Unity Communicator
News for Practitioners and Providers, Summer 2015
In this issue –
Don’t miss the new UW Health at
The American Center Grand Opening!
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UW Health at The American
Center Grand Opening
Member News Update
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J .A universal care center for outpatient diagnostic and treatment procedures
Drug Safety Corner –
Important updates, plus
formulary changes
J Physical and occupational therapy
Fitbit and Unity’s
Personal Wellness Portal –
Automatically upload
Fitbit steps
MedDrop –
A convenient way to
safely dispose of
unused medications
Coding Alert –
2015 Drug Screening and Testing Coding Changes
Unity Health
Management Programs
Clinical Practice
Guidelines –
Preventive Health Care
Formulary Update
J Countdown to ICD-10 –
Unity is on target
for implementation
On Sunday, August 2, UW Health at The American Center is throwing open
its doors to welcome everyone to its state-of-the-art facility. The new
three-wing facility houses –
J .A 56-bed inpatient hospital for orthopedic and general medical / surgical patients
J .Two floors of clinic exam rooms for outpatient care in a variety of clinical specialties
J .A wellness, fitness and sports performance wing with therapeutic pool, sports ..
court, sprint track, classrooms and demonstration kitchen
J .A 24-hour emergency center for evaluation and treatment or transport to
UW Hospital and Clinics’ full-service emergency department
UW Health at The American Center is a unique health care campus featuring inpatient
and outpatient services along with wellness and preventive care programs.
New for 2015 – Fitbit Works with
Unity’s Personal Wellness Portal
Unity members with access to the personal
wellness portal can integrate their step activity
directly from Fitbit! It’s easy. Just login to the
personal wellness portal and follow the instructions
to connect the applications. Once connected, the
member’s steps will automatically be tracked in the
portal. To visit the personal wellness portal, log
into unitymychart.com.
Note: The personal wellness portal is not part
of Unity’s Fitness First & More Program.
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Tell Your Dane County Patients About MedDrop
According to Safe Communities Madison-Dane County, unintentional poisonings killed more
Dane County residents than automobile crashes in the past year. Unused prescription medications
may have played a role in this sad statistic.
Fortunately, Dane County offers a convenient way to safely dispose of unused medications.
MedDrop accepts the following –
J Prescription Medicine (pills, liquids, creams,
powders and patches)
J Over-the-Counter Medicine (pills, liquids, creams,
powders and patches)
J Medications for Pets
J Vitamins
J Medication Samples
J Nebulizer Solution
J Inhalers
To dispose of medications in the MedDrop boxes,
people should bring their unused or expired medication
in a Ziploc or other resealable bag to the MedDrop location.
The boxes are not designed for –
J IV Bags
J Oxygen Tanks
J Nebulizer Machines
J Thermometers
J Sharps, Epi-pens or anything
with a needle or lancet
unityhealth.com
unityhealth.com
unityhealth.com
MedDrop locations
(or go to safercommunity.net/meddrop.php) –
J Blue Mounds Police Dept. – 11011 Brigham Ave.
J Cambridge Police Dept. – 200 South Spring St.
J Deerfield Police Dept. – 7 West Deerfield St.
J Fitchburg Police Dept. – 5520 Lacy Rd.
J Madison Police East District – 809 South Thompson Dr.
J Madison Police West District – 1710 McKenna Blvd.
J Mazomanie Police Dept. – 133 Crescent St.
J McFarland Police Dept. – 5915 Milwaukee St.
J Middleton Police Dept. – 7341 Donna Dr.
J Oregon Police Dept. – 383 Park St.
J Sun Prairie Police Dept. – 300 E. Main St.
J UW Police Dept. – 1429 Monroe St.
J Waunakee Police Dept. – 205 N. Klein Dr.
Coding Alert
2015 Drug Screening and Drug Testing Coding Changes
Member
Newsletter
Update
The 2015 code changes included a significant change to the reporting of
drug screening services. Technological advances in drug testing include
many updated testing procedures for quantitative testing. As a result, the drug
screening and testing code section was revised to allow for additional specificity
in differentiating the materials being tested.
The Amercian Medical Association (AMA) added 58 new codes for reporting
definitive drug testing services. The new definitive drug testing codes are in
the 80320 – 80377 code range. The AMA also deleted the current drug screening
codes and added five new presumptive drug screening codes for 2015. The new
presumptive drug screening codes are in the CPT 80300 – 80304 code range.
