Provider Resources

June 2019

Table of Contents

Breathe at Ease Program Offered at no Cost
Remind Patients with Diabetes to Take Statins
Continuous Glucose Monitoring Systems Covered
Do Your Patients Struggle with Insulin Cost?
Pharmacy and Therapeutics Changes: March and May

Retail Pharmacy Network to Transition from CVS to Walgreens

On January 1, 2020, Network Health will transition to Express Scripts (ESI) as the pharmacy benefits manager for all lines of business. ESI has provided pharmacy benefits management for Network Health Medicare members since 2005. Through the transition, the major retail pharmacy network will switch from CVS/caremark™ to Walgreens.

For our members’ convenience, Network Health will provide access to Walgreens pharmacies beginning August 1, 2019. CVS/caremark™ will continue to be in-network until December 31, 2019. This gives you and your patients time to work with a Walgreens pharmacist to transition pharmacy files from CVS/caremark™ (or any pharmacy).

If members decide not to participate in the early transition to Walgreens, we have advised them to refill prescriptions the last week of December 2019 to cover their medication needs until they can transfer their pharmacy files to an in-network pharmacy on January 1, 2020.

Members and providers can search the entire updated pharmacy network, both retail and mail order, through Find a Pharmacy starting November 1, 2019.

Breathe at Ease Program Offered at no Cost

Network Health offers members a proactive condition management program called Breathe at Ease that is designed to help patients with chronic bronchitis, emphysema and COPD to avoid flare-ups, control symptoms and potentially improve their lung conditions. The program is intended to supplement a physician’s care.

Breathe at Ease is available to qualified members at no cost. To learn more about the program and available locations, or to refer a patient to the program, contact Network Health’s condition management team at 920‑720‑1600.

Brand Inhalers Now Available as Generic

ProAir, Ventolin and Proventil inhalers are now available as a generic version. If you write your prescription as Albuterol HFA inhaler, the pharmacy will fill the prescription with the generic version.

Remind Patients with Diabetes to Take Statins

Network Health encourages members with diabetes to take their prescribed medications and undergo appropriate health screenings. Recently, our efforts revealed that some diabetic members are not taking a statin, or are unwilling to try a different statin, because of experienced side effects.

Statin-type cholesterol medications have been shown to greatly lower the risk of heart attack and stroke in patients with diabetes. The recommendation is that all diabetics, regardless of cholesterol levels, take a statin unless other medical reasons prevent it.

At Network Health, our pharmacists have created an informational member booklet that debunks the seven most common myths that discourage patients from taking statins. Statin Medications: Separating Truth from Myth was recently mailed to members with diabetes to encourage medication adherence. Please remind patients about the importance of taking their medications and review the benefits of statin medications with them.

 

Continuous Glucose Monitoring Systems Covered

A Continuous Glucose Monitoring System (CGM) is not for every person with diabetes, but for those who qualify, it may mean a big difference in keeping their blood sugars under control and avoiding hypoglycemic (low blood sugar) episodes. 

Two CGM systems are covered by Network Health under the pharmacy benefit: Dexcom and FreeStyle Libre. Both have their own unique features for monitoring blood sugars, so you can select which system would be the most appropriate for your patient. What both systems have in common is no more daily finger sticking by the patient.

Our Medicare members pay a $0 cost share when systems are obtained through their retail pharmacy. Both systems require the physician to complete a prior authorization request to make sure the patient is an ideal candidate for the CGM system.

Network Health is one of only two Medicare plans that covers these two CGM’s at a retail pharmacy at the $0 cost share. Other plans cover them under the medical benefit, making the member go through a DME company and pay 20 percent of the CGM system cost.

Network Health commercial and Healthcare Exchange members will pay the cost associated with their benefit. A prior authorizations request is also required.

Test Strip Systems Also Available

Most people with diabetes check their blood sugars with a diabetic test strip system. Network Health covers the One Touch and Accu-Chek brands at a $0 cost share to Medicare members.

Commercial members are offered One Touch as their preferred system, while Healthcare Exchange members have Accu-Chek as their preferred system. Member cost will vary based on the commercial or Healthcare Exchange benefit design.

Vouchers for a no-cost meter can be found on networkhealth.com/pharmacy-information.


Do Your Patients Struggle with Insulin Cost?

Prices for insulin for diabetes treatment have been skyrocketing over the past few years, leading many consumers to face the difficult decision of whether they can afford their monthly medications.

Studies show that high medication costs can lead to poor adherence, like skipping or rationing doses. When it comes to medications like insulin, poor adherence may lead to long-term complications, hospitalization or even death.

