Pharmacy Updates

Pharmacy Update During the COVID-19 Emergency

MetroPlusHealth covers a 90-day supply for most prescription maintenance medications. Practitioners and pharmacists should consider 90-day supplies of long-term maintenance medications for individuals in quarantine.

Questions regarding policy and billing guidance for pharmacy should be directed to MetroPlusHealth at 1-800-303-9626

For up-to-date guidance on Pharmacy policy during the disaster emergency, please visit the New York State Department of Health site.

Important Pharmacy Update. MetroPlusHealth Billing Guidance for COVID-19 Testing at Pharmacies, Vaccines, At-Home Testing, Oral Antivirals, Vaccine Counseling, Monoclonal Antibody Administration and Billing. Read more here.

90-day refills for maintenance medications. We recommend members refill long-term [chronic] maintenance medications eligible for 90-day supplies at local in-network pharmacies. Members can also have 90-day supplies filled by CVS Caremark Mail Service pharmacy and have them delivered with no additional charge.

SAMHSA Change Concerning the Prescribing of Buprenorphine

Please see below from Sharon Stancliff, MD, Associate Medical Director for Harm Reduction in Health Care for the AIDS Institute for the State of New York:

In light of the COVID-19 emergency, the Substance Abuse and Mental Health Services Administration (SAMHSA) made a critical change to policies concerning the prescribing of buprenorphine to patients with opioid use disorder.

The requirement to conduct an in-person initial visit has been waived for the term of the emergency. This visit may now be conducted via telephone. The SAMHSA announcement, which may be found here, includes the following language:

OTPs should feel free to dispense, and DATA-waived practitioners should feel free to prescribe, buprenorphine to new patients with OUD for maintenance treatment or detoxification treatment following an evaluation via telephone voice calls, without first performing an in-person or “telemedicine evaluation.”

SAMHSA also sent out a reminder on a previous policy change that also increases access:
To expand access to buprenorphine in 2018, SAMSHA raised the first-year patient limit from 30 to 100 for DATA-waived practitioners if one of two conditions are met:

1. The physician holds a board certification in addiction medicine or addiction psychiatry by the American Board of Preventive Medicine or the American Board of Psychiatry and Neurology; or
2. The practitioner provides medication-assisted treatment (MAT) in a qualified practice setting. Clinics should consider whether they meet these qualifications, as many comprehensive settings do.

A qualified practice setting is a practice setting that:

• Provides professional coverage for patient medical emergencies during hours when the practitioner’s practice is closed;
• Provides access to case management services for patients including referral and follow-up services for programs that provide, or financially support the provision of, services such as medical, behavioral, social, housing, employment, educational, or other related services;
• Uses health information technology systems such as electronic health records;
• Is registered for their State prescription drug monitoring program (PDMP) where operational and in accordance with Federal and State law; and
• Accepts third-party payment for costs in providing health services, including written billing, credit, and collection policies and procedures, or federal health benefits.

Additional information, including the definition of  a qualified practice setting, may be obtained here.