HMSA Healthpro News Provider Update (April 2017)

HealthPro News A monthly publication for participating HMSA health care providers, facilities, and their staff. April 2017

ADMINISTRATION & NEWS

C Q M Telephone Survey to Assess Appointment Availability What’s Thank you in advance for taking the time from your busy schedule to respond to our Inside telephone survey. SPH Analytics will call you soon on behalf of HMSA to ask about the availability of the following types of appointments for HMSA QUEST Integration Contract members (listed with their waiting time standards): Notification • Urgent care visits (high fever, ear pain, or infections): Within 24 hours. 2 • PCP pediatric sick visits: Within 24 hours. Programs • PCP adult sick visits: Within 72 hours. 11 • Behavioral health visits (routine visits for adults and children): Within 21 days. Policy News • PCP visits (routine visits for adults and children): Within 21 days. 12 • Specialist visits: Within four weeks.

Calendar • Non-emergency hospital stays: Within four weeks. 13 Our goal is 90 percent or better for appointment availability that meets the standards. The information you provide to SPH Analytics helps us maintain our successful relationship with the state of Hawaii for our QUEST Integration plan. Here are the results from our previous survey:

HMSA QUEST Integration Appointment Availability Report 4th Quarter 2016 % of requests that meet Average wait (days) for Provider type/class Wait standard waiting time standard those over standard Urgent care 24 hours 94.9% 11 calendar days PCP pediatric sick visits 24 hours 100.0 N/A PCP adult sick visits 72 hours 96.8 16 calendar days Behavioral health C Q M (routine visits for adults 21 days 100.0 N/A Commercial QUEST Medicare Integration and children) PCP visits (routine visits for 21 days 98.5 31 calendar days adults and children) Specialist 4 weeks 97.1 62 calendar days Non-emergent hospital stays 4 weeks 100.0 N/A

Hawai‘i Medical 818 Keeaumoku St. P.O. Box 860 hmsa.com Provider Resource Center Service Association (808) 948-6330 Honolulu, HI 96808-0860 hhin.hmsa.com hmsa.com/portal/provider

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ADMINISTRATION & NEWS (CONTINUED)

C Q M CAHPS Survey Your patients who are HMSA members may soon receive a survey from us asking for their feedback. Consumer Assessment of Healthcare Providers and Systems (CAHPS) is a nationally recognized series of surveys that rate how patients perceive their health care services and experiences. Questions cover topics like access to care and the communication that patients have with their providers. HMSA members are systematically selected to take part in the survey from February to June each year. Participation is voluntary. The survey gives us insight into member satisfaction and is a key component of quality initiatives such as the CMS Medicare Star Ratings quality improvement program and the National Committee for Quality Assurance (NCQA) accreditation process. HMSA uses the survey results to work with our providers and health care partners to improve the member experience. A good patient experience can be tied to better health outcomes. More information on the CAHPS survey is available at cahps.ahrq.gov. CAHPS composite measures directly related to provider experience are available on the Provider Resource Center at hmsa.com/portal/provider/zav_pel.aa.CAHPS.100.htm.

C Q M Healthways Fax Numbers If you’re sending a fax to the former Healthways team, please double-check the fax number to ensure that you’re using the correct number. In particular, please discontinue using the previous PCMH Referral Form and Care Model Referral Form that includes an outdated fax number, 748-0662. The new referral form has been updated with the new fax number, 948-8242. The form is available at hmsa.com/ portal/provider/HMSA_PCMHReferralForm.pdf. If you have questions or want to verify that you’re using the correct fax number, call 1 (855) 765-7264 toll-free.

C Q M Use HMSA’s Electronic Transactions HMSA provides you with electronic tools and resources to help save you time, money, and reduce paper: • HHIN. Verify member eligibility, benefits, and claim status. Request and track preauthorizations. • Electronic Claims Filing. Submit an eClaim or an EDI 837 batch transaction. • Electronic Funds Transfer. Get your payment directly deposited to your bank account. • Electronic Remittance Advice. Receive an EDI 835 transaction that provides claim payment information. For more information, call the ETS Outreach team at 948-6255 on Oahu or 1 (800) 603-4672, ext. 6255, toll-free on the Neighbor Islands. Or email [email protected].

CONTRACT NOTIFICATION

C Q M MAC Changes The following Maximum Allowable Charges (MACs) increased effective March 1, 2017.

