April 2024

The asthma medication montelukast (sold under the brand name Singulair) has been tied to an increased risk of neuropsychiatric effects. Here's what prescribers can do to help keep their patients safe.

Montelukast (brand name: Singulair) is used in the treatment of asthma. It has a boxed warning from the Food and Drug Administration (FDA) about serious neuropsychiatric (NP) effects since 2020. These NP effects include agitation, insomnia and other sleep disturbances, aggression, depression, suicidal thoughts, and behaviors. These adverse effects have been reported in patients of all ages, with and without pre-existing psychiatric disease, while taking montelukast or rarely after discontinuation. 

Neuropsychiatric events in children
Among younger individuals, particularly those between the ages of 1 and 17 years, many studies have suggested that use of montelukast is significantly associated with an increased risk of NP events. These adverse events typically involve sleep disturbances, insomnia, and nightmares. However, there may be an increased risk of other adverse events as described above. These adverse events led to a rate of discontinuation that, in at least one study, was higher than that associated with inhaled corticosteroids, the gold-standard of asthma treatment. 

Why the renewed concern?
On February 22, 2024, N.Y. Attorney General Letitia James called on the FDA to increase efforts to alert doctors about potential side effects of Singulair (generic montelukast) and to consider discouraging use of the drug for children. An examination by The New York Times, done in January 2024, found that people continued to report that they were not aware of the possible side effects when they took the medication or gave it to their children.

What can prescribers do?
Prescribers should counsel all patients receiving montelukast about mental health side effects and advise them to stop the medicine and contact a health care professional immediately if they develop any symptoms.

Health care professionals should consider the risks and benefits of montelukast when deciding to prescribe or continue patients on the medicine. Montelukast should be used with caution in patients with pre-existing conditions, especially pre-existing depression.

Although these side effects are rare, authorities recommend informing patients and stopping the medication if they note any mood changes. When patients are educated about the possibility of side effects, montelukast is generally well-tolerated and safe. 

National Healthcare Decisions Day is April 16, the annual reminder to encourage people to share their wishes for care through the end of life.

Making decisions about advance care planning and having uncomfortable, but necessary, conversations with loved ones regarding end-of-life wishes can prove to be invaluable to families when a health crisis strikes.

It’s important for individuals – your patients – to prepare advance directives in an effort to maintain autonomy during periods of incapacity or at the end of life.

Physician barriers to completing an advance directive include lack of time and discomfort with the topic.

On the patient's part, lack of knowledge, fear of burdening family, and a desire to have the physician initiate the discussion are common barriers.

Overcoming these barriers depends on effective communication at multiple visits, including allowing the patient the opportunity to ask questions. Involving the family or a proxy early and over time can help the process.

It may be helpful to begin to integrate advance directive discussions at selected stages of the patient's life, such as when a new diagnosis has been made or as health status changes.

For more information and guidance, please visit: Implementing Advance Directives in Office Practice | AAFP

Patients can also get started by using resources from The Conversation Project by the Institute for Healthcare Improvement.

Two important components of advance care planning include having a living will, which can include written instructions for end-of-life care, and a health care proxy, which allows individuals to appoint a health care agent – someone they trust to make health care decisions for them – if they are incapacitated or unable to do so themselves.

Experts agree no matter the age, people should consider taking the time to have these conversations, designate a health care proxy, and create a living will. It may very well prevent agonizingly difficult decisions down the road.

STIs go undetected and can have serious health consequences. The CDC offers up-to-date educational and informative resources for providers and patients alike. 

The Centers for Disease Control and Prevention (CDC) estimates, as of 2022, more than 2.5 million cases of chlamydia, gonorrhea, and syphilis were reported in the United States. According to the 2022 report, while reported cases of gonorrhea declined and chlamydia remained relatively level, syphilis cases increased 80% in the last five years. 

Many of these infections go undetected because they often have no recognizable symptoms. If left untreated, some of these infections can have serious health consequences and severe, adverse effects including:

• infertility
• ectopic pregnancy
• increased HIV transmission

STIs are preventable and treatable, and most are curable and encourage taking three simple actions— Talk. Test. Treat.

• Talk openly and honestly to your patients about sexual health and sexually transmitted infections, or STIs.
• Testing is the only way to know for sure if a patient has an STI. Many STIs don’t cause any symptoms, so patients could have one and not know it.
  
