depression utilizing an evidenced-based, validated screening tool (ex: PHQ2/9), and refer to a Behavioral Health Specialist, if the patient has a positive screen.
- Ensure linkage with an Obstetrician or Nurse midwife for early prenatal care, if pregnant.
- Perform a medication review and assess for potential contraindications.
- Document pregnancy information and any referrals made.
Need Help?
To assist you in helping patients manage uncontrolled chronic diseases or for care coordination needs, please call Independent Health’s Case Management team (716) 635-7822 from Monday – Friday, 8 a.m. to 5 p.m. One of our Case Managers will assist.
View our Maternity Toolkit is under the Resources menu on the secure provider portal.
Helpful Resources
Warning Signs poster: Urgent Maternal Warning Signs Educational Materials | HEAR HER Campaign | CDC
Dietary Guidelines for Americans, 2020 - 2025: Professional Resources | Dietary Guidelines for Americans
Patient Health Questionnaires: Administering the Patient Health Questionnaires 2 and 9 (PHQ 2 and 9) in Integrated Care Settings
Care coordination is integral to patients' health and recovery
Independent Health offers a variety of case management programs that can assist providers to coordinate appropriate care for their patients.
While lack of coordination leads to negative outcomes, communication and coordination lead to better chances for improved outcomes.
Independent Health has long recognized that when doctors and other health care providers work together and share patient information, the patients’ needs and preferences are made known and communicated at the right time to the right people, and the information is used to provide safe, appropriate, and effective care. This can help to keep patients healthier longer, better manage chronic conditions and experience care that is consistent with their goals.
When doctors and other health care providers don’t communicate effectively with each other, treatments prescribed by different doctors for a patient’s different health issues might conflict or become unmanageable for the patient. Lack of coordination can lead to negative health outcomes for patients, such as:
- Increased use of emergency care
- Medication errors
- Poor transitions of care from hospital to home, or other setting
- Medical errors
- Readmissions
These effects can have a larger negative impact on chronically ill patients or patients with multiple complex health conditions.
Discharge from a hospital is a critical transition point in a patient’s care. Poor care coordination at discharge can lead to adverse events for patients and avoidable rehospitalization. Health risks associated with hospitalization include infection, adverse drug events, loss of function, isolation and negative quality of life, and readmission.
Medication reconciliation also plays an integral role. This process is important to improve patient safety, for identifying and resolving discrepancies, such as duplicates, omissions, or incorrect dosages. By helping to reduce medication errors and adverse drug outcomes, patient safety is preserved.
Ideas for providers to help improve care coordination
- Use Care Coordinators or assign designated staff to improve care coordination efforts.
- Use a universal EHR care coordination screening tool.
- Build digital tools that allow care coordinators, social workers, and providers to identify community partners that address social determinants of health and make direct referrals.
Independent Health’s Care for You program helps our members with chronic health conditions get the medical care and assistance they need without having to navigate the health care system alone.
To address the specific and extensive care required by individuals with multiple chronic conditions, Care for You involves a dedicated care team of physicians, physician assistants, nurse practitioners, registered nurses, social workers, dietitians, and community health workers who work with the patients to develop individualized, proactive care plans in concert with their primary care physician. Care for You enhances access to the most appropriate care for individuals in order to reduce hospitalizations, readmissions and emergency room visits by wrapping around the delivery system to help enhance coordination and communication.
Independent Health offers a variety of case management programs that can assist providers to coordinate appropriate care for their patients. Programs are coordinated by licensed health professionals who include Registered Nurses, a Certified Diabetic Educator/Registered Dietitian, Exercise Physiologist and Behavioral Health Specialists.
For additional information and resources, please visit:
- Independent Health's Provider Portal > Resources tab
- Care Coordination | CMS
- Agency for Healthcare Research and Quality (ahrq.gov) Medication Safety
Ways to limit risky medication combinations in older patients
This article includes a chart of alternative agents with lower anticholinergic activity to minimize or eliminate the anticholinergic burden.
