Respiratory Syncytial Virus (RSV) Season

August 21, 2010

Dear Peach State Health Plan Clinician,

Please click the link below to review  the Peach State Health Plan (Peach State) Synagis^® Authorization Guidelines for the 2010-2011 RSV season.  These guidelines were developed based on recommendations of the American Academy of Pediatrics (AAP) and local Georgia physicians.

The following modifications have been made to the AAP guidelines for infants born between 32 weeks, 0 days through 34 weeks, 6 days:

• Must be younger than 3 months of age at the start of the RSV season or born during the RSV season, and
• Must either attend child care or have a sibling younger than 5 years of age.
• If patient meets above criteria, Synagis should only be given until the infant reaches 3 months of age.

 Peach State will again use Caremark as its preferred provider of Synagis for the 2010-2011 RSV season. Beginning immediately, all requests for Synagis should be forwarded to Caremark for initial screening to determine if the request meets criteria for coverage. A copy of the Caremark RSV enrollment form can be obtained by clicking the appropriate link below or in the Pharmacy forms section of the website. When submitting the enrollment form, please attach the NICU discharge summary to expedite the review process. 

Caremark will be responsible for the delivery of the injectable product and the overall coordination of the drug distribution process. All injectable products will be billed directly to Peach State by Caremark and shipped to your office.  Administration charges for the injection should be billed directly to Peach State on a (HCFA) CMS 1500 claim form using CPT code 96372. You can also bill for an appropriate office visit for each administration of the drug. 

Caremark specializes in specialty injectables and can provide the support and follow-up with Peach State members to ensure compliance and positive clinical outcomes. Caremark offers:

• 24-hour access to the Caremark case management team
• Patient education and compliance monitoring programs
• Direct refill and renewal coordination
• Approved clinical protocols and treatment guidelines
• Synagis approval for the entire RSV season

 For RSV enrollment, please call 1-800-237-2767, or fax a completed Caremark RSV enrollment form prior authorization request form to 1-800-323-2445.  For additional questions, contact the Peach State Pharmacy Department at 1-800-514-0083 option 2. 

 Thank you for your cooperation,

 Dean Greeson, M.D.

Vice President, Medical Affairs

Enclosures:

• Synagis 2010-2011 Authorization Guidelines (PDF)
• Synagis Administration Policy 2010-2011 season
• Respiratory Syncytial Virus _ Enrollment Form (PDF)

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Dear Peach State Provider:

 Peach State Health Plan (Peach State) is making an important change to our Preferred Drug List.  The change that will be made is described below:

1. Beginning October 1, 2010, Lexapro will be removed from the Peach State Preferred Drug List. Physicians must obtain prior authorization in order for a patient to receive Lexapro.

 Antidepressants covered by the Peach State Preferred Drug List include Citalopram, Paroxetine, Fluoxetine, and Sertraline.

 If you, as a physician, feel that your patient can not be treated with one of the antidepressant medications covered on the Peach State Preferred Drug List, you can submit a prior authorization request to US Script, the pharmacy benefit manager for Peach State Health Plan. The Medication Prior Authorization Request Form is available on the Peach State website, www.pshp.com, under the Provider Forms section. This form can be faxed to US Script at 1-866-399-0929.

 Thank you,

  Wendy D. Bailey, RPh.           Robyn A. Lorys, Pharm. D.

Director of Pharmacy             Director of Clinical Pharmacy

Peach State Health Plan         Peach State Health Plan

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 Contact:  Debra Peterson-Smith 

                    VP, Regulatory Affairs and Communications                

 PEACH STATE HEALTH PLAN ANNOUNCES

2010 PHYSICIAN SUMMIT AWARD

–OUTSTANDING PHYSICIANS AND PRACTIONERS FOR 2010–

 Smyrna, GA (August 18, 2010) — Peach State Health Plan™ (Peach State), in collaboration with its parent company, Centene Corporation (NYSE: CNC), a national leader in healthcare solutions today announced the recipients of its 2010 Summit Awards for Excellence In Care. The Summit Awards are given each year to Physicians, Practitioners, and Obstetricians for providing clinical excellence. There are two award categories, one for Obstetrics, and one for Primary Care.

“Peach State is committed to recognizing Georgia providers for the excellent care they provide to our members,” said Patrick Healy, President, and Chief Executive Officer for Peach State. “We are pleased to recognize these providers in particular for their individual commitment to providing quality care and improving the health outcomes of our members.”

Dean Greeson, MD, Vice President, Medical Affairs for Peach State, stated, “It gives us great pleasure to award four deserving physicians in Georgia with this prestigious award.”

The Practitioners are selected for exemplary performance in several areas, including follow up after emergency room visits and routine preventive and well care services for adults and children. 

Following are the 2010 Summit Award winners

(Primary Care)

 Peach State Health Plan (Georgia)

-Renee Renfus, M.D.

- Josephine Dunagan, M.D.

-Aaron Goldberg, M.D.

“The OB category recognizes the extraordinary efforts in providing high quality obstetric care to all of our members,” explained Dr. Mary Mason, Senior Vice President and Chief Medical Officer for Centene. “Feedback from the members and their case managers helped determine the winners.” The individual criteria included risk-adjusted cesarean delivery rates, participation in the notification of pregnancy process and utilization of 17P, a weekly steroid injection to prevent premature birth in certain high risk women.

“The Society of Maternal Fetal Medicine supports activities that help elevate the level of quality and safety in obstetric care for the Medicaid patient,” added Dr. Daniel O’Keefe, Executive Vice-President, and Society for Maternal-Fetal Medicine.

The 2010 OB Summit Award winner

Peach State Health Plan (Georgia)

-Moon Chung, M.D.

About Peach State Health Plan

Peach State Health Plan (Peach State) is a Care Management Organization that serves the Medicaid and PeachCare for Kids ™ population in partnership with Georgia Families. Peach State is a wholly owned subsidiary of Centene Corporation, a leading multi-line healthcare enterprise offering both core Medicaid and specialty services. Information regarding Peach State is available via the Internet at www.pshp.com.

 About Centene Corporation

Centene Corporation, a Fortune 500 company, is a leading multi-line healthcare enterprise that provides programs and related services to the rising number of under-insured and uninsured individuals. Many receive benefits provided under Medicaid, including the Children’s Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and long-term care, in addition to other state-sponsored programs, and Medicare (Special Needs Plans). Centene’s CeltiCare subsidiary offers states unique “exchange-based” and other cost-effective coverage solutions for low-income populations. The Company operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health, life and health management, managed vision, telehealth services, and pharmacy benefits management. More information regarding Centene is available at www.centene.com. 

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Please click the link below to read the summer issue of the Provider Report.

Provider Report – Summer 2010

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Please click the link below to review the Timely Appointment Access Guidelines.

Provider Watch – August 2010 (PDF)

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