The Centers for Medicare & Medicaid Services (CMS) recommended a delay in
pricing of the new 2015 drug codes. This recommendation was due to a CMS
concern about the potential for overpayment when providers bill for each
individual drug test rather than reporting a single code that reimburses the same
amount regardless of the number of drugs that are being tested. Therefore, CMS
created new HCPCS “G” codes to replace the 2014 CPT codes that were deleted.
They require that these new G codes be reported in the same manner which was
used to report the corresponding codes in 2014. The newly created G codes are
in the G6030 – G6058 HCPCS code range.
Unity currently will accept either the new CPT codes or the G codes as required
by CMS.
Unity’s Health Management Programs
Unity offers the following health
management programs –
J Asthma
J Diabetes
J Depression (chronic, situational
or postpartum)
J 9 Months & More
(prenatal / postpartum)
J Attention-Deficit / Hyperactivity .
Disorder (ADHD)
J Anxiety
J Hypertension
Each health management program
offers educational opportunities,
resources, self-management and
screening reminders for members
who may have a chronic condition.
If you would like more information
about these programs, visit
unityhealth.com/healthmanagement
or call Unity’s Health Services
Department at (866) 884-4601.
Your patients may ask you
questions related to these
articles –
J Cover Story – Articles on
summer sun, sunscreen
products and the dangers
of combining medications
with sun
J Back to school for college
students – How to make sure
your young adult child stays
healthy and stays covered
J Fitness – Workouts that count
and tools that help count
workouts
J Fresh eating – Eating fresh
food from the farmer’s market
is healthy and delicious!
Includes a fresh salsa recipe
J Men’s health – Seven tips for
leading a healthy life
J Active Living and Learning –
A program for members at risk
of developing diabetes
J Formulary Update
J UW Health at The American
Center – Grand Opening
August 2
Unity Communicator Spring 2015
Unity Communicator Spring 2015
Drug Safety Corner
Several drug safety alerts have been recently released by the Food and Drug Administration (FDA).
This column summarizes these recent safety alerts since the last newsletter.
Drug interactions with Hepatitis C drug
Harvoni (ledipasvir / sofosbuvir) or with
Sovaldi (sofosbuvir)
Taken in combination with another direct-acting
antiviral for the treatment of hepatitis C and
amiodarone may result in symptomatic bradycardia
The FDA warns that symptomatic bradycardia can occur
when the antiarrhythmic drug amiodarone is taken together
with either –
J The hepatitis C drug Harvoni (ledipasvir / sofosbuvir)
J Or with Sovaldi (sofosbuvir) or in combination with another .
direct-acting antiviral for the treatment of hepatitis C .
infection.
The review of submitted post-marketing adverse event
reports found that patients can develop a serious and
life-threatening symptomatic bradycardia when either
Harvoni or Sovaldi combined with another direct-acting antiviral
is taken together with amiodarone. The reports included the
death of one patient due to cardiac arrest and three patients
requiring placement of a pacemaker to regulate their heart
rhythms.
The other patients recovered after discontinuing either the
hepatitis C drugs or amiodarone or both.
Information for the Health Care Professional.
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For patients taking amiodarone who have no other . alternative treatment options and who will be
co-administered either Harvoni or Sovaldi in
combination with another direct-acting antiviral –
1.
Counsel patients about the risk of serious
symptomatic bradycardia. Signs or symptoms
of this condition include –
J Near-fainting or fainting
J Dizziness or light-headedness
J Malaise
J Weakness
J Excessive tiredness
J Shortness of breath
J Chest pains
J Confusion or memory problems
2. It is recommended that cardiac monitoring in
an in-patient setting for the first 48 hours of
co-administration is provided. Following this, . outpatient or self-monitoring of the heart rate . would occur on a daily basis through at least
the first two weeks of treatment.
J For patients who do not have other treatment ..
options, but have not yet started amiodarone .
therapy (are taking either Harvoni or Sovaldi in
combination with another direct-acting
antiviral) should undergo the cardiac
monitoring outlined above.
Patients discontinuing amiodarone just prior to
starting Harvoni or Sovaldi in combination with another
direct-acting antiviral, should also undergo similar cardiac
monitoring as outlined above. This is due to the long
half-life of amiodarone.
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If you have any questions about any of these alerts, please contact the Unity Pharmacy Program at (888) 450-4884.
Additional information for each of these alerts is available on the FDA website located at fda.gov/Safety/MedWatch/default.htm.
