Pharmacy Information and Preferred Drug List Changes - 4th Quarter 2022
Date: 10/21/22
90-Day Maintenance Medication Prescription Coverage
If your Trillium patients are on a maintenance medication, you may be able to prescribe a 90-day supply of their drugs. Patients can only get more than 31 days of a drug if it is a maintenance drug and any network retail or mail order pharmacy can fill the extended day supply. The Trillium Preferred Drug List (PDF) says “MP” next to drugs that are maintenance products. You can also call Trillium Member Services at 1-877-600-5472 (TTY: 711) and ask for a paper copy.
Coverage of Prescription Refills
Did you know that the day supply and type of medication prescribed impacts how early Trillium patients can refill their medication? View the table for refill coverage thresholds and how early members can get their medications for commonly prescribed amounts.
Be sure to inform your Trillium patients that they don’t need to wait until they are out of medications to request refills from their Pharmacy, especially if the prescription label says they’re out of refills.
Expansion of Contraceptive Coverage
Effective January 1, 2023 Trillium members will be able to fill up to a 12-month supply of oral hormonal contraceptives. Talk with your Trillium patients to determine the prescription duration that will work best for them and be sure that the prescriptions indicate when an extend duration fill is preferred.
Additional Preferred Options for Gender-Affirming Hormonal Therapy
This year Trillium has worked hard to listen to providers and members to ensure that we are providing appropriate and accessible gender-affirming hormonal therapy options for our members. Earlier this year Trillium removed the prior authorization requirement on generic testosterone gel and generic estradiol patches for members 17 years of age and older and as of September 1, 2022 estradiol valerate intramuscular oil has been added to the list of preferred agents. See the table (PDF) for a comprehensive list of the current preferred gender-affirming hormonal therapy options.
January 1, 2023 Changes to Direct-Acting Antiviral Treatment of Hepatitis C
Effective January 1, 2023 initial treatment of hepatitis C virus (HCV) with preferred direct-acting antiviral (DAA) agents will no longer require PA. Retreatment and extended duration treatments (Mavyret treatment greater than 8 weeks and sofosbuvir-velpatasvir treatment greater than 12 weeks) will still require PA. Case management services will continue to be offered to members filling DAAs to address treatment barriers and help them achieve sustained virologic response (SVR), but will no longer be a requirement for coverage.
Update on Specialty Pharmacy Restricted Medications
In most cases, Trillium Oregon Health Plan members must fill specialty drugs through Acaria Health Pharmacy. Recently this restriction has been removed from several drugs effective December 1, 2022.
View this notice (PDF) for specialty drugs that will no longer be locked into Acaria Health and can be filled by any network pharmacy when coverage restrictions are met.
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
View this notice (PDF) for all HCPC codes affected by changes in the third quarter of 2022. These codes require prior authorization for coverage for Trillium Community Health Plan members.
Oregon Health Plan Pharmacy Services Announcements
This update contains changes to the pharmacy services of Trillium Community Health Plan (Trillium) Oregon Health Plan. Based on the recommendations of the Trillium Pharmacy and Therapeutics (P&T) Committee, the Trillium Community Health Plan medication coverage guidelines (criteria) and Preferred Drug List (PDL) have been revised for the fourth quarter of 2022. PDL revisions are as indicated on page 7 of this notice (PDF). Updated criteria and PDL can be accessed by going to the Provider Resources section of our website. Changes will go into effect January 1, 2023.
The Trillium Community Health Plan P&T Committee determines updates to criteria and the PDL based on quarterly, comprehensive reviews. Criteria and the PDL serves as a reference for providers to use when prescribing pharmaceutical products for Trillium members with pharmacy coverage. Medications newly approved by the FDA require prior authorization until reviewed by P&T. Prior authorization (PA) does not guarantee payment. PA determination is based on multiple factors in conjunction to the criteria posted in drug coverage guidelines. These factors include but are not limited to: treatment of a funded vs non-funded condition as defined by the Oregon Prioritized List and applicable guidelines; prior trial and failure of agents on the PDL; comparative costs of available treatment options.
Quarterly Update on Pharmacy Coverage Guidelines
View this notice (PDF) for all the updated or new Trillium Community Health Plan coverage guidelines that were approved by P&T at our fourth quarter meeting October 6, 2022. All coverage guidelines will go into effect on January 1, 2023 and will become available to view in their entirety at our website.
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.