like us on facebook connect with us on linkedin follow us on twitter February 15, 2023

 

Sanofi Care Assist

To learn more about Sanofi's CareAssist, CLICK HERE.

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MSHO Featured Corporate Sponsor Assistance Programs

• Advanced Accelerator Application's AAA PatientCONNECT™
• Incyte Cares 
• Mirati & Me

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WPS Oncology Related LCD Updates

February 2023

Stay current on retired and revised policies/articles

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WPS Recent Oncology Related News

• New Live Events Resource
• Fee Schedules
• Medicare Hot Links

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CMS-Medicare

Recent Oncology Related Articles

• Resources for End of the COVID-19 PHE
• CMS Prescription Drug Inflation Rebate Program
• MIPS Call for Quality and Cost Measures Overview Webinar 
• Recent Learn Resource & MedLearn Matters Articles
• And more

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Recent RAC Monitor Article

This edition includes articles on

• Why the GAO Considers HHS a “High Risk” 
• Understanding the Need for Eligibility Checks for Visits and Preauthorization for Procedures
• Appeal by Midnight, or Else – Patient Waver of Liability

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BCBSM/BCN

Recent Oncology Related News

• HEDIS medical record reviews
• ICD-10-CM laterality policy 
• Requirements changed for some commercial medical benefit drugs
• We’re no longer requiring prior authorization for 29 medical oncology drugs
• And more

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BCBSM/BCN

Publications

• The Record
• BCN Provider News

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Current Payer Issue Tracking Page

Last Reviewed/Updated 2/15/23

• 10/11 Update on BCBSM Denials for Auth Exceeds Allowed

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Aetna

• Changes to NPL
• Velcade Policy update
• Clotting Factors

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Health Alliance Plan

• CMS Ruling on Payment Rates for Drugs Acquired Through 340B Program

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Medicaid

Recent Oncology Related News

Medicaid Updates Include
• Medicaid Drug Rebate Program
• Medicaid & CHIP Application, Eligibility, & Enrollment Data
• 2023 Federal Poverty Level Standards
• MSA Bulletin Updates
• Biller "B" Aware Notices

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Molina

Recent Oncology Related News

• New Essentials workflow

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Priority Health Update

• 2023 fee schedules
• Medicare & Medicaid quality
• Value-based incentive programs
• And more

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United Healthcare

• Prior authorization for new medications and CPT® codes
• Medical Benefit Specialty Drug Update
• And more

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Recent Oncology Related FDA Approvals and Expanded Indications

• GSK Jemperli (dostarlimab-gxly)
• Stemline Orserdu (elacestrant)
• Gilead Trodelvy® (sacituzumab govitecan-hziy)
• LillyJaypirca™ (pirtobrutinib)
• Merck Keytruda (pembrolizumab)
• SeaGen Tukysa (tucatinib)
• BeiGene Brukinsa (zanubrutinib)

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ASK MSHO

February 2023 Frequently Asked Questions

• Same drug, multiple HCPCS codes

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