To sign up to receive email drug safety notification directly from the FDA Medwatch Program, refer to fda.gov/Safety/
MedWatch/ucm228488.htm. Each email contains a summary of the safety alert. When you need to know more, a link in
the email directs you to more detailed information.
unityhealth.com
unityhealth.com
Chantix (varenicline) and interaction
with alcohol
Increased cardiovascular risk for
testosterone use
The FDA warns that the prescription smoking cessation
medicine Chantix (varenicline) can change the way people
react to alcohol. In rare instances, seizures in patients
treated with varenicline have been reported.
The FDA provided a reminder that prescription testosterone
products are approved only for men who have low testosterone
levels caused by certain medical conditions. The benefit and
safety of testosterone replacement therapies have not been
established for the treatment of low testosterone levels due to
aging, even if a man’s symptoms seem related to low testosterone.
Information for the Health Care Professional
Interactions between alcohol and varenicline have
resulted in some patients experiencing increased
intoxicating effects of alcohol, sometimes associated
with aggressive behavior and / or amnesia.
J Advise patients to reduce the amount of alcohol
they consume while taking varenicline until they .
know whether the drug affects their tolerance for .
alcohol.
J Seizures have been reported in patients treated with
varenicline.
J Weigh the potential risk of seizures against the
potential benefits before prescribing varenicline in . patients with a history of seizures or other factors that
can lower the seizure threshold.
J Advise patients to discontinue varenicline and seek .
medical attention immediately if they experience a . seizure while on treatment.
J Advise patients to immediately stop taking varenicline
if they develop agitation, hostility, aggressive behavior,
depressed mood or changes in behavior or thinking that are not typical for them or if they develop suicidal
ideation or behavior.
J Encourage patients to read the patient Medication Guide at
fda.gov/downloads/Drugs/DrugSafety/UCM088569.pdf
or patient information they receive with their
varenicline prescription.
In addition, based on the available evidence from published
studies and expert input from an Advisory Committee meeting,
the FDA has concluded that there is a possible increased
cardiovascular risk associated with testosterone use. These
studies included aging men treated with testosterone. Some
studies reported an increased risk of heart attack, stroke or death
associated with testosterone treatment, while others did not.
Information for the Health Care Professional
J Testosterone replacement therapy is approved for use
only in men with primary or secondary hypogonadism
resulting from certain medical conditions.
J The safety and efficacy of testosterone replacement .
therapy for age-related hypogonadism have not been
established.
J Before initiating testosterone replacement therapy,
ensure that the diagnosis of hypogonadism has been
confirmed with laboratory testing. Verify that serum
testosterone concentrations have been measured
on at least two separate mornings and are consistently
below the normal range. Avoid measuring testosterone
concentrations later in the day, when measurements
can be low even in men who do not have
hypogonadism.
J For each patient, weigh the potential increased risk of
major adverse cardiovascular outcomes and other
risks of testosterone replacement therapy against the
potential benefits of treating hypogonadism.
J Inform patients of the potential increased cardiovascular
risk associated with testosterone replacement therapy.
J Encourage patients to read the patient Medication .
Guide at fda.gov/Drugs/DrugSafety/ucm085729.htm
or patient information leaflet they receive with their .
testosterone prescriptions.
Unity Communicator Spring 2015
Unity Communicator Spring 2015
Clinical Practice Guidelines – Preventive Health Care
The clinical practice guideline for Preventive Health Care has recently been updated. This guideline contains preventive
health recommendations for screening, counseling, education and interventions in patients from birth to geriatric ages.
Specific topics may also include recommendations for patients considered to be at increased or high risk.
Highlights of guideline changes include –
J Summary tables have been modified
by population type with active links
inserted.
J Blood Lead recommendations for
Medicaid patients have been added.
J Blood Pressure screening to be
completed in –
• Atriskpediatricpatientsoflessthan
three years of age
• Patients aged three to 18 years
annually
• Every visit for adults 18 years of age
or older
J Breast Cancer –
• A breast density-related risk table
has been added that includes
consideration for life expectancy.
• Physician education additions related .
to the position of national societies on
screening interval are included.
• Recommendations against screening
average-risk patients using MRI or
ultrasound have been added.
• Digital breast tomosynthesis language
has been revised to allow for
consideration.
• Recommendations for high risk
patients have been modified /
expanded.
J Cervical Cancer –
• Recommendations against more
frequent screening (i.e., annual) and
HPV testing in patients < 21 – 29 years
of age have been added.
• Physician education regarding
screening in HPV-vaccinated patients
and using HPV testing as a primary
screening have been added.
• Surveillance guidance added and high
risk recommendations have been
modified.
unityhealth.com
unityhealth.com
J Chlamydia and Gonorrhea –
• MSM recommendations have been
modified so that test is based on
sexual behavior.
• Testing options have been specified
for all patients.