Procedure Description MAC 90736 Zoster (shingles) vaccine (HZV), live, for subcutaneous injection $240.97

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CONTRACT NOTIFICATION (CONTINUED)

The following MAC was effective January 1, 2017.

Procedure Description MAC Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative 90674 $21.73 and antibiotic free, 0.5 ml dosage, for intramuscular use.

C Q M Control Formulary Changes The Pharmacy and Therapeutics Committee made the following formulary changes effective July 1, 2017. The Control Formulary is available in the HMSA Provider Resource Center at hmsa.com/portal/provider/HMSA_ Control_Formulary.pdf.

Utilization Management Generic Name Brand Name Drug Class Current Tier New Tier Description/Notes Alternatives: alfuzosin alfuzosin HCl tablet Uroxatral tablet Genitourinary 3 Non-formulary ext-rel, tamsulosin aprepitant for oral Emend suspen- Gastrointestinal Non-formulary 3 suspension sion Central Nervous System armodafinil tablet Nuvigil tablet 2 3 Alternative: use generic Agent Astepro nasal azelastine HCl nasal spray Respiratory 2 3 Alternative: use generic spray Alternatives: topical anti- benzoyl peroxide liquid benzoyl peroxide Dermatology – Acne 1 Non-formulary bacterials (i.e., clindamycin, erthromycin) Alternatives: topical anti- benzoyl peroxide- Vanoxide-HC Dermatology – Acne 3 Non-formulary bacterials (i.e., clindamycin, HC lotion lotion erthromycin) buprenorphine HCl buccal Belbuca Film Opioid Analgesics Non-formulary 3 film Alternative: calcitonin- calcitonin nasal solution Miacalcin spray Endocrine and Metabolic 3 Non-formulary salmon nasal spray Hylatopic Plus dermatological products Topical Non-formulary 3 lotion dexmethylphenidate HCl Focalin XR Central Nervous System 2 3 Alternative: use generic SR 24 hour capsule capsule digoxin oral solution Digoxin solution Cardiovascular Non-formulary 3 digoxin tablet Lanoxin tablet Cardiovascular 3 Non-formulary Alternative: digoxin enalapril maleate oral Epaned solution Cardiovascular Non-formulary 3 solution

Alternatives: authorized generic for Adrenaclick Anaphylaxis Treatment epinephrine auto injector Adrenaclick 3 Non-formulary or authorized generic for Agents EpiPen/EpiPen Jr. Effective April 1, 2017

epinephrine inj Anaphylaxis Treatment epinephrine auto injector (authorized ge- Non-formulary 1 Agents neric for EpiPen) Alternatives: dihydroergota- ergotamine with caffeine Central Nervous System Cafergot tablet 3 Non-formulary mine mesylate nasal spray, tablet Agent Relpax, Zomig Nasal Spray erythromycin ethylsuc- Alternatives: generic E.E.S. granules Anti-infectives 3 Non-formulary cinate for suspension erythromycins

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CONTRACT NOTIFICATION

Utilization Management Generic Name Brand Name Drug Class Current Tier New Tier Description/Notes erythromycin erthylsuc- Alternatives: generic eryth- Eryped suspension Anti-infectives 3 Non-formulary cinate for suspension romycins estradiol-norethindrone Endocrine and Combipatch 2 Non-formulary Alternative: Climara Pro patch Metabolic estradiol-levonorgestrel Climara Pro Weekly Endocrine and Non-formulary 2 patch patch Metabolic

fluticasone furoate- Breo Ellipta Respiratory Non-formulary 3 vilanterol aerosol

Alternatives: OTC hydro- hydrocortisone acetate Anucort-HC Miscellaneous 1 Non-formulary cortisone, phenylephrine, pramoxine products

Alternatives: OTC hydro- hydrocortisone acetate Hydrocort-AC supp Miscellaneous 1 Non-formulary cortisone, phenylephrine, pramoxine products

Alternatives: OTC hydro- Hydrocortisone hydrocortisone/pramoxine Miscellaneous 1 Non-formulary cortisone, phenylephrine, Acetate/PR pramoxine products

Alternatives: anticholinergic hyoscyamine sulfate tab Hyoscyamine tab Anticholinergic 1 Non-formulary medication (i.e., dicyclomine)

