NETWORK MATTERS November 2014

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1 HPHCURRENT EVENTS Join Us for the Mobile Farmers Market in Hartford Harvard Pilgrim would like to invite our Connecticut providers and their patients to the Tuesday, Nov. 18, 2014 launch of the Hartford Mobile Market, of which the Harvard Pilgrim Health Care Foundation is a founding funder. Join us from 10:30-11:30 a.m. on the steps of Hartford City Hall (550 Main Street) for an introduction to the program and a tour of the mobile market. (Note: In the event of rain, the launch event will take place in the City Hall Atrium.) The program, created by the Hispanic Health Council and Hartford Food System, features a year-round mobile produce market that sells fresh fruits and vegetables to Hartford neighborhoods that may lack sufficient access to these nutritious foods. By making produce more affordable and accessible, the Hartford Mobile Market aims to foster healthier eating habits. Starting with a schedule of two stops a week to neighborhoods in the north and south ends of the city, the Hartford Mobile Market will expand its route over the course of its first year to 12 stops in five target areas: Clay Arsenal, Upper Albany, Northeast, Frog Hollow, and Barry Square. Created in 1980, the Harvard Pilgrim Foundation supports Harvard Pilgrim s mission to improve the quality and value of health care for the people and communities we serve by providing the tools, training, and leadership to build healthy communities throughout Connecticut, Maine, Massachusetts, and New Hampshire. The Foundation is committed to providing increased access to fresh food, addressing health disparities affecting diverse populations, and supporting communities through grant contribution and community service. For any questions about the launch event or the Hartford Mobile Market, please contact Pauline Zaldonis at For any questions about the launch event or the Hartford Mobile Market, please contact Pauline Zaldonis at Let s Go! Healthcare Launches Childhood Obesity Webinar Series Let s Go! Healthcare a childhood obesity-focused program funded by Harvard Pilgrim Health Care Foundation and implemented in partnership with MaineHealth is now offering a bi-monthly informational webinar series. Harvard Pilgrim Health Care 1 Network Matters November 2014

2 So, what exactly do the people at Let s Go! Healthcare do? They partner with primary care physicians and hospitals to help prevent childhood obesity, providing support and training on healthy eating and physical activity for physicians working with children and their families. The new webinar series will address topics of importance to providers: the assessment and treatment of conditions associated with childhood obesity, including type II diabetes, sleep apnea, constipation, NASH (pediatric liver disease), and hypertension. If you missed the October webinar on Type II Diabetes and Childhood Obesity, it s not too late to hear the session. A recording of the webinar is available online. Webinars will be held from noon 1 p.m. on the following Thursdays: December 11, February 12, April 9, and June 11. If you would like to participate in the December webinar on Sleep Apnea and Childhood Obesity, please visit the registration page. New WeighingIn Blog Creates an Online Community of Nutrition and Obesity Prevention Experts In the new WeighingIn Blog, health care professionals share their expertise on nutrition and obesity one of the nation s foremost health problems. The blog is an online community of researchers and other expert contributors from the Obesity Prevention Program part of the Harvard Pilgrim Health Care Institute s Department of Population Medicine (DPM), a joint research and teaching initiative launched by the Harvard Pilgrim and Harvard Medical School. The WeighingIn Blog serves as a forum for obesity prevention experts to share their insights and discuss research findings on diet, wellness, and obesity and associated health problems. Recent posts include such topics as: Are We Not Paying Enough Attention to "Fat Burners?," The Sleep Diet and Texting Your Way to a Healthier Weight. We encourage you to contribute to the WeighingIn Blog by reading and commenting on posts, and recommending topics you would like to see covered. The blog will be updated at least once a week, so check back often for new posts. Since the blog posts are written for patients and providers alike, you may want to share this informative resource with your patients, too. Harvard Pilgrim Health Care 2 Network Matters November 2014

