Pharmacy Information and Preferred Drug List Changes - 2nd Quarter 2022
Date: 05/02/22
Updates to Gender-Affirming Hormonal Treatment Coverage
In an effort to better serve our members, generic testosterone gel and generic estradiol patches will no longer require prior authorization effective May 1, 2022 for members 17 years of age and older; quantity restrictions apply as detailed in the table on page 8. Additionally, the coverage guidelines OR.CP.PHAR.1002 for Gender Dysphoria have been updated to add these agents as preferred agents for treatment and will no longer require a comprehensive mental health evaluation for approval of treatment. These coverage guideline changes will be in effect July 1, 2022.
Available Seats on the Pharmacy and the Therapeutics Committee
Seats are open on the combined Trillium Community Health Plan and Health Net of Oregon Pharmacy and Therapeutics (P&T) Committee. We are looking for community-based practitioners representing various clinical specialties who adequately represent the membership of our health plans. Meetings are held once a quarter and are comprised of a remote review of clinical drug information and coverage guidelines, electronic vote and committee meetings. Individuals who are selected to join the committee are eligible to receive an honorarium to compensate them for the time spent reviewing materials and attending meetings. If you are interested in learning more or attending a quarterly meeting, please email DeAnn Pierce.
Peer to Peers Available with a Pharmacist
Trillium Community Health Plan pharmacists are available to discuss prior authorization denials and help you navigate treatment options for your patients. If you would like to speak to a pharmacist, please call our Provider Services team at 1-877-600-5472.
Prior Authorization Changes to Specialized Medications Given in Office
See the table for all HCPC codes affected by changes in the second quarter of 2022. These codes now require prior authorization for coverage for Trillium Community Health Plan members.
Additional Information
For additional information regarding changes to the Trillium Preferred Drug List (PDL), contact Trillium by telephone at 1-877-600-5472. For the most current version of the PDL, visit the Trillium website.
For additional information on the drug classes and medication coverage guidelines reviewed by the P&T committee, visit the Provider Resources section of Trillium’s website.
If you have questions regarding the information contained in this update, contact Trillium Provider Services through the Trillium website or by telephone at 1-877-600-5472.