• Screening recommendations for
pregnant women have been modified
to include a complete screening
at first prenatal visit (regardless of
pre-pregnancy screening) and to
repeat for at-risk patients during the
third trimester.
J Colorectal Cancer –
• Recommendations for patients aged
76 years or older have been added.
• Physician education regarding
Cologuard has been added. In
addition, a table of screening test
options has been added.
• Surveillance guidance has been
included and a “high risk
recommendations table” has been
added.
J Depression –
• Assessment tools specified for
pediatric patients have been added.
• A modified recommendation to
support annual screening in adults
has been added.
J Diabetes –
• The Guidelines have been updated to
match 2014 ADA. This includes
additional recommendations for
screening in pediatrics and
adolescents.
• Gestational diabetes testing has been
modified to 24 – 28 weeks.
J Immunizations –
• A reference to WIR for physician
education and reference to vaccine
refusal policy have been added.
• Call-outs to birth dose Hep B and
Tdap / Influenza during pregnancy
are now included, as these
vaccinations are often missed.
J Prenatal Care –
• Anemia screening recommendations
to repeat test during 24 – 28 weeks
have been added.
• The recommendations for
aneuploidy / NTD have been
expanded; guidance tables for testing
options have been added.
• Conditions for administering RhoGAM
have been added as well as additional
details related to breast feeding.
• The offer of cystic fibrosis screening to
all patients has been expanded.
• High risk recommendations for folic
acid are now included as well as
gestational weight gain
recommendations.
• GBS algorithms have been added
as well as specific testing options for
hemoglobinopathies based on
ethnicity.
J Tobacco Use –
• Specific screening questions have
been added.
• Resources for pregnant women who
smoke have been added.
The guideline can be found in its entirety
at unityhealth.com/clinicalguidelines.
Formulary Update
The following drugs have changed formulary status. These changes were made between February 2015 and April 2015. Members affected by these changes received a letter from
Unity containing more details.
A change in formulary status of drugs may affect out-of-pocket costs, depending on the current drug benefit. The complete formulary, a description of Unity’s different pharmacy benefit
designs and copayment or coinsurance requirements and current prior authorization criteria are available at unityhealth.com, in writing upon request or by calling (888) 450-4884.
Members covered under the State of Wisconsin health insurance program should contact Navitus Health Solutions at navitus.com to learn more about their prescription drug benefits.
Members covered under the BadgerCare Plus insurance program should call (800) 362-3002.
Recently Approved Medications
New Product
Generic
Formulary
Status / Notes
amphetamine (Evekeo)
carbidopa / levodopa ER (Rytary)
edoxaban (Savays)
empagliflozin / linagliptin (Glyxambi)
Tier 3
Tier 3, PA, QL
Tier 3
Tier 3, PA
fentanyl patches (new strengths)
37.5mg, 62.5mg, 87.5mg
Tier 3, PA, QL
other strengths
available at Tier 1,
PA, QL
Tier 3
hydrocodone / guaifenesin (Obredon)
insulin human, inhalation powder
(Afrezza)
insulin human recombinant analog,
glargine (Toujeo Solostar U-300)
lenvatinib (Lenvima)
Tier 3, PA
naloxegol (Movantik)
Tier 3, PA, QL
olaparib (Lynparza)
Tier 3, PA
Tier 3
Tier 3, PA
palbociclib (Ibrance)
Tier 3, PA
secukinumab (Cosentyx)
Tier 3, PA
sotalol suspension (Sotylize)
Tier 3
testosterone nasal (Natesto)
Tier 3, PA
umeclidinium (Incruse Ellipta)
Tier 3
PA = prior authorization required; QL = quantity limit;
SP = specialty pharmaceutical; ST = step-therapy required;
HT = Half tab program; CL = clinic-administered
Products Newly Available as Generics
As a reminder, when a new generic becomes available, the brand becomes non-formulary restricted
and if the prior authorization is approved, the brand is covered at the Tier 3 copay.
Product / Category
Equivalent Brand
Product
Generic
Formulary
Status / Notes
dexmethylphenidate ER
Focalin XR
Tier 3
estradiol twice weekly patch
Vivelle-dot
Tier 1, QL
guanfacine ER
Intuniv
Tier 3, QL
lamotrigine ODT
Lamictal
Tier 3
Pharmacy and Therapeutics Changes
(Refer to updated Medication PA Criteria on unityhealth.com)
Product / Category
Change and Effective Date
atazanavir / cobicistat (Evotaz)
Effective April 20, 2015 added to Tier 2, SP Program
Cephalosporin class review
Effective April 20, 2015; cefaclor, cefadroxil, cefuroxime and cefprozil were all
added to the formulary at Tier 1
darunavir / cobicistat (Prezcobix)
Effective April 20, 2015 added to Tier 2, SP Program
elvitegravir (Vitekta)
Effective April 20, 2015 added to Tier 2, SP Program
eslicarbazezepine (Aptiom)
Effective March 16, 2015; Tier 3
Growth hormones class review
(somatropin) – PA, SP required
Effective March 16, 2015 the preferred formulary somatropin product is
Norditropin. All somatropin products are included in the Unity Specialty Program.
