Provider Resources

News and Announcements

June 21, 2019

ESI Care Continuum (CCUM) Updated Drug List Published

Network Health has published an updated list of medical drugs that require prior authorization through ESI Care Continuum (CCUM). The the most recent update is effective July 21, 2019.

This list will continually update throughout the year to remain in alignment with the evolving pharmaceutical marketplace.

The current and upcoming lists have been combined in one document to keep you informed in advance of any changes. The document currently includes the lists for the following effective dates. 

Effective July 21, 2019
Effective July 1, 2019
Effective May 1, 2019

The document also includes links to help you navigate the lists by effective date. 


May 2019

Submit Medical Drug Authorization Requests via ExpressPAth

Network Health has partnered with ESI Care Continuum (CCUM) for medical drug prior authorization effective May 1, 2019.

ESI Care Continuum handles pre-determination and prior authorization requests for medical drug (excluding oncology drug) for all lines of business.

Providers should submit medical drug requests via the ExpressPAth portal as of May 1. Online submissions will streamline communication and improve turnaround times for these authorizations.

Providers also have seamless access to ExpressPAth through the Network Health provider portal. ExpressPAth is available 24 hours a day, seven days a week.

Visit the tutorial page on the ExpressPAth site for assistance on how to navigate the portal. For additional information, please contact Network Health’s Utilization Management Department or your contract manager.

Read more in the latest issue of The Pulse

 

 

Every month, The Pulse newsletter delivers the latest industry news, claims updates, tips about programs available to you and your patients, pharmacy notifications, treatment information, code changes and more. 

Check out the latest issue of The Pulse


Pulse Newsletter Archives

January 2019
February 2019
March 2019
April 2019 
May 2019 

May 2018
July 2018
September 2018
October 2018
November 2018
December 2018

 

 

January 2019

Medicare formulary change: Steroid/Beta-Adrenergic inhaler $8

For 2019, the generic for AirDuo (Fluticasone/Salmeterol) will now be available at an $8 cost to members for one inhaler. The member’s $260 or $395 deductible also doesn't’t need to be satisfied if the member receives this generic (Fluticasone/Salmeterol) versus Advair, Breo Ellipta, Dulera or Symbicort.

The generic version of the inhaler not only offers significant savings to the member, but it also might increase compliance with using the inhaler as prescribed.

Read more in the latest issue of The Script

The Script is the quarterly newsletter produced by the Network Health pharmacy department to inform providers of current and upcoming pharmacy-related news.

Check out the latest issue of The Script

Script Newsletter Archives

January 2019


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