Alternatives: fluorouracil 5% Dermatology – Actinic imiquimod cream Zyclara cream 2 Non-formulary cream, fluorouracil solution, Keratosis imiquimod, Picato Alternatives: fluorouracil 5% Dermatology – Actinic imiquimod pump cream Zyclara pump cream 2 Non-formulary cream, fluorouracil solution, Keratosis imiquimod, Picato Dermatology – Actinic ingenol mebutate gel Picato gel Non-formulary 2 Keratosis

BD pen needle Endocrine and insulin pen needle Non-formulary 2 32G x 4mm Metabolic Comfort EZ pen Endocrine and insulin pen needle needles Non-formulary 3 Metabolic 33G x 4mm PenTips 29G x 12mm (1/2”) 31G x 8mm (1/3” or Endocrine and insulin pen needle 5/16”) Non-formulary 3 Metabolic 31G x 5mm (3/16”) 31G x 6mm (1/4”) 32G x 4mm(5/32”)

Pro Comfort Endocrine and insulin pen needle Non-formulary 3 32G x 6mm Metabolic Unifine pen needles 29G x 12mm (1/2”) 31G x 8mm (1/3” or Endocrine and insulin pen needle 5/16”) 3 Non-formulary Alternatives: PenTips Metabolic 32G x 4mm (5/32”) 31G x 5mm (3/16”) 31G x 6mm (1/4”)

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CONTRACT NOTIFICATION (CONTINUED)

Utilization Management Generic Name Brand Name Drug Class Current Tier New Tier Description/Notes

BD U-500 Endocrine and insulin syringe Non-formulary 2 31G x 6mm Metabolic insulin syringe U-100 Endocrine and insulin syringe 31 x 5/16” 2 Non-formulary Metabolic 30 x 1/2” 30 x 5/16” ipratropium bromide HFA Alternative: ipratropium Atrovent HFA Respiratory 3 Non-formulary inhaler inhalation solution isavuconazonium sulfate Cresemba capsule Anti-infectives Non-formulary 3 capsule Alternatives: triptans or sometheptene- Isometh/APAP cap butalbital products (i.e., ge- dichloralphenazone- Analgesic 1 Non-formulary dichlor neric sumatriptan or butalbital acetaminophen combination products) ivabradine HCl Corlanor tablet Cardiovascular Non-formulary 2 Endocrine and lancets Caretouch Twist 30 Non-formulary 3 Metabolic Goodsense lancets Endocrine and lancets Non-formulary 3 30G Metabolic Endocrine and lancets Topcare lancets 33G Non-formulary 3 Metabolic Endocrine and lancets Travel lancets 28G Non-formulary 3 Metabolic Endocrine and lancets Universal 1 Mis 33G Non-formulary 3 Metabolic lomustine capsule Gleostine capsule Antineoplastic Agents Non-formulary Oral chemo Alternatives: OTC folic acid, magnesium-calcium-folic Magnebind Miscellaneous 3 Non-formulary calcium carbonate, magne- acid tab 400-200-1 mg sium supplements Emverm chewable mebendazole chewable Anti-infectives Non-formulary 3 tablet methenamine- Alternatives: urinary hyosc-methylene blue- Hyophen Anti-infectives 1 Non-formulary analgesic agents (i.e., OTC benzoic acid-phenyl sal phenazopyridine products) Alternatives: urinary methenamine- anti-infective agents, urinary hyosc-methylene blue- Uribel Anti-infectives 1 Non-formulary analgesic agents (i.e., nitrofu- sod phosphenyl sal rantoin, OTC phenazopyridine products) miltefosine capsule Impavido capsule Anti-infectives Non-formulary 3 nitrofurantoin macrocrys- Macrodantin capsule Anti-infectives 3 Non-formulary Alternative: nitrofurantoin talline capsule nitroglycerin sublingual Nitrostat sublingual Alternatives: nitroglycerin Cardiovascular 2 3 tablet tablet sublingual, Nitrolingual norgestimate-ethinyl Ortho Tri-cyclen Lo Endocrine and 2 3 Alternative: use generic estradiol tablet tablet Metabolic Alternatives: OTC phenazopyridine HCl phenazopyridine HCl Analgesic 1 Non-formulary phenazopyridine products Alternatives: OTC selenium selenium sulfide selenium sulfide Dermatological 1 Non-formulary sulfide shampoos