3 CLINICIAN CORNER Harvard Pilgrim Offers Reports to Help Improve Medication Adherence Approximately half of all patients with chronic conditions do not take their medications as prescribed. Poor adherence to medications has many negative health consequences, and increases health care costs in the U.S. by an estimated $100 billion per year or more. To help providers improve medication adherence among their patients, Harvard Pilgrim has developed four reports for patient populations with diabetes, acute myocardial infarction, asthma, or rheumatoid arthritis. Using pharmacy claims data, Harvard Pilgrim identifies patients with gaps in their prescription fill history and makes this available to the members PCPs to help improve adherence rates and clinical outcomes. Four adherence reports available Diabetes multiple prescriber report This report focuses on patients with diabetes who have had more than five prescribers in the previous six months and includes a graphical representation of prescribers and medication dispensed. The report, which aids PCPs in identifying potential drug duplication and noncompliance is mailed semi-annually in January and June, and is also available through a secure electronic file transfer. Cardiac medication adherence report Also mailed semi-annually in January and June and available through a secure electronic file transfer, this report lists and graphically displays the fill history for all cardiac medications prescribed after a heart attack and provides the medication possession ratio (MPR) for beta blocker therapy. This MPR information alerts the PCP to potential noncompliance to beta blocker therapy. Asthma adherence report This report lists the number of controller and reliever medications prescribed and filled, as well as the name of the prescribing physician. PCPs can better assess asthma control by examining the ratio of controller to reliever medications provided in this report, which is mailed annually in September. Rheumatoid arthritis adherence report Our newest report, the rheumatoid arthritis adherence report is also mailed annually in September to PCPs whose patients have been diagnosed with rheumatoid arthritis, but have not been prescribed a disease-modifying anti-rheumatic drug (DMARD). DMARDs can be Harvard Pilgrim Health Care 3 Network Matters November 2014

4 an important part of a rheumatoid arthritis treatment plan, since they slow the progression of the disease. We re striving to make these reports as valuable as possible, providing actionable claims-based prescription data, which might not otherwise be available, in an easy-toread format. For more information on any of these reports, please contact our Clinical Programs Department at Reminder: Value Formulary Offered in 2015 As we announced in last month s issue of Network Matters, Harvard Pilgrim will be offering a new formulary option for employer groups beginning Jan. 1, The Value formulary is a closed formulary that will be offered in addition to our current open formulary (the Premium formulary). Harvard Pilgrim s Value formulary balances costeffectiveness with benefits, and was developed to include virtually all drug classes, with alternatives available in each class. Formulary overview The Value formulary will include most generic drugs and single-source brand-name drugs (i.e., those without generic equivalents), while multi-source brand name drugs are excluded. However, there are some exceptions, including the following covered multisource brand name drugs: Dilantin, Tegretol XR, Synthroid, Levothroid, and Unithroid. Information for providers and members Harvard Pilgrim has developed an 2015 Value Formulary Non-Covered Drug List (Abridged) identifying commonly used medications excluded from the Value formulary, as well as their covered alternatives. A complete searchable formulary is also available in the pharmacy section of Harvard Pilgrim s provider website. To aid members who are transitioning to the Value formulary, Harvard Pilgrim will mail letters to members who have been prescribed medications in the last year that are not covered in the Value formulary, prior to the effective date of their coverage. This notification will include a list of the non-covered drugs and the covered alternatives, and will encourage the member to contact their physician to discuss which medication is appropriate for them. Harvard Pilgrim Health Care 4 Network Matters November 2014

