Connection supplemental articles and policies - September 2008

Download the print version

Connection - Sept. 2008 (pdf, 153 KB)

Download the Postpartum Visit Scheduling Tool (pdf, 26 KB)

supplemental articles

It Fits! adds skiing to reimbursement list
Chantix: Wondering about the “wonder drug?”
Formulary changes – commercial plan & Medicare Part D
List of new ICD-9-CM codes, effective October 1, 2008

policies and forms

The following policies are new:

Ambulatory surgery — facility payment policy (pdf, 81KB)
Ambulatory surgery — professional payment policy (pdf, 84 KB)

The following policies have been reviewed and changes are indicated on each policy:

It Fits! adds skiing to reimbursement list

Since we introduced it in 2004, It Fits! has garnered attention as an innovative program to get FCHP members active. This fitness reimbursement program has evolved over the years into a way for the entire family to get involved with aerobic activity. We’ve received positive feedback from employers, members and physicians regarding the program’s last expansion, which included activities such as school and town sports programs, dance lessons, gymnastics, karate, swimming lessons and much more.

This year, as winter looms, FCHP is pleased to announce that we’re expanding It Fits! again. Our members may now be reimbursed for daily and seasonal ski lift passes and ski lessons, and we’re asking you to help us spread the word! If you have an FCHP member who is an avid skier, or someone who is new to the sport, let them know that they may now be reimbursed up to $300* for ski lift passes and lessons.

If you have any questions about our It Fits! program, please contact Provider Relations at 1-866-275-3247, option 4.

* Benefits may vary by product and employer

Chantix: Wondering about the "wonder drug?"

By T.J. Sweeney, Tobacco Treatment Specialist and team leader of the Quit Coaches with FCHP’s Quit to Win program

The harm tobacco causes doesn’t change much from year to year, nor does the soaring cost of treating tobacco-related medical conditions. So it’s no wonder that in the past two years a new tobacco-treatment medication has attracted a lot of attention.

Perhaps you were interested in Chantix® (varenicline) because you heard that it yielded higher quit rates than any other medication in clinical trials. Anecdotally, we’ve seen many people succeed at quitting with Chantix after several unsuccessful attempts by other methods. For some quitters, it really does seem to be the silver bullet that finally slays the tobacco monster.

Or, perhaps you’re more keenly aware of Chantix because of the negative press that’s been raised over concerns of suicidal ideation or other potentially serious health concerns.

Chantix’s approval was “fast-tracked” by the FDA when it came to market in August 2006. Had it been held back a couple of years, we may have become skeptical after hearing warnings of increasing suicidal thoughts in patients using Chantix.

However, with approximately 5 million Chantix users, some experts have questioned whether or not the rate of suicidal thoughts reported by Chantix users is significantly different from the rate of suicidal thoughts in 5 million non-users. Recently, the Veteran’s Administration was criticized for sending late-warning letters to its 30,000 Chantix users. The VA noted, however, that its observations showed the rate of suicidal ideation among those Chantix users was much lower than reports among veterans not using Chantix! Since every medication may cause side effects in some users, we might ask how the known risks of continuing to smoke compare to the potential side effects of Chantix.

In whatever way you decide to help your patients quit, you’ll feel better knowing they are under the trained and compassionate care of one of our Quit Coaches. And, if they are FCHP members, they’re eligible to participate in our Quit to Win program free of charge. Statistics show that people who participate in a weekly program while quitting are measurably more successful than people who quit on their own. FCHP’s program is one of the most successful quit-smoking programs in the country.

If we can be of assistance to you, your staff or your patients, we hope you’ll contact us by e-mail at QuitToWin@fchp.org; by phone at 1-888-807-2908; or by fax at 1-508-798-8394.

Formulary updates

Fallon Community Health Plan often makes changes to its formularies, including changing prior authorization requirements and adding new medications. Please note the following changes to our commercial plan formulary.

Commercial plan formulary

Additions

Anestafoam^® (lidocaine)	Tier 3
EvaMist^® (estradiol transdermal)	Tier 3
Dazidox^® (oxycodone)	Tier 3
Fenoglide^® (fenofibrate)	Tier 3
Isentress^® (raltegravir)	Tier 3
Letairis^® (ambrisentan)	Tier 3, PA required
Lybrel^® (levonorgestrel/ethinyl estradiol)	Tier 3
Simcor^® (niacin/simvastatin)	Tier 3
Tekturna HCT^® (aliskiren/HCTZ)	Tier 3, PA required

New to market policy*

Intelence™ (etravirine)

* FCHP’s New to Market Policy was enacted to ensure patient safety and to allow for adequate time for the development, review and approval of clinical criteria. When a new medication first becomes available, it will fall under this policy and be excluded from coverage. A process is in place that allows for the quick review of provider requests for noncovered pharmaceuticals.

Medicare Part D formulary