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Change in Prior Authorization Requirements

Effective November 21, 2020, Buckeye Health Plan (Buckeye) is making changes to services requiring prior authorization for Medicaid members.  This letter is provided as notification of the changes and resource information related to the specific services that will be impacted.

Please note the following important changes:

  • Epoetin alfa-epbx, Retacrit, Q5105 and Q5106 (preferred)
  • Darbepoetin alfa, Aranesp, J0881 and J0882
  • Epoetin Alfa, Epogen, Q4081 and J0885
  • Epoetin Alfa, Procrit, Q4081 and J0885
  • Methoxy polyethylene glycol-epoetin beta, Mircera, J0887 and J0088

On November 21, 2020, the following changes will take effect.

1. Epoetin alfa-epbx, Retacrit, Q5105 and Q5106 will be the preferred erythropoiesis-stimulating agent (ESA) for new and continuation therapy.  

These changes effect the following site of care settings: provider-administered, outpatient hospital or ambulatory care center. These changes do not effect dialysis centers.

To further assist you in this transition, you may access forms and updated materials on our website at our Forms-Resources page. 

Please contact Buckeye’s Provider Services Department at 1-866-296-8731 with any questions. Thank you for your partnership and for the quality care you provider to Buckeye members.

Change in PA Requirements for Preferred Botulinum Toxins

Effective December 16, 2020, Buckeye Health Plan (Buckeye) is making changes to services requiring prior authorization for Medicaid members.  This letter is provided as notification of the changes and resource information related to the specific services that will be impacted.

Please note the following important changes:

  • IncobotulinumtoxinA, Xeomin, J0588 (preferred)
  • AbobotulinumtoxinA, Dysport, J0586 (preferred)
  • OnabotulinumtoxinA, Botox, J0585

On December 16, 2020, the following changes will take effect.

1.    IncobotulinumtoxinA, Xeomin, J0588 will be the preferred botulinum toxin for limb spasticity (ages 18 and older), cervical dystonia, blepharospasm, and chronic sialorrhea.

2.    AbobotulinumtoxinA, Dysport, J0586 will be the preferred botulinum toxin for limb spasticity (ages 2 and older) and cervical dystonia.

These changes effect the following site of care settings: provider-administered, outpatient hospital or ambulatory care center. To obtain forms and more detailed information, please visit Buckeye’s website at Provider Home Page or contact Provider Services at 866-296-8731.

To further assist you in this transition, you may access forms and updated materials on our website at in the forms and resources section.  

Please contact Buckeye’s Provider Services Department at 1-866-296-8731 with any questions. Thank you for your partnership and for the quality care you provider to Buckeye members.

As a Buckeye Health Plan provider you know that quality health care is a high priority for the Centers for Medicare & Medicaid Services (CMS). CMS considers statin use in patients with cardiovascular disease and statin therapy in members with diabetes very important quality measures that should be appropriately managed and monitored. Buckeye has put in place the following initiatives to improve our measures and the success of Buckeye Health Plan quality efforts and the quality care of the members that we serve relies on each provider’s attention to these initiatives.

  1. Working with our data analytics team a monthly report is generated that identifies BHP members that fall into each of these measures.
  2. Our pharmacy team will make up to 2 fax attempts to each provider for each member identified.
  3. If no response from our fax outreach then a BHP clinical Pharmacist will attempt to contact the provider to review and resolve each opportunity.

Please consider the following for members that fall into these measures:

  • Evaluate and consider if member would benefit from the use of statin therapy (either during annual wellness exam or by responding to BHP outreach)  
  • Consider prescribing the medication electronically to the patient’s pharmacy of choice.
  • Make it easier for the patient to adhere to treatment by prescribing a 90-day supply, mail order or auto-refills – especially for patients stable on therapy.
  • Assess health literacy to determine need for additional support in medication management.
  • Educate the member on the role the medication plays in their disease process and what to do if they experience a side effect.

Measures For Your Reference:

SUPD Statin Use in Persons with Diabetes (Medicare)
Definition: 
Percentage of patients 40-75 years of age during the measurement year with at least 2 diabetes medications dispensed, and who also received a statin medication fill during the measurement year.

*STAR Weight: Currently 1 Star and will be 3 Star for 2020

The SPC and SPD CMS Quality measures can be found on the NCQA website.