Are you aware that Moda Health has partnered with Magellan Rx Management (Magellan Rx) to assist you in medical pharmacy management through the provider-administered injectable drug program? To ensure our members receive quality, affordable care, we will implement updates to the review and approval processes of certain injectable medications.

• An outpatient facility
• A patient's home
• A physician's office

• Tuesday, Dec. 15, 2015, 8 - 9 a.m. PT
• Wednesday, Dec. 16, 2015, 8 - 9 a.m. PT

The efficacy and safety of the vaccine has been demonstrated in clinical trials, per the Centers for Disease Control and Prevention (CDC). Currently, more than 95 percent of women who have not been previously infected are protected against cervical cancers by HPV 16 or 18. The vaccine is also 100 percent effective in preventing vulvar and vaginal pre-cancers and genital warts in women caused by the vaccine types. In males, HPV4 demonstrated 90 percent vaccine efficacy in preventing genital warts and 75 percent vaccine efficacy in preventing anal and pre-cancers caused by the vaccine types.

 

Despite the inherent risks, HPV vaccination rates currently remain low. Per the CDC, only 33 percent of teenage girls ages 13 - 17 received three doses of HPV vaccine in 2012. Doctor recommendations remain one of the most successful methods of influencing patients to get vaccinated. At Moda, we're doing our part to help keep our local community and schools safe by covering routine immunizations for members of all ages at $0 copay (for most Moda plans) when received from an in-network professional provider or pharmacy. Encourage your patients to get vaccinated today!

 

Free continuing education credits and tips about how to start the conversation with your patients are available through CARDEA. To find out more or register, go to cardeaservices.org/resourcecenter/you-are-the-key-to-hpv-cancer-prevention.

If you or your practice/facility needs to update any of your information, please contact providerupdates@modahealth.com and provide the current information.

A new prior authorization list will be posted on the Moda website that will be effective March 1st, 2016 with a new look and improved access to criteria and important prior authorization information.

Self-administered medications are prescription medications labeled by the FDA for self-administration. They can be safely administered by the member or the member's caregiver outside of a medically supervised setting (e.g., outpatient hospital, physician office or infusion center) and do not require administration by a licensed medical provider.

If self-administered medications are billed through the medical benefit on Jan. 1, 2016 or after, the charges may be denied as non-covered. This can be identified on the Provider Disbursement Register (PDR) with the explanation that "self-administered medications are excluded when supplied directly by a clinician's office, outpatient facility or clinic instead of through the pharmacy benefit." Administration of the medication in the provider office or outpatient setting will remain a covered benefit under the medical plan.

This coverage change begins on Jan. 1, 2016, for all individual members, and will become effective for ASO, small group and large group members at the time of their plan renewal. To verify member eligibility and benefit requirements, please visit our Benefit Tracker tool at modahealth.com/EBTWeb/.