Tag: Drug Coverage
Superior Pediatric Vaccines 11/1/2023
For questions, please contact Pharmacy Provider Services
Updated: Vaccine Information
Date: 11/01/23
The best way to stay protected against COVID-19 and flu is by staying updated on vaccines. Superior HealthPlan would like to inform providers about current COVID-19 and flu vaccine coverage.
COVID-19 Vaccines
The United States Food and Drug Administration (FDA) approved updated versions (2023-2024 formulation) of the COVID-19 vaccines; both the Pfizer and Moderna versions were approved in September and the Novavax version was approved in early October.
The Vendor Drug Program (VDP) is still working on getting the new COVID-19 vaccines added to the pharmacy formulary with no provided ETA. Superior Medicaid and CHIP members can obtain the new COVID-19 vaccines through their medical provider in the meantime or wait and return to the pharmacy once the VDP and the Texas Health and Human Services Commission have added the new vaccines to the pharmacy benefit. Please check the VDP Product Search for the most updated coverage of vaccines.
Flu Vaccines
The 2023-2024 flu vaccine formulations were added by the VDP to the pharmacy benefit on September 1, 2023. Similar to last year’s flu season, Medicaid and CHIP members who are 3 years of age and older can obtain their flu vaccine from a participating pharmacy. All members under 3 years of age will need to obtain a flu vaccine from their medical provider.
BCBS Pharmacy Quarterly Update
Changes Effective October 1, 2023
Just in Aetna OfficeLink Update
Changes to Aetna’s Commercial drug list BEGIN ON JULY 1st
“On July 1, 2023, we’ll update our pharmacy drug lists. Changes may affect all drug lists, precertification, step therapy and quantity limit programs.
You’ll be able to view the changes as early as May 1. They’ll be on our Formularies and Pharmacy Clinical Policy Bulletins page.”
Ways to request a drug prior authorization:
- Submit your completed request form through our Availity provider portal.*
- For requests for non-specialty drugs, call 1-800-294-5979 (TTY: 711). Or fax your authorization request form (PDF) to 1-888-836-0730.
- For requests for drugs on the Aetna Specialty Drug List, call 1-866-814-5506 or go to our Forms for Health Care Professionals page and scroll down to the Specialty Pharmacy Precertification (Commercial) drop-down menu. If the specific form you need is not there, scroll to the end of the list and use the generic Specialty Medication Precertification request form. Once you fill out the relevant form, fax it to 1-866-249-6155.
For more information, call the Provider Help Line at 1-800-AETNA RX (1-800-238-6279) (TTY: 711).
Seasonal Influenza Vaccines Pricing
The Medicare Part B payment allowance limits for seasonal influenza (flu) vaccines are 95% of the Average Wholesale Price (AWP), as reflected in the published compendia.
In hospital outpatient departments, payment is based on reasonable cost.
Annual Part B deductible and coinsurance amounts don’t apply for the influenza virus vaccinations. All physicians, non-physician practitioners, and suppliers who administer these vaccinations must take assignment on the claim for the vaccine.
Annual Influenza Vaccine season starts on August 1 and ends on July 31 of the following year.
Payment Allowances and Effective Dates by Flu Season
UHC Network News Brief 10/1/2021
Catch All the UHC UPDATES
October 2021 Policy and Protocol Updated Overview
- Medical policy update: October 2021
- Pharmacy Updates
- Prior Authorization and Notification Requirement Updates and 2021 Summary of Changes
- Reimbursement Policy Updates: October 2021
- Specialty Medical Injectable Drug Program Updates: October 2021
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