• Treat if a patient tests positive for an STI, utilizing evidenced based clinical practice guidelines.

To learn more and view resources for healthcare providers, please visit the CDC’s STD webpages.

Testing will now be required during third trimester.

Please note that effective May 3, 2024, NYS law will require a syphilis test during the third trimester of pregnancy in addition to syphilis testing at the time of first examination. Prior to this change, syphilis testing was required at the time of first examination and again at delivery (as per 10 NYCRR section 69-2.2).

Please click HERE for complete reference to this new testing requirement and for interim guidance on syphilis testing during pregnancy in light of this change in the law.

As noted in the release, though the law expansion effectively requires at least three syphilis screens during pregnancy, additional screening may be warranted. 

For questions or inquiries on syphilis screening and/or reporting requirements of same during pregnancy, please contact the NYSDOH Office of Sexual Health and Epidemiology (OSHE) at stdc@health.ny.gov.

Benefits vary by plan; verify coverage before rendering podiatry services

Effective June 1, 2024, Independent Health will be following Medicare guidelines from Local Coverage Article A57759 regarding routine foot care for Commercial, Medicare and Self-funded lines of business.

Please note: We have identified instances of members who were receiving coverage for routine foot care that will no longer be covered. We will be notifying those members.  Benefits vary by plan, so please contact Independent Health to ensure coverage before rendering services.

The Routine Foot Care policy and all other Independent Health policies are posted in our provider portal. 

If you have questions, please contact our Provider Relations Department by calling (716) 631-3282 or    1-800-736-5771 Monday through Friday from 8 a.m. to 6 p.m.

Benefits cover contraceptive drugs, devices, methods and counseling

Independent Health is required by state and federal agencies to ensure our participating providers complete this annual compliance training.

The 2024 training modules for our participating providers to complete their annual required training are now available on our website.

Independent Health is required by state and federal agencies to ensure our participating providers complete this annual compliance training.  

Staff members of practices required to complete this training include physicians, mid-levels, ancillary providers, registered nurses, licensed practical nurses, administrative and office staff, technicians, coders and others.

 Once again, participating practices have to attest to completing each of the following by December 31, 2024:

 
1. Cultural Competency Training 
All providers who treat Independent Health’s commercial and state program must attest annually that they have completed cultural competency training for all staff who have regular and substantial contact with Independent Health members.

In addition, the New York State Department of Health requires that all providers annually attest to completion of cultural competency training for all staff who have regular and substantial contact with Independent Health Medicaid and HARP members. 

To satisfy this training requirement, staff must complete the U.S. Department of Health & Human Services  online module, “The Guide to Providing Effective Communication and Language Assistance Services,” or the comparable Think Cultural Health training that corresponds with the provider’s scope of practice, and submit the electronic attestation to confirm completion.
 
This cultural competency training and attestation is available online.
 
2. Fraud, Waste & Abuse Training 
Independent Health requires each of its participating provider groups or practices to complete Fraud, Waste & Abuse Training and submit an electronic attestation to confirm completion of this training by each of their staff members. 
 
Staff members of practices required to complete this training includes physicians, mid-levels, ancillary providers, registered nurses, licensed practical nurses, administrative and office staff, technicians, coders and others.
 
If your practice has already completed the 2024 Fraud, Waste & Abuse training and attestation through Independent Health, it is not necessary to attest to doing so again. 
 
All related details, the downloadable training modules for your staff, and an attestation to verify with Independent Health that this training has been completed are available online.
 
Who must submit each attestation?
 Each of the above attestations should be submitted by an authorized representative on behalf of all individuals under a practice’s Tax Identification Number (TIN). Therefore, each individual staff member who completes each training does not need to submit the attestation.
 
If your practice has already completed this 2024 training through another source and has a roster or spreadsheet with the dates the training was completed, you may submit the attestation through each of Independent Health’s public provider portal pages above.
 
Questions?
If you have questions, please call Independent Health Provider Relations Department at (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m.

Representatives will begin conducting the annual phone survey about appointment access and availability for Independent Health members to ensure compliance with requirements.

Throughout the year, the Health Care Services and Population Health Management Departments deploy various tactics to encourage members to take a more active role in their health.

Cost-effective alternatives are available on Independent Health's drug formularies

Stay up-to-date on Independent Health's pharmacy policies and formulary updates.