Anticholinergic Agents
Anticholinergics have consistently appeared on the Beers Criteria as potentially inappropriate medications for older adults due to their heightened sensitivity to side effects from these medications. These adverse effects include tachycardia, urinary retention, constipation, dry mouth, blurred vision, exacerbation of narrow-angle glaucoma, cognitive impairment, psychomotor slowing, confusion, sedation, and delirium.
Current guidelines advise avoiding the concurrent use of two or more anticholinergic drugs due to the elevated risk of these side effects, particularly cognitive decline (such as delirium, dementia, and cognitive impairment). The longer these medications are used, the greater the associated risk.
To promote safer prescribing, limit anticholinergic medication use in individuals over 65 and consider deprescribing when feasible. When an anticholinergic drug is necessary, recommend using the lowest effective dose for the shortest duration and regularly reassessing its benefit. Additionally, explore alternative agents with lower anticholinergic activity to minimize or eliminate the anticholinergic burden.
Below is a list of alternatives for reference:
High Risk Anticholinergic Medications |
Safer Alternatives |
---|---|
Antidepressants: amitriptyline, desipramine, amoxapine, clomipramine, doxepin, imipramine, trimipramine, nortriptyline, paroxetine |
Sertraline, escitalopram, venlafaxine, trazodone, duloxetine |
Muscle Relaxants: cyclobenzaprine, orphenadrine |
Treat underlying problem with non-pharmacologic treatment physiotherapy, heat, or cold application; correct seating and footwear For spasticity: antispasmodics like baclofen or tizanidine |
Antihistamines: brompheniramine, chlorpheniramine, cyproheptadine, dimenhydrinate, diphenhydramine (oral), doxylamine, hydroxyzine, meclizine, triprolidine |
Alternative antihistamines: loratadine, fexofenadine, cetirizine For anxiety: escitalopram, venlafaxine, duloxetine, or buspirone For sleep: low dose trazodone For nausea: ondansetron or granisetron |
Antiparkinsons agents: Benztropine, trihexyphenidyl |
For extrapyramidal disorders caused by antipsychotic medications: decrease antipsychotic dose or switch to atypical antipsychotic such as risperidone or aripiprazole. |
Antipsychotic Medications: chlorpromazine, olanzapine, clozapine, perphenazine |
Alternative atypical antipsychotics: risperidone or aripiprazole. Caution with all antipsychotics especially in elderly with dementia. |
Antimuscarinics (urinary incontinence) medications: darifenacin, fesoterodine, flavoxate, oxybutynin, solifenacin, tolterodine, trospium |
Nonpharmacological interventions: lifestyle interventions (dietary modifications, weight loss, fluid restriction), bladder training, pelvic floor muscle training and other physical therapy
Pharmacologic alternative: Myrbetriq |
Antispasmodic Medications: atropine, dicyclomine, clidinium-chlordiazepoxide, homatropine, hyoscyamine, scopolamine |
Use lowest effective dosage for shortest duration possible; make sure still indicated & necessary |
Antiemetic Medications: prochlorperazine, promethazine |
Ondansetron or granisetron |
Opioids & Benzodiazepines
Simultaneous use of opioids and benzodiazepines raises the risk of potentially fatal severe respiratory depression or overdose. According to the 2023 Geriatric Beers Criteria, healthcare providers should avoid prescribing opioid pain medications and benzodiazepines together whenever possible, except when patient circumstances necessitate appropriate concurrent use (e.g., severe acute pain in a patient on long-term, stable low-dose benzodiazepine therapy).
For chronic pain management, non-pharmacologic options include acupuncture, chiropractic care, cold and heat therapy, exercise, movement, massages, occupational therapy, physical therapy, rehabilitation therapy, and high-tech treatments using radio waves and electrical signals.
Cognitive behavioral therapy has demonstrated effectiveness in treating depression, anxiety, stress, and chronic pain. As safer alternatives for anxiety treatment, consider escitalopram, venlafaxine, duloxetine, or buspirone.
The CDC recommends tapering opioid medications before tapering benzodiazepines due to the higher risks associated with benzodiazepine withdrawal compared to opioid withdrawal.
To learn more, here is a link to deprescribing resources and guidelines.
