Humana's Your Practice

Changes to Humana's 2008
Drug List Available Online

Effective January 1, 2008, several changes will be made to the Humana Drug List for most members. Preclusive edits, which are safety edits that help prevent members from taking drugs that could potentially have harmful interactions, will also be implemented across all Humana plans. (Please note that for Texas groups, these changes will not become effective until the groups' renewal effective date. This date is not necessarily January 1, 2008.)

To help facilitate safe, appropriate and cost-effective drug benefits for all members, all Humana plans will utilize additional prior authorization (PA), step therapy protocols (ST) and quantity limit (QL) edits.

Providers can view the entire list of changes by visiting Humana.com. Click on "Providers" and then "Prescription Tools" in the "Quick Links" box. Click on "Humana's Drug List" and scroll down to see "Drug List Changes" for 2008.

Providers can search by taking the following steps:

Select a Humana prescription drug plan category, either Medicare or commercial.
Search for a drug using one of four methods:
a. Drug name – enter first three letters
b. Alphabetical search – search all drugs by first letter
c. Therapeutic class search – search for drugs according to therapeutic class, such as cardiology, oncology and other specialties
d. Most commonly referenced drugs list – click directly on the names of some of the most searched drugs

The search provides you with information on whether a drug requires any type of prior authorization, dispensing limits, authorization for continued therapy, quantity limits or step therapy. Providers are also given a list of possible alternative prescription drugs that are available in the same therapeutic class.

Some other helpful tools offered as part of the Drug List search include:

A link that allows users to toggle back and forth between Medicare and commercial plans for the same drug
A viewable and printable version of the Drug List
A Medicare Part D exception and appeals page

The Drug List is updated weekly, and contains information on approximately 12,000 drugs.

Humana continues to encourage members to use generic and cost-effective brand medications whenever possible. When filling prescriptions, Humana encourages members and providers to take advantage of RightSource^SM, Humana's prescription home delivery service. Providers can order new prescriptions for members by calling RightSource at (800) 379-0092 or by fax at (800) 379-7617. Visit RightSourceRx.com for more information, to download forms or to view frequently asked questions.

For more information about the drug list, call 1-800-4-HUMANA.

Tips for Improving HEDIS Results

Humana utilizes the Healthcare Effectiveness Data and Information Set (HEDIS®) to assess its performance in meeting clinical care guidelines and satisfying members' needs. Performance measures cover a variety of clinical and preventive indicators, including immunizations, cancer screenings, prenatal care, asthma, diabetes, hypertension and heart disease monitoring.

Humana, in collaboration with its network physicians, collects HEDIS information annually through claims, pharmacy, lab and encounter data, and medical record documentation. Physicians can facilitate an accurate assessment of their patient care by doing the following:

Providing appropriate care within the designated time frames
Accurately coding all claims and encounters
Thoroughly documenting a member's care in his or her medical record

HEDIS measures also reflect documentation of common diagnoses and treatment protocols for certain conditions. Following are some tips to help you meet HEDIS assessment measures.

Comprehensive diabetes care
Members diagnosed with Type 1 or Type 2 diabetes mellitus should have the following procedures documented:

Lipid profile in the past 12 months (most recent LDL-C should be less than 100 mg/dl)
HbA1c (result should be less than 7.0)
Dilated eye exam (an annual eye exam is a covered benefit for all Humana members with diabetes.)
Microabuminuria test or documented treatment for nephropathy
Blood pressure reading (should be <130/80)

Cholesterol management for patients
with cardiovascular conditions
A lipid profile should be performed 60 to 365 days after hospital discharge following an acute myocardial infarction (AMI), coronary artery bypass graft (CABG), percutaneous transluminal coronary angioplasty (PTCA) or for members with a diagnosis of ischemic vascular disease. The results must be documented in the medical record; the low-density lipoprotein cholesterol (LDL-C) result should be less than 100 mg/dl.

Controlling hypertension
The medical record should contain documentation confirming a diagnosis of hypertension and documentation of the last blood pressure reading. Adequate control is defined as a systolic blood pressure less than 140 and a diastolic blood pressure less than 90.

Cervical cancer screening
Medical records of all female members 21 to 64 years old should include the results of a Pap smear done during the measurement year or the two prior years.

Breast cancer screening
Medical records of female members 40 to 69 years old should include the results of a mammogram done during the measurement year or prior year.

Colorectal cancer screening
For members 50 to 80 years old, documentation of one of the following screening tests should be included in the medical record:

Colonoscopy during the measurement year or prior nine years
Flexible sigmoidoscopy during the measurement year or prior
four years
Double contrast barium enema during measurement year or prior four years
Fecal occult blood test (three cards submitted by member with results documented in the medical record) during the measurement year

Childhood immunizations
The medical records for all pediatric patients should contain the documentation listed below. To achieve a "pass" score on this HEDIS measure, all vaccinations must be given on or before a child's second birthday.

Four DTaP/DT vaccinations and the dates of administration
Three IPV, one MMR, three H influenza type B, three hepatitis B, one varicella zoster (VZV) or a seropositive result for any of the above
Four pneumococcal conjugate vaccines

Documentation must include the date each antigen was given. Mention of chicken pox in history is not sufficient; the record should include documentation of the child's age when infected and/or the date of infection. New pediatric patients must transfer prior immunization records to the current physician's office to satisfy immunization documentation requirements.