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CONTRACT NOTIFICATION

Utilization Management Generic Name Brand Name Drug Class Current Tier New Tier Description/Notes selenium sulfide- Alternatives: OTC selenium pyrithione zinc in urea Selrx Dermatological 1 Non-formulary sulfide shampoos shampoo 2.3% Dermatology – Skin Alternatives: imiquimod, sinecatechins ointment Veregen ointment and Mucous Mem- 3 Non-formulary podofilox brane Alternatives: topical antibac- sodium sulfacetamide/ sodium sulfaceta- Dermatological 1 Non-formulary terials for acne/rosacea (i.e., sulfur mide/sulfur metronidazole) sotalol HCl tablet Betapace tablet Cardiovascular 3 Non-formulary Alternative: sotalol sotalol HCl (AFIB/AFL) Betapace AF tablet Cardiovascular 3 Non-formulary Alternative: sotalol tablet thyroid NP Thyroid Thyroid Agent 1 Non-formulary Alternative: levothyroxine triamterene capsule Dyrenium capsule Cardiovascular 3 Non-formulary Alternative: amiloride zonisamide capsule Zonegran capsule Anticonvulsants 3 Non-formulary Alternative: zonisamide

Specialty

Utilization Management Generic Name Brand Name Drug Class Current Tier New Tier Description/Notes cabozantinib S-malate Cabometyx tablet Antineoplastic Agents Non-formulary Oral chemo Prior authorization tablet cholic acid capsule Cholbam capsule Gastrointestinal Non-formulary 5 Prior authorization deferasirox tablet Jadenu tablet Hematologic Non-formulary 5 Prior authorization dichlorphenamide tablet Keveyis tablet Cardiovascular Non-formulary 5 elvitegrav-cobicemtric- Genvoya tablet Anti-infectives Non-formulary 4 itab-tenofovir AF tablet emtricitabine-rilpivirine- Odefsey tablet Anti-infectives Non-formulary 4 tenofovir AF tablet emtricitabine-tenofovir- alafenamide fumarate Descovy tablet Anti-infectives Non-formulary 4 tablet ixazomib citrate capsule Ninlaro capsule Antineoplastic Agents Non-formulary Oral chemo Prior authorization lenvatinib capsule Lenvima capsule Antineoplastic Agents Non-formulary Oral chemo Prior authorization lumacaftor-ivacaftor Orkambi tablet Cystic Fibrosis Agent Non-formulary 5 Prior authorization tablet mycophenolate sodium Alternative: mycopheno- Myfortic tablet Immunologic Agents 4 5 tablet late sodium obeticholic acid tablet Ocaliva tablet Gastrointestinal Non-formulary 5 Prior authorization patiromer sorbitex calcium for suspension Veltassa powder Endocrine and Metabolic Non-formulary 4 packet rucaparib camsylate Rubraca tablet Antineoplastic Agents Non-formulary Oral chemo Prior authorization tablet triflurdine-tipiracil tablet Lonsurf tablet Antineoplastic Agent Non-formulary Oral chemo Prior authorization

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CONTRACT NOTIFICATION (CONTINUED)

C Q M Essential Prescription Formulary Changes The Pharmacy and Therapeutics Committee made the following formulary changes effective July 1, 2017. The Essential Prescription Formulary is available in the HMSA Provider Resource Center at hmsa.com/portal/provider/ HMSA_Essential_Prescription_Formulary.pdf.