Anti-Inflammatory Reliever (AIR) Therapy for Asthma
Understanding the significant advancement in asthma management
Anti-Inflammatory Reliever (AIR) therapy involves the use of a combination inhaler for both maintenance and immediate relief of asthma symptoms. Combination inhalers that work for AIR must contain two key medications:
1. Formoterol: a long-acting beta2-agonist (LABA) that acts as a reliever medication, quickly opening the airways to alleviate acute symptoms.
- The onset of action of formoterol is within 5 minutes after inhalation. It typically lasts up to12 hours.
- The onset of action of albuterol is also within 5 minutes after inhalation or nebulization. However, unlike formoterol, albuterol typically only lasts 3-6 hour
2. Inhaled Corticosteroid (ICS): This component addresses the underlying inflammation in the airways, which is a primary cause of asthma symptoms and exacerbations. The steroid used most is budesonide. This allows a combination product containing budesonide and formoterol (generic Symbicort) to be used. Mometasone may also work, but the combination (generic Dulera) is not covered on any line of business at Independent Health.
The combination of these medications in a single inhaler (generic Symbicort) allows for both immediate relief of symptoms and long-term control of inflammation, making it a dual-action therapy. It is important to know that Symbicort and its generics are not FDA approved for use as AIR, though it is guideline recommended.
Other LABA agents (including salmeterol and vilanterol) do not work fast enough to be used as AIR therapy. If considering AIR, do not order generic Advair (fluticasone/salmeterol) or Breo (fluticasone/vilanterol).
Benefits of AIR Therapy
- Immediate Symptom Relief: Formoterol provides rapid bronchodilation, offering quick relief from acute asthma symptoms such as wheezing, shortness of breath, and chest tightness
- Inflammation Control: The budesonide component works to reduce airway inflammation, which helps in preventing future exacerbations and maintaining long-term asthma control.
- Reduced Need for Multiple Inhalers: By combining both medications in one inhaler, AIR therapy simplifies the treatment regimen, potentially improving patient adherence to their asthma medications.
- Flexibility in Use: AIR therapy can be used as needed for symptom relief or as part of a single maintenance and reliever therapy (SMART) plan, providing flexibility based on the patient's needs.
When to Prescribe AIR Therapy
The as needed use of a short acting beta agonist (SABA) with an inhaled corticosteroid is recommended as Step 1 therapy in children 12 years and older. Simplifying this to as needed low dose budesonide /formoterol is the preferred controller in this population. This combination can also be used in children aged 6 to 11.
AIR therapy is particularly beneficial in the following scenarios and offers benefits over typical treatment with albuterol:
- Newly Diagnosed Asthma: For patients newly diagnosed with asthma who experience occasional symptoms, AIR therapy can provide both immediate relief and long-term control.
- Seasonal Asthma: Patients who experience asthma symptoms primarily during certain times of the year, such as pollen season, can benefit from the dual-action of AIR therapy.
- Exercise-Induced Asthma: For patients whose asthma is triggered by physical activity, AIR therapy can offer quick relief and reduce inflammation, making it easier to manage symptoms during and after exercise.
- Allergen-Triggered Asthma: Patients who have asthma symptoms triggered by specific allergens, such as pet dander, can use AIR therapy to manage acute symptoms and control inflammation.
Conclusion
AIR therapy offers a comprehensive approach to asthma management by combining immediate symptom relief with long-term inflammation control. Its flexibility and effectiveness make it a valuable option for various asthma presentations. Physicians should consider AIR therapy for patients who require both rapid relief and ongoing control of their asthma symptoms.
For more information, refer to the latest guidelines and clinical studies on AIR therapy. Global Strategy for Asthma Management and Prevention [Web document]. Retrieved from: www.ginasthma.org.
Office Matters
Submit 2025 Gaps-in-Care Corrections through the portal
Our online resources are available to help with gaps-in-care reporting.
Gaps in Care Correction allow for submitting medical record documentation to “close gaps” for deficiencies in quality measure results due to a variety of reasons, including:
- Encounters or lab values not available to the health plan;
- Exclusions from a historical event (e.g., mastectomy);
- Service that was rendered under a different payer.