5 For more details on the Value formulary, please refer to this FAQ. If you have any other questions or feedback about the Value formulary, contact Pharmacy Services at Prior Authorization on Select Opioid Analgesics Beginning next year, Harvard Pilgrim will require prior authorization on a select number of opioid analgesics used to manage moderate to severe chronic pain. Because there is a risk of addiction, abuse, and misuse with these medications, careful management is necessary. Given the heightened awareness of opioid abuse at the state level, Harvard Pilgrim is implementing these prior authorization requirements as an addition to our opioid management program. Harvard Pilgrim is not requiring any members currently taking these medications who have a presumed cancer diagnosis (as determined by ICD-9 code or medication history) to obtain prior authorization. However, any members beginning treatment with opioid analgesics or members currently taking these medications who have not been diagnosed with cancer will require prior authorization beginning next year. Earlier this month, Harvard Pilgrim mailed letters to the few members who had filled prescriptions for these medications within the last 6 months who do not have a cancer diagnosis to notify them of the new prior authorization requirements. Zohydro Effective Jan. 1, 2015, Zohydro ER, a long-acting hydrocodone product that is not formulated with abuse-deterrent mechanisms, will require a prior authorization on the Harvard Pilgrim s Premium (open) formulary. Zohydro ER is not covered on our Value (closed) formulary or the 2015 Medicare Advantage formulary. Transmucosal immediate-release fentanyl products Also beginning on Jan. 1, 2015, Harvard Pilgrim will require prior authorization on all transmucosal immediate-release fentanyl products (for example, fentanyl citrate lozenges, Fentora, and Subsys) for all formularies (Value, Premium, and Medicare Advantage). These products are used to manage breakthrough pain in patients with cancer who are 18 years of age and older and are already receiving, and are tolerant to, around-the-clock opioid therapy for their underlying, persistent cancer pain. Harvard Pilgrim Health Care 5 Network Matters November 2014

6 Requesting prior authorization To request prior authorization for any of the medications listed above, please review the clinical criteria and submit the appropriate Medication Request Form by fax to MedImpact Healthcare Systems at The clinical criteria and medication request form will be available on the prior authorization section of our Pharmacy webpage by Dec. 15. Reminder: Use of Non-Participating Ambulance Providers Using ground ambulance services that do not participate in Harvard Pilgrim s network can result in higher out-of-pocket costs for your patients. As a reminder, it s important to use a Harvard Pilgrim contracted ambulance provider when coordinating ground ambulance services for our members, including transportation between facilities, such as hospitals, skilled nursing facilities, and rehab facilities. Below is a partial list of the most commonly used ambulance companies that do not participate in Harvard Pilgrim s network. Please avoid using these ambulance services for Harvard Pilgrim members. Partial List of Non-Participating Ambulance Services Action Ambulance Service Lifeline Ambulance Service MedStar Ambulance Professional Ambulance Patriot Ambulance Trinity EMS Inc Vital Emergency These ambulance providers do not participate in our network. Please avoid using these providers for Harvard Pilgrim members. Instead, please select a Harvard Pilgrim participating ambulance provider. You can find a complete list of Harvard Pilgrim participating ambulance providers in our Provider Directory. Harvard Pilgrim Health Care 6 Network Matters November 2014

7 OFFICE ASSISTANT A New Alliance: Health Plans, Inc. and UnitedHealthcare Earlier this fall, Health Plans, Inc., Harvard Pilgrim s wholly owned subsidiary, began partnering with UnitedHealthcare to enhance its existing product offerings for multistate employers based in Massachusetts, New Hampshire, and Maine. This alliance allows members to seamlessly access the extensive UnitedHealthcare Options PPO Network in addition to the Harvard Pilgrim Health Care provider network. As a result of this new partnership, member ID cards for Health Plans members are changing. ID cards for members of the plans offered jointly by Health Plans and UnitedHealthcare will include logos for Harvard Pilgrim, UnitedHealthcare, and Health Plans. In addition, any new cards produced for new or existing Health Plans members, regardless of their plan, will no longer include the 3-digit code that precedes current group numbers (001), as shown in the updated sample ID cards below. Member ID card for members living in Harvard Pilgrim s service area (above) Member ID card for members living outside of Harvard Pilgrim s service area (above) Harvard Pilgrim Health Care 7 Network Matters November 2014

8 Claims for all products should continue to be submitted to Health Plans. Please call Health Plans at with any additional questions about the alliance with UnitedHealthcare. Network Matters is a monthly newsletter for the Harvard Pilgrim provider network Eric H. Schultz, President and Chief Executive Officer Richard Weisblatt, Ph.D., Senior Vice President, Provider Network Annmarie Dadoly, Editor Kristin Edmonston, Production Coordinator Read Network Matters online at For questions or comments about Network Matters, contact Annmarie Dadoly at annmarie_dadoly@harvardpilgrim.org or (617) Harvard Pilgrim Health Care 8 Network Matters November 2014