Utilization Management Generic Name Brand Name Drug Class Current Tier New Tier Description/Notes adefovir dipivoxil Hepsera Anti-infective Agent 3 Non-formulary Alternative: use generic Angiotensin II Receptor amlodipine/olmesartan Azor 3 Non-formulary Alternative: use generic Antagonist Angiotensin II Receptor amlodipine/olmesartan/HCTZ Tribenzor 3 Non-formulary Alternative: use generic Antagonist Step therapy: must try azelastine HCl – fluticasone Dymista Nasal Steroid Non-formulary 3 fluticasone AND flunisolide propionate Effective April 1, 2017 Step therapy: must try beclomethasone dipropionate Qnasl Nasal Steroid Non-formulary 3 fluticasone AND flunisolide Effective April 1, 2017 Step therapy: must try metformin or metformin combination canagliflozin/metformin XR Invokamet XR SGLT-2 Inhibitors 3 2 products Effective April 1, 2017 Dermatology – acne Alternative: clindamycin clindamycin Clindacin 3 Non-formulary vulgaris (topical) Dermatology – acne Alternative: clindamycin clindamycin Clindagel 3 Non-formulary vulgaris (topical) Dermatology – acne Alternative: clindamycin clindamycin Evoclin 3 Non-formulary vulgaris (topical) Dermatology – topical Alternative: clindamycin/ clindamycin/benzoyl peroxide Benzaclin 3 Non-formulary antibiotic combinations benzoyl peroxide Dermatology – topical Alternative: clindamycin/ clindamycin/tretinoin Veltin 3 Non-formulary antibiotic combinations tretinoin (generic Ziana) Alternatives: terbinafine, efinaconazole Jublia Topical antifungals 3 Non-formulary itraconazole Step therapy: must try metformin or metformin combination empagliflozin Jardiance SGLT-2 Inhibitors Non-formulary 2 products Effective April 1, 2017 Step therapy: must try metformin or metformin combination empagliflozin/metformin Synjardy SGLT-2 Inhibitors Non-formulary 2 products Effective April 1, 2017 Step therapy: must try metformin or metformin combination empagliflozin/metformin XR Synjardy XR SGLT-2 Inhibitors Non-formulary 2 products Effective April 1, 2017 Alternatives: authorized generic for EpiPen/EpiPen epinephrine EpiPen, EpiPen Jr. Epinephrine 2 Non-formulary Jr. or authorized generic for Adrenaclick

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CONTRACT NOTIFICATION (CONTINUED)

Utilization Management Description/ Generic Name Brand Name Drug Class Current Tier New Tier Notes Dermatology – erythromycin/benzoyl Alternative: erythromycin/benzoyl Benzamycin topical antibiotic 3 Non-formulary peroxide peroxide combinations estradiol vaginal tab Vagifem Estrogen 2 Non-formulary Alternative: use generic maraviroc solution Selzentry solution Anti-infective Agent Non-formulary 3 Cardiovascular nitroglycerin sublingual Nitrostat 2 Non-formulary Alternative: use generic Agent Cardiovascular olmesartan Benicar 3 Non-formulary Alternative: use generic Agent Cardiovascular olmesartan/HCTZ Benicar HCT 3 Non-formulary Alternative: use generic Agent Central Nervous quetiapine ext-rel Seroquel XR 2 Non-formulary Alternative: use generic System Agent Prior authorization removed Cardiovascular sacubitril/valsartan Entresto 3 2 Quantity limit: 60 tablets per 30 days Agent Effective April 1, 2017 Alternatives: terbinafine, itraconazole, tavaborole Kerydin Topical antifungals 3 Non-formulary ciclopirox tenofovir alafenamide Vemlidy Anti-infective Agent Non-formulary 2 Effective April 1, 2017

C Q M Metallic Formulary Changes The Pharmacy and Therapeutics Committee made the following formulary changes effective July 1, 2017.

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CONTRACT NOTIFICATION (CONTINUED)

Utilization Management Generic Name Brand Name Drug Class Current Tier New Tier Description/Notes Step therapy: must try metfor- empagliflozin/metformin min or metformin combination Synjardy XR SGLT-2 Inhibitors Non-formulary 2 XR products Effective April 1, 2017 Alternatives: authorized generic epinephrine EpiPen, EpiPen Jr. Epinephrine 2 3 for EpiPen/EpiPen Jr. or authorized generic for Adrenaclick estradiol vaginal tab Vagifem Estrogen 2 Non-formulary Alternative: use generic insulin aspart/insulin Alternative: Novolog (insulin as- Ryzodeg Insulin 3 Non-formulary degludec part) plus Lantus (insulin glargine) insulin degludec Tresiba Insulin 3 Non-formulary Alternative: Lantus insulin glargine Basaglar Insulin 3 Non-formulary Alternative: Lantus insulin, inhaled Afrezza Insulin 3 Non-formulary Alternative: Novolog maraviroc solution Selzentry solution Anti-infective Agent Non-formulary 3 nitroglycerin sublingual Nitrostat Cardiovascular Agent 2 Non-formulary Alternative: use generic olmesartan Benicar Cardiovascular Agent 3 Non-formulary Alternative: use generic olmesartan/HCTZ Benicar HCT Cardiovascular Agent 3 Non-formulary Alternative: use generic Central Nervous quetiapine ext-rel Seroquel XR 2 Non-formulary Alternative: use generic System Agent Prior authorization removed Quantity limit: 60 tablets per 30 sacubitril/valsartan Entresto Cardiovascular Agent 3 2 days Effective April 1, 2017

