Harvard Pilgrim Health Care Home
  HPHConnect
 
  Learn more.
  Sign up for HPHConnect.
Medical Management
E-Transactions
HPHConnect
Pharmacy
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Newsroom
Office Support
Products
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
 
Print    Text Size

Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

December 2015

Pharmacy Updates: 90-day Supplies at Retail and Controlled Substance Limitations


Beginning January 1, 2016, Harvard Pilgrim will introduce several new pharmacy policies, including offering members the opportunity to receive 90-day supplies of maintenance medications at retail pharmacies. In the past, 90-day supplies of medications were only available through mail order.

Other related changes include a limitation on mail service to 90-day supplies of maintenance medications only and limitations on supplies of controlled substances, such as opioid medications.
 
90-day supplies available at retail pharmacies

Starting in January, your patients with prescription drug coverage will be able to purchase 90-day supplies of maintenance medications at retail pharmacies that participate in MedImpact’s choice90RX program. Beginning in January, members can use our online pharmacy locator to find participating pharmacies. (Providers can view this at www.harvardpilgrim.org/providers by selecting the “Pharmacy” link on the left side of the page, and then the appropriate prescription drug program and “Find a retail pharmacy.”).
 
Members will pay their typical cost sharing (3 times their cost sharing for a 3-month supply) at retail locations. Discounts still apply for lower-tier drugs ordered through the Walgreen’s mail service program, which is another option for members who choose to receive 90-day supplies of maintenance medications.

Mail service for maintenance medications only

While the mail service program may be used for 90-day supplies of maintenance medications, as of January 1, 2016, it cannot be used for other medications or smaller supplies. Non-maintenance medications may be purchased in 30-day increments at retail locations only.

Maintenance vs. non-maintenance medications

Maintenance medications are generally prescribed for the long-term treatment of chronic conditions, and are taken continuously, not intermittently or as needed. Maintenance medications include but are not limited to:

  • Antidepressants
  • Asthma/COPD medications
  • Cholesterol lowering drugs
  • Diabetes medications
  • Estrogen therapies
  • Heart medications
  • High blood pressure medications
  • Oral contraceptives
  • Seizure medications
  • Thyroid medications

Conversely, non-maintenance medications are typically used for treatment of acute conditions. Examples of non-maintenance medications include antibiotics, erectile dysfunction drugs, and controlled substances.

Controlled substance limitations

These policy changes are consistent with efforts to better manage the dispensing of controlled substances, such as opioid medications. These limitations are a response to the current opioid epidemic and calls by government and public health organizations to enact policies that support safe prescribing and prevent these medications from being stolen from the mail, misused, and shared inappropriately.

In October, Harvard Pilgrim announced that schedule II (C-II) opioids would no longer be available through our Walgreens-administered mail service program, based on the recommendations of the Massachusetts Opioid Working Group. Now, through this policy, other controlled substances will no longer be available through mail service and dispensing limits will be in place. Under the revised policy:

  1. C-II medications (opiates) will require a new prescription for each 30-day (max) fill.
  2. C-II medications (stimulants) for ADD/ADHD/narcolepsy can be filled at retail pharmacies, where allowed by state prescribing laws, for up to a 60-day maximum supply.
  3. C-III and C-IV medications should be prescribed in a 30-day supply, with up to 5 refills at retail pharmacies only.

For more information on our pharmacy programs, please refer to the Pharmacy section of Harvard Pilgrim’s provider website.

Email this article to a colleague   


Network Matters Archives

Download printer-friendly version

HPHCURRENT EVENTS

Harvard Pilgrim Welcomes New Employer Accounts and Products for 2016

CLINICIAN CORNER

PCSK9 Inhibitors: Prior Authorizations and Innovative Contract for Repatha

Pharmacy Updates: 90-day Supplies at Retail and Controlled Substance Limitations

Reminder: Referral Procedure Change for Massachusetts Providers

Reminder: Prior Authorizations for Medicare Advantage via NIA

Administration of Zostavax by Pharmacists

CMS Requirement: Enrolling as a Participating Medicare Provider

Substance Abuse Screening and Referral for Treatment

Reminder: Mandate on Inpatient Care Related to Breast Cancer

OFFICE ASSISTANT

Professional Claim Submission Available on HPHConnect

Improvements in Provider Claims Reporting Tools

Urgent Care Network Requirements

PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator