Switch can improve medication adherence and a patient’s health

Did you know that Independent Health Medicare members can fill a 100-day supply of their Tier 1 drug?
This simple switch from a 30-day or 90-day prescription to a 100-day supply can increase access to medication at home, improving medication adherence and a patient’s overall health.

Especially important is facilitating the switch for Medicare members who are filling 30-day supplies of maintenance medications to treat chronic conditions. Examples include statins, ACE inhibitors, ARBs, and drugs used to treat diabetes including metformin and pioglitazone.
 

Lowering Member Drug Cost is an Added Benefit

Tier 1 drugs are zero cost for a majority of our Medicare members most of the time. However, there are instances when a member will have a low out-of-pocket cost. The cost-share of the 100-day supply will be the same (or very close to the same) cost-share of the 90-day supply. Switching to the larger supply reduces the number of fills in a year, lowering annual drug costs for our members. 

How You Can Help

• Encourage your Medicare patients to ask their providers for 100-day prescriptions. If the benefit doesn’t apply to the drug or the member, you can always adjust the quantity.
• If you are given a prescription for a 100-day supply to fill, don’t assume it’s not covered. 
• Facilitate the switch when you request refills on behalf of your Medicare patients. Ask the prescribers to write a new script for the larger supply.

Working together, we can improve medication adherence and clinical outcomes by increasing awareness of this valuable benefit.

Benefit covers both prescription and over-the-counter drugs and devices

Independent Health offers more than sixty $0 cost preventative services to our commercial and FEHB members. (Self-funded plan members should check their plan documents for details.) Included on this comprehensive list of no cost preventative services are all FDA-approved contraceptive drugs, devices, and services.

As health care providers on the front lines, pharmacists may find the FDA’s birth control chart a helpful tool for patient consultations. 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 the majority of 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: Pharmacies sell many over-the-counter contraceptive drugs and devices that are covered at $0 cost, including male and female condoms, spermicides, and sponges. Members 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.

First quarter changes are available for review in PDF. We encourage you to open and download them, as they contain important information and updates.

Policy changes for the First Quarter of 2024 are summarized here.

Formulary changes for the First Quarter of 2024 are summarized here.

View the most up to date versions of Independent Health’s policies when logged in to our provider portal.

Independent Health's Drug Formularies

Access Independent Health's drug formularies here.

Nova Nordisk discontinuing Levemir^® Insulin

Independent Health has cost-effective alternatives on the drug formulary.

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.

Maintaining Affordable Care for Members

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

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 formulary.

Independent Health added commercially available Paxlovid and Lagevrio to our formularies.

On February 1, commercially available Paxlovid and Lagevrio were added to the Medicare and commercial formularies. This was done in preparation for the transition from government-managed distribution to traditional commercial distribution.

Depleting the Government (USG)-distributed Drug Supply

Remaining supply
The FDA recently issued a communication stating that the USG-distributed antiviral drug supply is no longer authorized for emergency use after March 8, 2024. 

Reimbursement
Independent Health will process claims for any remaining supply of the USG-distributed, EUA-labeled drugs through March 8. Beginning March 9, only the commercially available antiviral drugs will be covered.

Billing

To ensure accurate billing, be sure to use the correct NDC:

• Commercial Paxlovid (NDA-labeled):  
  • Carton: 0069-5321-30; 0069-5317-20
  • Blister: 0069-5321-03; 0069-5317-02
• Commercial Lagevrio (EUA-labeled):  0006-5055-09

Billing by Plan Type:

Medicare Advantage Plans

Commercially available Paxlovid is a $0 cost-share for our Medicare members. Independent Health enrolled in the Part D Plan-Facilitated USG Patient Assistance Program with Pfizer to be able to offer the $0 cost-share.  

The commercially available Lagevrio is a $0 cost-share for our Medicare members.  

Commercial (Employer and Individual/Family), Essential, and Child Health Plus Plans

Members will have a Tier 2 cost-share for either drug. 

For members concerned about drug cost: Pfizer, the manufacturer of Paxlovid, is offering a Patient Assistance Program at the time of this post. Details at https://www.paxlovid.com/paxcess

If you have any questions regarding information in this issue, please call our Pharmacy Help Desk at (716) 631-2927 or 1-800-993-9898, Monday through Sunday from 7 a.m. to 11 p.m.

Thank you for your continued care of our community.