Prior authorization tavaborole Kerydin Topical antifungals 3 3 Alternatives: terbinafine, itraconazole, ciclopirox

tenofovir alafenamide Vemlidy Anti-infective Agent Non-formulary 2 Effective April 1, 2017

Select Formulary Changes The Pharmacy and Therapeutics Committee made the following formulary changes effective July 1, 2017. The Select C Q M Formulary is available in the HMSA Provider Resource Center at hmsa.com/portal/provider/index.htm. Utilization Management Generic Name Brand Name Drug Class Current Tier New Tier Description/Notes Step therapy: must try canagliflozin/metformin metformin or metformin Invokamet XR SGLT-2 Inhibitors 3 2 XR combination products Effective April 1, 2017 Step therapy: must try metformin or metformin empagliflozin Jardiance SGLT-2 Inhibitors 3 2 combination products Effective April 1, 2017

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CONTRACT NOTIFICATION (CONTINUED)

Utilization Management Generic Name Brand Name Drug Class Current Tier New Tier Description/Notes Step therapy: must try metformin or metformin empagliflozin/metformin Synjardy SGLT-2 Inhibitors 3 2 combination products Effective April 1, 2017 Step therapy: must try empagliflozin/metformin metformin or metformin Synjardy XR SGLT-2 Inhibitors 3 2 XR combination products Effective April 1, 2017 Alternatives: authorized EpiPen, generic for EpiPen/EpiPen epinephrine Epinephrine 2 3 EpiPen Jr. Jr. or authorized generic for Adrenaclick estradiol vaginal tab Vagifem Estrogen 2 3 Alternative: use generic Prior authorization insulin Xultophy Antidiabetic 3 3 degludec/liraglutide Alternative: Lantus plus Victoza Prior authorization insulin Soliqua Antidiabetic 3 3 glargine/lixisenatide Alternative: Lantus plus Victoza nitroglycerin sublingual Nitrostat Cardiovascular Agent 2 3 Alternative: use generic Central Nervous System Alternative: use generic quetiapine ext-rel Seroquel XR 2 3 Agent Prior authorization removed sacubitril/valsartan Entresto Cardiovascular Agent 3 2 Quantity limit: 60 tablets per 30 days Effective April 1, 2017 Prior authorization tavaborole Kerydin Topical antifungals 3 3 Alternatives: terbinafine, itraconazole, ciclopirox tenofovir alafenamide Vemlidy Anti-infective Agent 3 2 Effective April 1, 2017

C Q M QUEST Integration Formulary Changes The Pharmacy and Therapeutics Committee made the following changes to the HMSA QUEST Integration formulary effective July 1, 2017. We encourage you to talk with your patients to determine if an alternative medication is appropriate for them. Patients who are currently taking a medication that will be removed from the formulary must switch to a formulary alternative that’s a benefit of their plan. If you believe your patient should continue taking their current medication, you can request a non-formulary exception. Please use the form at hmsa.com/portal/provider/CVS_Formulary_Exception_(BR)_Prior_Auth_122812.pdf. The HMSA QUEST Integration formulary is available in the HMSA Provider Resource Center at hmsa.com/portal/ provider/index.htm.

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CONTRACT NOTIFICATION (CONTINUED)

Utilization Medication Strength Drug class Change/Criteria Management Basaglar inj 100unit/ml Antidiabetics Formulary addition Non-formulary Cleocin supp 100mg Vaginal Anti-infectives Alternatives: clindamycin cream, metronidazole gel 5mg Corlanor tablet Heart Failure Formulary addition 7.5mg

epinephrine inj Formulary addition 0.15mg/0.15ml Anaphylaxis Treatment Agents QL (generic Adrenaclick) Quantity limit: 8 syringes per 365 days 1mg 2mg Non-formulary Pomalyst capsule Antineoplastic Agent 3mg Alternative: Revlimid 4mg Formulary addition Premarin vaginal cream 0.625mg Vaginal Estrogens Effective March 2017 Non-formulary Serevent Diskus 50mcg Respiratory Agent Alternative: Striverdi Respimat 50mg 100mg Non-formulary Thalomid capsule Antineoplastic Agent 150mg Alternative: Revlimid 200mg Non-formulary Ulesfia lotion 5% Dermatology Alternative: permethrin

Specialty

Utilization Medication Strength Drug class Change/Criteria Management Formulary addition Orkambi tablet 100-125mg Cystic Fibrosis PA Prior authorization 200mg Formulary addition Rubraca tablet Antineoplastic Agents PA 300mg Prior authorization

PROGRAMS

C Q M Well-being Resources In addition to the care that patients receive from their PCP, HMSA offers well-being resources to help patients with asthma, chronic obstructive pulmonary disease (COPD), cardiovascular disease (coronary artery disease, congestive heart failure, and hypertension), and diabetes. Well-being resources offer additional support, strengthen the patient-PCP relationship, and enhance patients’ awareness of their condition.