In a research letter published in the Journal of the American Medical Association (JAMA) Internal Medicine, about one in four patients reported cost-related insulin underuse and about one-third of these patients did not discuss this with their provider.

The survey results indicated that patients who reported cost-related underuse were 43 percent more likely to have poor glycemic control compared to 28 percent in the control group. The article suggests that clinicians should screen all patients for cost concerns to help them address their medication related challenges.

How Can Providers Help?

  1. Have “The Talk” about the cost of medications. Initially, your patient may be reluctant or embarrassed to discuss medication affordability. Approaching the subject with open-ended questions related to adherence may help break the ice (e.g. “What challenges do you have remembering to take your medications every day?”). Review labs or other clinical findings. The retail pharmacy or health plan also can be an excellent resource for obtaining information related to medication adherence, member cost and alternative options.

  2. Be savvy about prescribing lower-priced insulins. Could NPH insulin (e.g. Novolin N) be considered instead of the more expensive long-acting basil insulins (e.g. Lantus, Levemir, or Tresiba)? If a basal insulin is most appropriate, would a switch to Basaglar (a biosimilar to Lantus) be an appropriate alternative? Regular insulin (e.g. Novolin R) proves to be a more cost-effective approach than fast-acting insulin (e.g. Novolog).

Medication*

Strength

Quantity

Ingredient cost (AWP)**

Basaglar Kwikpen

100 units/ml

5x3ml pens (one box)

$392

Lantus SoloStar

100 units/ml

5x3ml pens (one box)

$510

Levemir Flexpen

100 units/ml

5x3ml pens (one box)

$555

Tresiba Flextouch

100 units/ml

5x3ml pens (one box)

$610

Novolog Flexpen

100 units/ml

5x3ml pens (one box)

$671

Novolin N

100 units/ml

10 ml vial

$165***

Novolin R

100 units/ml

10 ml vial

$165***

* Currently, Humulin and Humalog insulins are non-preferred on all lines of business **Ingredient costs last updated March 2019. Price subject to change. *** Ingredient cost for WalMart’s Relion brand of Novolin insulins is $25 per vial (Novolin N or Novolin R). Last confirmed in March 2019, price subject to change.

  1. Help patients find assistance programs. Check with the drug manufacturer about programs that may help with the medication cost. org is a useful resource. The Juvenile Diabetes Research Foundation (JDRF) and American Diabetes Association (ADA) provide multiple avenues for patient assistance, including options for those that do not qualify for manufacture assistance. Local Aging and Disability Resource Centers (ADRC) can be helpful resources not only for health care, but also for assisting with other needs such as transportation, nutrition and meal programs. Find a local center near you.
    The 340B Drug Discount Program was created by the federal government requiring drug manufacturers to provide outpatient drugs to eligible health care organizations and covered entities at significantly reduced prices. To search eligible health care organizations, covered entities or instructions on how to register, visit www.hrsa.gov/opa/eligibility-and-registration.
  2. Refer patients to Medication Therapy Management. Refer your Medicare patients for a comprehensive medication review (CMR) with their health plan pharmacist. The discussion gives members an opportunity to review their medication and identify potential cost-saving strategies. A referral can be placed through the provider portal or you can instruct your patient to call Network Health customer service and ask to speak with a pharmacist about the MTM program.

  3. Encourage patients to make lifestyle modifications. Reducing calorie intake, losing excess weight and regularly exercising can help improve blood sugar control. Network Health offers support for lifestyle changes through health and wellness programs

 

 

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Contact Network Health Pharmacy Department

A pharmacist at Network Health is always available to help your office staff with any pharmacy-related questions. They can be reached at  apeterso@networkhealth.com, bcoopman@networkhealth.comgmelis@networkhealth.com, awheaton@networkhealth.com or tregalia@networkhealth.com.

Pharmacy Review

If you have questions about the 2019 pharmacy prescription benefits for Network Health members, or questions about websites where members can obtain information on patient assistance programs to help cover cost of medications, please contact Gary Melis at gmelis@networkhealth.com or 920-720-1696. Gary is available for office visits to discuss any pharmacy-related topics with pharmacy staff.

Preferred Drug List

Network Health’s current Preferred Drug List is available from multiple electronic sources. It can be viewed and printed from networkhealth.com in the Prescription Benefit section.


THE SCRIPT is a publication of Network Health.

Editor: Gary Melis, RPh. gmelis@networkhealth.com
Co-Editor: Anna Peterson Sanders, Pharm.D. apeterso@networkhealth.com

The information herein is provided with the understanding that Network Health is not rendering pharmacy advice, medical advice or other professional services. If pharmacy advice, medical advice or other professional services are required, an appropriate professional should be consulted.


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