The Gaps-in-Care Correction process is not a “replacement” for the normal claims process and practices should not focus on submitting documentation for services that were just rendered recently.
If Independent Health accepts the documentation submitted, the correction should be reflected in an update to your, and Independent Health’s, quality rates, which allows for:
- A more accurate depiction of the quality of care that was rendered;
- More accurate quality program reporting;
- More targeted quality improvement effort.
Online Resources
- View the Gaps-in-Care Correction Process User Guide for more information about how to submit corrections. To view the document, enter "Gaps in Care" as a search term in Document Manager.
- View Correctable Measures for 2025. Enter “Correctable Measures” as a search term in Document Manager.
- View a webinar about the Gaps in Care Correction Process.
The last day to submit Gaps-in-Care Corrections for 2025 is Wednesday, December 31, 2025.
A few measures of note for 2025 are below:
- Eye Exam for Patients with Diabetes (EED) measure is now an administrative only measure and will no longer be able to be collected during our “hybrid” HEDIS season during the spring. Gap in Care Corrections may be submitted for this measure to help improve rates.
- Cervical Cancer Screening (CCS-E) is now an ECDS measure and will no longer be able to be collected during our “hybrid” season. Gap in Care Corrections may be submitted for this measure to help improve rates.
- Breast Cancer Screening (BCS-E) measure has an updated date range of 40 to 74 years of age, however, the 40-to-50-year-old age range won’t begin to show up as gaps on the provider portal until we switch over to the updated software in the fall.
- Immunizations for Adolescents (IMA-E) measure has updated the timeframe for the meningococcal measure to be between the ages of 10 to 13. This change won’t be reflected until we switch over to the updated software in the fall.
For more information on all the Measure Year 2025 measure changes, please visit the HEDIS Provider Guide and Reference Manual which is now posted under the Policies & Guidelines menu item in the provider portal.
If you have questions about the gaps in care correction process, performance reports or anything related to our provider portal:
- Contact your Independent Health Physician Engagement Specialist
- Email ProviderPortal@independenthealth.com
Rite Aid announces plans to close stores: how we're supporting your patients
Switching pharmacies is easy; mail order is available for maintenance medications.
Rite Aid is planning to close all of its stores. Unfortunately, these closures will impact not just our members, but the entire region.
At this point, we do not know when each store will close, but Rite Aid locations will remain in our pharmacy network as long as they are open and serving customers.
Independent Health is advising our members they may continue as Rite Aid customers for the time being, or they can switch to a new participating pharmacy at any time. Independent Health’s retail pharmacy network includes many independent and chain pharmacies (such as Tops, Wegmans, and Walgreens) locally and nationwide. We also offer mail order options for certain maintenance medications. Our list of participating pharmacies is online under the Find-a-Doctor menu item on our website. (As a reminder, CVS pharmacies are not part of Independent Health's pharmacy network).
We have informed our members who have online accounts with us about their options and how to switch their prescriptions to a new pharmacy.
In the meantime, if your Independent Health patients have questions about switching pharmacies, you may refer them to MyIH.com/SwitchRx for simple step-by-step instructions.
Has your practice information changed? We need to know.
Notify us of any practice changes so we can update our information.
A core focus of CMS and the New York Department of Health is to ensure that health plans' provider directories are accurate and up to date so plan members can make informed decisions regarding their care. To support their efforts, we need your help.
Please notify us of any changes that occur within your practice, such as:
- A change in your phone number
- Your ability to accept new patients.
Also, it's important that you always return the quarterly data sheets to networkoperations@independenthealth.com
Submitting these updates is contractually required and essential for our members to have access to the most current information about your practice. We appreciate your help!
Understanding health care provider burnout
Recognize the symptoms and take proactive steps to help those who are facing burnout.
As the backbone of the health care system, providers are often under immense pressure, which can lead to physical, emotional, and mental exhaustion. Recognizing and addressing burnout is not only essential for the well-being of health care professionals but also for the quality of care they provide to patients.