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PROGRAMS (CONTINUED)

Well-being resources include: • Tools that help patients learn more about their condition and keep track of their medications, exercise, and action plans. • Potential phone calls from trained clinicians. During these calls, clinicians may conduct a health and well-being assessment, answer questions, help patients create a self-care goal plan, provide information about their disease, and offer psychological support. • Reminders about important screenings and exams. • Other educational materials upon request. Eligible patients are identified through claims information and are automatically enrolled in the program. Soon after, they’ll receive a letter in the mail confirming their enrollment. Patients can opt out of services at any time by calling HMSA at 948-6111 on Oahu. Brochures are available for HMSA’s participating providers to download and print or may be ordered at no cost through our Provider Services department. To order copies, email [email protected]. Please include your practice name, the title of the brochure, and the quantity. If members have been diagnosed with a chronic condition but haven’t heard from us, they can call 1 (855) 329-5461 toll-free. QUEST Integration members should call 1 (855) 817-0211 toll-free on the Neighbor Islands. A specialist will help determine if they qualify for well-being resources.

POLICY NEWS

Medical policies are in the Provider E-Library at hmsa.com/prc0004. To request copies or to ask questions, call Provider Services at 948-6330 on Oahu or 1 (800) 790-4672 toll-free on the Neighbor Islands.

C Q M New Medical Specialty Drug Policies HMSA is developing a new medical specialty drug policy for Gonal-f. The effective date of the policy is July 1, 2017. More information to come.

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CALENDAR

C Q M Well-Being Workshops The following workshops are available to HMSA members at no cost. These informative sessions can help your patients improve their health and well-being. Non-HMSA members may attend if space is available. For more information, refer your patients to hmsa.com/well-being/workshops or have them call 1 (855) 329-5461 toll-free to register at least three days before the workshop.

HAWAII ISLAND OAHU Back to Basics Back to Basics Practice good posture, proper lifting techniques, Practice good posture, proper lifting techniques, and back stretches. and back stretches. • 4/6, 10–11 a.m. • 4/15, 10–11 a.m. HMSA Center @ Hilo HMSA Center @ Pearl City • 4/25, 10–11 a.m. • 4/18, 9:30–10:30 a.m. HMSA Kailua-Kona Office HMSA Center @ Honolulu Brain Fitness • 4/27, 10–11 a.m. Learn how to strengthen your brain. HMSA Center @ Pearl City • 4/20, 10–11 a.m. • 4/29, 9:30–10:30 a.m. HMSA Center @ Hilo Kaimuki Plaza, Kaimana Room Brain Fitness KAUAI Learn how to strengthen your brain. Back to Basics • 4/15, 10–11 a.m. Practice good posture, proper lifting techniques, Kaimuki Plaza, Kaimana Room and back stretches. • 4/21, 10–11 a.m. • 4/10, 5–6 p.m. HMSA Center @ Honolulu Kuhio Medical Center • 4/22, 10–11 a.m. MAUI HMSA Center @ Pearl City Back to Basics • 4/28, 5:30–6:30 p.m. Practice good posture, proper lifting techniques, Kaimuki Plaza, Kaimana Room and back stretches. Meatless Alternatives • 4/20, 5–6 p.m. Learn ways to reduce meat in your diet. HMSA Maui Office • 4/19, noon–1 p.m. Kalihi YMCA

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CALENDAR (CONTINUED)

