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Family Care Update for Providers on Pharmacy Benefits

January 31, 2018

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Key Highlights:

  • All previous prior authorizations and prescriptions will continue to pay for up to 90 days, including claims filled at Walgreens, which is not in CareOregon’s network.
  • After this transition period we will work to minimize disruption and prior authorization burden by:
    • Early communication to you for safe formulary switches during the transition phase.
    • Allow lifetime or extend PA approval duration on a subset of drugs/drug classes.
    • Potential formulary changes.

Key Formulary Differences Observed:

Drugs/Drug Classes

FamilyCare Formulary

CareOregon Formulary

Insulins

Lantus vials, Levemir vials/pens

Basaglar pens

Topical diclofenac

Diclofenac gel

Oral NSAIDs, capsaicin cream

PPI

Lansoprazole

Omeprazole and pantoprazole

Combo ICS/LABA Inhaler

Advair, Symbicort, Dulera

Generic AirDuo (Advair and Symbicort will continue to pay for existing users)


Cough/Cold products

Various classes: decongestants, antitussives, expectorants

Non-formulary agents (Treatment of below-the-line conditions)

Abx for acne

Doxycycline, minocycline and tetracycline

Doxycycline: short term only (#14 days per 60 days)

Minocycline and tetracycline: Not covered

Topical higher potency steroids

Clobetasol and betamethasone augmented ointment

Betamethasone cream 0.05% or desoximetasone 0.25% cream


What do we need from you now?

  • Inform your FamilyCare patients to switch from Walgreens to a CareOregon network pharmacy. Pharmacies can be found in our provider directory: http://coapps.careoregon.org.
  • Switch to CareOregon preferred formulary agents when it is clinically appropriate.
  • Partner with your clinic pharmacists (where available) to switch patients to CareOregon formulary agents and network pharmacies.


CareOregon Pharmacy Resources

Oregon Health Plan (OHP) Benefit:

Prioritized List: http://www.oregon.gov/OHA/HPA/CSI-HERC/Pages/Prioritized-List.aspx


Formulary Look up tool:

  • Formularies on CareOregon Website (PDFs)

Medicaid: http://www.careoregon.org/Providers/PharmacyHelpDesk/FormularylistAndUpdates.aspx

Medicare:http://www.careoregonadvantage.org/providers/rx-and-drug-information

  • Medicaid – CareOregon
  • Medicare – CareOregon Advantage Plus MA or CareOregon


Advantage Star MA 

  • ePocrates Mobile products: download at App Store or GooglePlay

 

Prior Authorization (PA) Look up:

  • Criteria and PA forms :

http://www.careoregon.org/Providers/ProviderFormsandPolicies.aspx

 

 

Pharmacy Contact information:

  • Customer Service: 503-416-4100 (M-F: 8 am – 5 pm)

Option 3 for provider, option 2 for medication related questions, and then option 2 again for a pharmacy staff member.

  • PA Fax: 503-416-8109
  • Injectable Drugs PA Fax: 503-416-4722
  • Appeals Fax: 503-416-1428

DME No auth required: http://www.careoregon.org/Res/Documents/Providers/DME_HCPCS_Code_List.pdf