Understanding Burnout
Burnout is a state of chronic stress that leads to physical and emotional exhaustion, cynicism, and a feeling of reduced professional efficacy. It is particularly prevalent in high-stress professions like health care, where providers are constantly dealing with life-and-death situations, long hours, and the emotional toll of patient care. Symptoms of burnout can include fatigue, insomnia, depression, anxiety, and a decrease in job performance.
The Impact on Health Care Providers
Health care providers experiencing burnout are at risk of numerous negative outcomes. These can range from mental health issues such as depression and anxiety to physical health problems like cardiovascular disease. Burnout can also lead to substance abuse as providers may turn to alcohol or drugs as a coping mechanism. The personal toll is significant, but it also affects their relationships, the people they care for, and the people they love.
The Consequences for Patient Care
The repercussions of burnout extend beyond the individual provider to the patients they care for. Burnout can lead to decreased empathy, impaired judgment, and increased likelihood of errors, all of which can compromise patient safety and care quality. Burnout is associated with lower patient satisfaction, longer recovery times, and higher rates of medical errors. Therefore, addressing burnout is crucial for maintaining high standards of patient care.
Organizational Responsibility
Health care organizations have a responsibility to recognize and mitigate burnout among their staff. This can be achieved through various strategies, such as promoting a healthy work-life balance, providing mental health support, and creating a supportive work environment where everyone feels appreciated and important. Implementing regular check-ins, offering professional development opportunities, and ensuring manageable workloads are also effective measures. By fostering a culture that prioritizes the well-being of health care providers, organizations can enhance job satisfaction and reduce turnover rates.
The Role of Self-Care
While organizational support is vital, health care providers must also prioritize their own well-being. Practicing self-care, setting boundaries, and seeking professional help when needed are essential steps in preventing and managing burnout. Engaging in regular physical activity, maintaining a healthy diet, and ensuring adequate rest are fundamental aspects of self-care. Additionally, providers should cultivate hobbies and interests outside of work to maintain a balanced and fulfilling life.
Conclusion
Recognizing and addressing burnout in health care providers is imperative for the sustainability of the health care system. By taking proactive steps to support the well-being of providers, both organizations and individuals can ensure that health care professionals remain healthy, motivated, and capable of delivering the highest quality of care to their patients. It is a shared responsibility that ultimately benefits everyone involved in the health care continuum.
Upcoming member campaigns to encourage our members to take greater control of their health
Coming up: social needs self-screening, osteoporosis outreach, eye exams for patients with diabetes and more.
Health-Related Social Needs Self Screening
This email campaign will encourage Essential Plan members to complete a self-administered health-related social needs screening as well as provide community resources for members to contact if an area of need is identified.
- Target Population: Essential Plan members
- Outreach Method: Email
- Timeframe: ongoing
Osteoporosis Management in Woman Who Had a Fracture (OMW) Member Outreach
Independent Health’s Case Manager will outreach telephonically to Medicare members that fall into the Osteoporosis Management in Woman Who Had a Fracture (OMW) measure.
Independent Health’s Case Manager will contact members to discuss their fracture, provide education on fractures and falls prevention, and discuss options for gap closure.
The Case Manager will discuss the option of an in-home heel ultrasound with Stall Senior Medical (SSM). If the member is interested, the Case Manager will ask for consent for the member to be contacted by the SSM team and then SSM will call the member to schedule the appointment. All results will be sent to the member’s Primary Care Physician (PCP) for follow-up.
The Case Manager will also discuss other options for gap closure, depending on the member’s preference, and refer back to the member’s PCP. Each call will be individualized based on the member’s needs.
- Target population: The OMW measure focuses on females 67 to 85 years of age who had a fracture and have six months following the fracture to close the gap by having a bone density scan, filling a script for an osteoporosis medication, or receiving an injection for osteoporosis treatment.
- Timeframe: This outreach is on-going. Monthly, new members who fall into this measure are called.
Eye Exam for Patients with Diabetes (EED) Member Outreach
Independent Health will be facilitating outreach telephonically to Medicare members that have a gap in care for the Eye Exam for Patients with Diabetes (EED) measure. Independent Health will call members and discuss the option of an in-home eye exam with Stall Senior Medical (SSM). If the member is interested, Independent Health will ask for consent for the member to be contacted by the SSM team and then SSM will call the member to schedule the appointment. All results will be sent to the members’ Primary Care Physician (PCP) for follow-up.