Nasal steroids – PA required
beclomethasone (Beconase, Qnasl)
budesonide (generic Rhinocort AQ)
ciclesonide (Omnaris, Zetonna)
flunisolide
fluticasone furoate (Veramyst)
mometasone (Nasonex)
Effective April 1, 2015; all non-formulary nasal steroids require PA. The preferred
formulary alternative is fluticasone propionate. Triamcinolone is available
over-the-counter without a prescription.
naltrexone ER inj (Vivitrol) – PA
required, Medical Benefit
Effective March 16, 2015, naltrexone ER inj (Vivitrol) requires PA. Naltrexone ER inj is
clinic-administered by a health care practitioner and is included as part of the Unity
Medical Benefit.
omeprazole magnesium (Prilosec
OTC) formulary removal
Effective June 30, 2015 omeprazole magnesium (Prilosec OTC) will be removed
from the formulary. Generic omeprazole is available on the formulary.
Where to find information when you have questions
Topic
Where Available
To review Pharmacy Policies and Programs
unityhealth.com/pharmacy
To check the formulary status or restriction status of a drug or to obtain a copy of the formulary
unityhealth.com/drugformulary
To review criteria for coverage of a clinic-administered or prescription medication
Unity Clinical Pharmacy Program – (888) 450-4884 or unityhealth.com/medpriorauth
To speak to a clinical pharmacist about why a Prior Authorization Request was denied
Unity Clinical Pharmacy Program – (888) 450-4884
To appeal a Prior Authorization denial
Unity Customer Service – (800) 362-3310
To request written information about any pharmacy policy
Unity Clinical Pharmacy Program – (888) 450-4884
Unity Communicator Spring 2015
Unity Communicator Spring 2015
PRSRT STD
U.S. POSTAGE
PAID
MADISON WI
PERMIT NO. 406
Unity Health Plans Insurance Corporation
840 Carolina Street
Sauk City, WI 53583-1374
In
In this issue –
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Barron
Chippewa
Eau Claire
Portage
go
Outagamie
qu
ar
Green
Lake
MedDrop
J Health Management
Programs
J Member News Update
J Drug Safety Corner
J Clinical Practice Guidelines
J Formulary Update
J ICD-10 Implementation
Fond du Lac
M
Juneau
et
te
W
in
ne
ba
Waushara
Adams
Monroe
Fitbit works with Unity’s
Personal Wellness Portal
J Coding Alert –
2015 Drug Screening and Testing Coding Changes
Waupaca
Wood
UW Health at The American Center Grand Opening
n
to
Columbia
Dodge
ing
Sauk
sh
Richland
Cr
aw
Wa
fo
rd
Vernon
Iowa
Dane
Waukesha
Grant
Lafayette
Green
Rock
Provider Coordinator Service Area
Kathy
Season
Call (800) 362-3309
Ext. 1442
Call (800) 362-3309
Ext. 1497
Walworth
Tammy
Call (800) 362-3309
Ext. 1524
Includes providers in Iowa
and St. Mary’s Hospital in
Dane County.
For questions, contact
Unity Customer Service –
J Send a message through Ask an Expert
within MyUnity at unityhealth.com
J Call (800) 362-3310 and press 2
Monday – Friday 7 a.m. to 7 p.m.
For paper copies of any material, please call
(800) 548-6489.
Countdown to ICD-10
Unity is on target for the implementation of ICD-10, effective October 1, 2015.
Unity does not require that providers test the process. However, we strongly
encourage testing. Our testing period began May 15, 2015 and will end on June
30th, 2015.
To set up testing, simply submit a request to EDI@unityhealth.com. The testing
will start immediately. Any questions can be directed to EDI@unityhealth.com.
Unity will follow the CMS Guidance concerning ICD-10 coding, which can be
found at unityhealth.com/icd10.
Comments and suggestions are welcome.
Contact – communications@unityhealth.com
Unity Health Insurance is a Qualified Health Plan Issuer in
the Health Insurance Marketplace.
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