Medicare Flashes

February 12, 2019

The prescription form of polyethylene glycol is no longer being manufactured, and only the over-the-counter (OTC) versions are available. The Centers for Medicare & Medicaid Services (CMS) excludes OTC medications from the Part D benefit.

With this change, we can no longer cover polyethylene glycol under Part D. Claims for coverage of this drug will be denied based on the CMS decision.

Polyethylene glycol is currently listed as a Tier 1 medication on the 2019 Medicare formulary, and we can’t remove it from the formulary at this point in the year. It will be removed from the 2020 formulary.

Polyethylene glycol is used for constipation and in bowel preparation regimens for colonoscopies. Most medications used for constipation, such as MiraLAX, are available OTC.

There are still several bowel-prep kits on the formulary, including:

• Gavilyte-C, Gavilyte-G and Gavilyte-N covered at Tier 2
• PEG 3350/electrolytes solution covered at Tier 2

If you have any questions, call Broker Support at 1-877-917-8489 or email BrokerServices@healthalliance.org.

February 6, 2019

We have updated sales kits with the 2019 Medicare age-in books. The four versions are also available to order from Your Health Alliance for brokers.

• Midwest: Illinois/Indiana, Quad Cities
• Reid Health Alliance: Indiana/Ohio
• Health Alliance Northwest: Confluence and Signal Health.
• Spanish version for Health Alliance Northwest

Please order enough to replace the 2018 books in any sales kits you already have.

If you have any questions, call Broker Support at 1-877-917-8489 or email BrokerServices@healthalliance.org

January 29, 2019

Village Pharmacy in Leavenworth has closed and will no longer be a preferred cost-sharing pharmacy for Health Alliance Northwest members. Safeway Pharmacy in Leavenworth is the closest preferred cost-sharing pharmacy, and there are many other in-network pharmacies in the area where members can get prescriptions filled at the standard cost-sharing coverage amount.

A preferred cost-sharing pharmacy is an in-network pharmacy that has signed a contract with us to offer certain prescription drugs at a lower cost. At these pharmacies, members can get $0 Tier 1 generics and a 90-day supply of their medication for 2 copays. At standard cost-sharing pharmacies, members have a small copay for Tier 1 generics and can get a 90-day supply of their medication for 2.5 copays.

If you have clients on Confluence plans who may have used Village Pharmacy, please let them know about its closing and their other options.

January 23, 2019

Our Medicare Advantage Part D members now have access to Deterra^®, a safe and convenient way to dispose of unused medication, through OptumRx. Members must receive their pharmacy coverage through a Health Alliance Medicare plan with drug coverage to qualify for this benefit.  This program helps reduce the amount of drugs that enter our water system from flushing unwanted meds.

Any member with an OptumRx mail drug benefit can request up to two drug disposal kits per year. They must call OptumRx at 1-800-562-6223 and register a home delivery account.

An OptumRx customer service representative will answer the call, and the member or authorized representative should ask for a Deterra kit. The customer service rep will ask a few questions about why the kit is needed. All the member needs to say is that they need it for disposal of unneeded medication.

The kit should arrive in about 7–10 business days.

During the call, the customer service rep will also talk to the member about the benefits of home delivery and ask if they would like to use it. If the member is not interested, they can say no.

It is important to know that members are not required to change the way they receive their medications to home delivery to take advantage of this program, especially if they already enjoy cost savings at one of our preferred cost-sharing pharmacies, like Walgreens.

If the member or authorized representative wants to ask specific questions about Deterra kits and how to use them, an OptumRx pharmacist may speak to the member. Any other questions about the program can be directed to our Pharmacy Department at 1-800-851-3379, option 4.

January 8, 2019

We sent current individual Medicare Supplement members a rate renewal letter and new rate sheets on November 30. These rates are approved for January 1–December 31, 2019.

Our rates for each age range decreased by 5 percent this year, so any increase members have will be from moving into a new age bracket.

If you have any questions, call Broker Support at 1-877-917-8489 or email BrokerServices@healthalliance.org.