- Target population: Medicare HMO members with a diagnosis of Diabetes (type 1 or 2) who have not had a retinal eye exam. An eye exam in the year prior must be negative for any type of retinopathy. If year prior eye exam is positive, then an eye exam in the current measurement year is needed.
- Outreach method: Outbound telephone call campaign.
- Timeframe: Campaign kicked off in mid-to-late March and runs through December 2025
Gaps in Care Reminder Calls
Independent Health’s Member Servicing team will perform telephonic outreach to provide education and encourage members with an open gap in care to reach out to their provider to schedule the appropriate appointments and/or get a vaccination to complete the gaps in care.
- Target populations: Medicaid Managed Care members who have open gaps for: breast cancer, colorectal, and/or cervical cancer screenings. Medicaid Managed Care and Child Health Plus members (ages 9-12) who have not started or who have started but not completed the series for HPV vaccinations.
- Timeframe: Call campaign began in May
Falls Prevention Campaign
This campaign targets Medicare members identified as having a high likelihood of falling or history of falls to provide fall prevention education and encourage members to speak to their doctor about ways to prevent falls.
- Target population: Medicare members who have a high likelihood of falling or a history of falls.
- Outreach method: Outbound telephone call and email campaign.
- Launch Date: Telephonic outreach began in late April; Email campaign will occur between May through July.
Physical Activity Campaign
This campaign targets Medicare members identified as having low physical activity levels to provide education regarding the benefits of physical activity and encourages members to speak to their doctor about ways to be more active.
- Target population: Medicare members who have low physical activity levels.
- Outreach method: Outbound telephone call and email campaign.
- Launch Date: Telephonic outreach began in late April; Email campaign will occur between May through July.
Bladder Control Campaign
This campaign targets Medicare members identified as having urinary incontinence and encourages them to speak to their PCP regarding urinary incontinence and potential solutions.
- Target population: Medicare members who self-identify as having urinary incontinence.
- Outreach method: Outbound telephone call and email campaign.
- Launch Date: Telephonic outreach began in late April; Email campaign will occur between May through July.
Physical and Mental Health Campaign
This campaign targets Medicare members identified as having concerns with their physical or mental health to provide education regarding who to contact about any physical and mental health concerns and encourages them to speak to their doctor about these concerns.
- Target population: Medicare members who are identified as having concerns with their physical or mental health.
- Outreach method: Outbound telephone call and email campaign.
- Launch Date: Telephonic outreach began in late April; Email campaign will occur between May through July.
Pharmacy Updates
Formulary and Policy Changes
View our up-to-date formularies and policies online
Drug Formulary Changes
View the formulary changes for the Second Quarter of 2025.
View the formulary deletions, effective June 1, 2025:
- Medicare Advantage formulary deletions for individual & group plan members
- Pharmacy Benefit Dimensions 3-Tier formulary deletions
- Pharmacy Benefit Dimensions 5-Tier formulary deletions
Access Independent Health's drug formularies here.
Drug Policy Changes
The policy changes for the Second Quarter of 2025 are now available online. Log in to the provider portal to view the changes. Click on ‘Monthly Policy Updates’ under the News tab once you are logged in.
Search for and view the most current versions of all Independent Health’s drug policies when logged in to our provider portal.
Prime Therapeutics (formerly Magellan Rx) reviews prior authorizations for select oncology and specialty drugs on Independent Health's behalf. View Prime Therapeutics' policies for the drugs it reviews.
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 5 p.m.
Spotlight
Top Takeaways this Month
July 2025 Policy Updates: New & revised policies will be posted to the secure portal on June 1, under the News tab on the menu bar. It is very important to review the monthly updates.
We post new and updated policies 30 days before their effective date. Please visit that page on the first of each month.
Upcoming Pediatric Office Matters on June 11. View the agenda and register here.
Remember to view our HEDIS Reference Manual posted under the Policies & Guidelines tab in the portal
Participating Labs List: Review our updated list of participating laboratories.