Peach State Health Plan Blog

Vaccine Discrepancies between DCH and GRITS (Georgia Immunization Registry System) PDF

This entry is filed under Blog.

July 28, 2009

Dear Peach State Health Plan Provider:

 
As children return to school, the number of upper respiratory tract infections (URTIs) increases. Peach State wants to provide you, our providers, with information regarding treatment of these infections. 

URTIs are very common among adults and children. In fact, these illnesses are the most frequent cause of utilizing medical care in the United States and, not surprisingly, drive about 75% of all antibiotic prescriptions written each year. While URTIs represent a broad range of disorders, including the common cold, otitis media, bronchitis, pharyngitis, pneumonia, and sinusitis, it is important for the clinician to treat these conditions appropriately.¹ The Healthcare Effectiveness Data and Information Set (HEDIS) measures and evaluates patients who were given a diagnosis of URTI only and were not given an antibiotic prescription. A higher rate indicates appropriate treatment of an URTI, or a greater proportion of patients who were not given antibiotics.

It is necessary for physicians to be prudent in their prescribing habits to treat URTIs, due to the growing resistance to antimicrobials. Streptococcus pneumonia, the common causative agent of bacterial meningitis, bacterial pneumonia, bacterial sinusitis and otitis media, has gained increased antibiotic resistance in the past several years. Recent antibiotic exposure is one of the most significant predictors of antibiotic resistance.¹  The causative agent of upper respiratory symptoms, such as cough, rhinorrhea, sinus pain, and/or a sore throat can be bacterial, but more often these symptoms can be attributed to a virus. Antibiotics are ineffective in treating viral infections. ¹

Inappropriate treatment of URTIs may contribute to antibiotic resistance, but can
also lead to adverse drug events (including allergies) and drug-drug interactions. Inappropriate use of antibiotics will often lead to unnecessary increased medical costs. ¹ Many clinicians are concerned that patients will not be satisfied with their care if they do not receive an antibiotic prescription for upper respiratory tract symptoms. However, in a study published in the Journal of Family Practice, patients found the quality of the interaction with their clinician to be more important than being prescribed an antibiotic.² Appropriate treatment and assessment of URTIs is an important piece of medical practice. URTIs are very frequent in the United States and inappropriate treatment can lead to increased healthcare costs, adverse drug events, drug to drug interactions and increased antimicrobial resistance; therefore, it is important to reserve antibiotic use for patients in which they are absolutely necessary.

 References

1.  Gonzales, R. MD, MSPH; Bartlett, J. MD; Besser, R. MD; et al. Principles of
Appropriate Antibiotic Use for Treatment of Acute Respiratory Tract Infections in
Adults: Background, Specific Aims, and Methods. Ann of Intern Med. 2001; 134: 479-486.
2.  Hamm, R, Hicks, R, Bemden, D. antibiotics and respiratory infections: are patients more satisfied when expectations are met? J Fam Pract. 1996; 43: 56-62.

This entry is filed under News.

Attached is July’s Provider Watch.  This Provider Watch is also located in the News/Media page in the Newsletters section of the website.

This entry is filed under News.

 August 1, 2009

 Dear Peach State Provider:

 
Peach State is making an important change in policy to improve quality of care for our members, and we are writing to communicate this change to you. Beginning August 17, 2009, Peach State will require prior notification to bill Mirena and ParaGard and the placement of these Intrauterine Devices (IUD). You will not be paid for the IUD or the placement unless the prior notification form is completed, returned to Peach State, and a reference number is issued prior to the date of service.

You must provide the IUD from your office stock and bill for the device with the insertion.

• If your office does not stock IUDs, then you may purchase them directly from Caremark. Please contact Caremark Mirena Support at (p) 866-647-3646 (f) 888-281-8199 or on online at www.mirenasupport.com if you do need to purchase a Mirena from Caremark. Once you purchase the Mirena and have it in stock, then you can fax the prior notification form to Peach State at 1-866-374-1579 to receive your reference number to be used in billing the Mirena and the insertion.
• If you already have the IUD in stock and do not need to purchase it from Caremark, then you can fax the prior notification form directly to Peach State at 1-866-374-1579.

 IUD Checklist Form (PDF)

Once Peach State receives the completed form, we will send a fax to you communicating a reference number. This number must be included in your claim submission in order for payment to be made. If you have any questions about the new process, please contact the Peach State Pharmacy Department at 1-800-514-0083 (option 2). We will be happy to assist you.

 
Thank you,

Dean Greeson, MD MBA
VP of Medical Affairs
Peach State Health Plan

This entry is filed under News.

June 2009

Dear Peach State Provider:

Peach State Health Plan  is making some important changes to our Preferred Drug List, and we are writing to communicate the changes to you. Effective September 1, 2009, the following changes will be made:

Member’s medication regimen is restricted two narcotic analgesic medications per month. This will include the products listed below.

Brands/generics (containing any of the following ingredients): 

1. Oxycodone
2. Hydrocodone
3. Propoxyphene
4. Codeine
5. Butalbital (not a controlled substance, but still has potential to be a drug of abuse)
6. Morphine
7. Methadone
8. Meperidine
9. Fentanyl
10. Buprenorphine
11. Oxymorphone
12. Hydromorphone
13. Pentazocine

 
As the member’s physician, If you feel that a patient will require medication therapy outside of the above guidelines, you are required to submit a prior authorization request to Peach State. The Medication Prior Authorization Request form is available on the Peach State website, www.pshp.com, in the Pharmacy Forms section. The completed form  must be  faxed to US Script at 1-866-399-0929 for review.

Thank you,

Wendy Bailey, RPh.                         Robyn Lorys, Pharm. D.
Director of Pharmacy                     Director of Clinical Pharmacy
Peach State Health Plan                 Peach State Health Plan

This entry is filed under News.