C Q M Community Activities Adult Fitness at Queen’s: Learn body shaping, tai chi, kickboxing, yoga, and more. Times and instructors vary. The Queen’s Medical Center, Women’s Health Center Classroom. Six classes for $66. Call 691-7117 for details and to register. Health & Education at Queen’s: The Queen’s Medical Center, Women’s Health Center Classroom. • Genetics Class: Learn about prenatal genetic screening and tests to check the health of your baby. 691-7633. Free. • Lamaze Class: Sundays, 1–4 p.m. Get birthing techniques from a Lamaze-certified instructor in this birth-partner-focused class. $150 per couple for five sessions. Instructor: Nicia Platt. • Lymphedema/Breast Cancer Clinic: First and third Thursdays, 1:30–2:30 p.m. Learn exercises to prevent lymphedema (swelling of the arms). Free. • Mammogram and Cervical Cancer Screening: Every other Friday, 8 a.m.–noon. Free for women ages 50–64, uninsured or underinsured, or low income. 691-7726. Aloha Kidney Classes: Learn how to manage conditions related to chronic kidney disease (CKD). Free six-week series. To enroll or for more information, go to alohakidney.com or call 585-8404. American Diabetes Association Workshops: Information and tips for managing or preventing diabetes. 947-5979. Big Island Ostomy Group: April 15, 11:30 a.m. Hilo Medical Center. Open to ostomates, pre-ostomy patients, caregivers, medical professionals, and the general public. 339-7640. COPD Support Group: April 11, 10 a.m.–noon. Pali Momi Women’s Center at Pearlridge. Get support and information on medication, breathing techniques, exercise, and more. To register, call Valerie Chang at 699-9839, email [email protected], or visit hawaiicopd.org. Diabetes Adult Support Group: April 6, 1–2:30 p.m. American Diabetes Association Office, Honolulu. This month, Nutrition and Healthy Eating with Joy Higa, Pharm.D., C.G.P., C.D.E. Free. Parking validation available. 947-5979. Eat Well for Life: April 27, 6–7:15 p.m. Castle Wellness Center. Travel the world of plant-based cuisine as we learn about ingredients and sample vegan dishes of different regions and countries. This month, Chef Eileen Towata takes us on a trip to Thailand. $12 per person. 263-5050. Farmers Market at HMSA: Every Friday, 11 a.m.–2 p.m. HMSA Center @ Honolulu. Fresh island-grown produce and ready-to-eat local food. For information on vendors, call HMSA at 948-6521. Hawaii Prostate Cancer Support Group: This free support group provides men and their families with information, materials, and support to help them make informed decisions about prostate cancer treatment. For locations and meeting times, go to hawaiiprostatecancer.org or call 486-9675. In Sickness and In Health: April 13, 6–7:30 p.m. Castle Wellness Center. The discussion, “Good Bacteria: The Story of Our Missing Genes and Why You Should Care!” looks at how our lifestyle choices affect what types of bacteria thrive or struggle and how their story ultimately becomes our story of health or disease. 263-5400 or castlemed.org. Kardiac Kids Support Group: April 14, 6:30–9 p.m. Kapiolani Medical Center Cafeteria. Education, encouragement, and support for families with children who have congenital heart defects. Jullie Passos, 227-4558. Mommy & Me Hui: Every Friday, 11:15 a.m.–12:30 p.m. Castle Medical Center. Learn about breastfeeding and connect with new mothers. 263-5400.

C Q M Commercial QUEST Medicare Integration 15 w HealthPro News - Health Care Providers, Facilities, and Staff April 2017

CALENDAR (CONTINUED)

Oral, Head, and Neck Cancer Screening: Free and open to the public. • April 5, noon–3 p.m. Queen’s Cancer Center. • April 14, 7:30–11 a.m. Kuhio Medical Center. Preventing Diabetes: April 12, 5:30–7:30 p.m. Castle Wellness Center. A class for anyone diagnosed with prediabetes, impaired fasting glucose, impaired glucose tolerance, or metabolic syndrome. Learn strategies for healthy eating, meal planning, and increasing physical activity. $7 per person. Preregistration and prepayment are required. 263-5400 or castlemed.org. Stroke Support Group: April 11, 4–5 p.m. Hilo Medical Center. A forum for stroke survivors, caregivers, family members, and friends. Amy Shipley, 932-3049 or [email protected]. Walk Around the Block with a Doc: April 22, 7 a.m. Wilcox Medical Center. Walk around the medical center campus with a physician and other walkers, and then enjoy a healthy breakfast and presentation about a health topic. Registration is required. 245-1198. Walk with a Doc on Hawaii Island: Every Sunday, 8 a.m. Liliuokalani Gardens, Hilo. Walk includes a brief warm-up/stretch and an informative talk from a community physician or medical student. Meets rain or shine. wwadbigisland.org.

C Q M Commercial QUEST Medicare Integration