January 2024

As of Feb. 1, 2024, J1745 Remicade and infiximab will be the preferred biologics.

Effective February 1, 2024 the following drugs will be our preferred infliximab products:

• J1745 Remicade and infliximab (unbranded biologic)

This switch will ensure we cover the most cost-effective agent as good stewards of our members’ premium dollars.

Impact & Action Items

• Inflectra will no longer be covered as our preferred product.
  
• J1745 Remicade and infliximab (unbranded biologic) will be covered for U.S. Food & Drug Administration (FDA) approved indications only.

Members Impacted

• Commercial, Self-Funded and MediSource plans: those currently receiving therapy and those new to treatment.
• Medicare Advantage: only those new to therapy.

Prescriber Action

An authorization for J1745 Remicade/infliximab (unbranded biologic) will be entered for members with an active Inflectra authorization.

• Providers may switch patients to Remicade/infliximab (unbranded biologic) beginning February 1 or at the expiration of the patient’s current Inflectra authorization.
• Note: you will need to request a new Remicade/infliximab authorization once the Inflectra authorization expires.

We look forward to our continued partnership in providing quality care for our members and your patients. For questions, please call our Provider Relations Department at (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m.

The number of deaths from cervical cancer continues to decline, thanks to regular screening and the HPV vaccine. 

The number of deaths from cervical cancer in the United States have decreased substantially since the implementation of widespread cervical cancer screening and the rate continues to decline.

Most cases of cervical cancer occur among women who have not been adequately screened. Strategies that aim to ensure that all women are appropriately screened and receive adequate follow-up are most likely to succeed in further reducing cervical cancer incidence and mortality.

The United States Preventive Services Task Force (USPSTF) recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years.

For women aged 30 to 65 years, the USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting).

HPV vaccine is another important tool in cervical cancer prevention. Per the Centers for Disease Control, HPV vaccination prevents new HPV infections but does not treat existing HPV infections or diseases. HPV vaccine works best when given before any exposure to HPV.

Vaccine Recommendations:

• HPV vaccine is recommended for routine vaccination at age 11 or 12 years. (Vaccination can be started at age 9.)
• The Advisory Committee on Immunization Practices (ACIP) also recommends vaccination for everyone through age 26 years if not adequately vaccinated when younger. HPV vaccination is given as a series of either two or three doses, depending on age at initial vaccination.
• Vaccination is not recommended for everyone older than age 26 years. Some adults ages 27 through 45 years might decide to get the HPV vaccine based on discussion with their clinician, if they did not get adequately vaccinated when they were younger. HPV vaccination of people in this age range provides less benefit, for several reasons, including that more people in this age range have already been exposed to HPV.
• For adults ages 27 through 45 years, clinicians can consider discussing HPV vaccination with people who are most likely to benefit.

For more information, please view the following recommendations:

• USPSTF A & B Recommendations
• HPV Vaccination Recommendations  

Self-funded and commercial members who renew their plans in 2024, along with new subscribers, will be assigned new ID numbers that begin with W.

When submitting claims, providers must submit the National Clinical Trial (NCT) identifier; other information will be required upon request.. 

At Independent Health, we acknowledge the importance of clinical trials in the treatment of serious conditions. As outlined in our Clinical Trials policy, Independent Health covers medically necessary routine patient costs of a Qualified Individual participating in an approved clinical trial, as well as the routine costs of treating any side effects and/or complications associated with the approved clinical trial.

In support of our Clinical Trials Policy, the National Clinical Trial (NCT) identifier must now be included on any claim submission in the Demonstration Project field for both institutional and professional claims. Independent Health will reject claims that do not include the NCT identifier in the Loop 2300 REF Demonstration Project Identifier (REF*P4) on the 837. This change is effective February 1, 2024.

As a reminder, providers will also need to continue submitting the following clinical trial information upon request:

• Clinical trial protocol including Approved Clinical trial number, member information and medical history
• Clinical trial sponsor budget
• Protocol billing grid/treatment calendar

We recommend providers become familiar with the policy and its coverage exclusions. Log into your secure provider portal to view the Clinical Trials policy. 

Despite the cold weather and short winter days, there are many ways patients can stay active and engaged for their own health. 

Winter has arrived and with it comes decreased daylight, falling temperatures and fewer activities outside. Cold weather easily contributes to decreased motivation to exercise and the potential for increased isolation. Shorter days with less daylight reduce our exposure to vitamin D. This may lead to fatigue and disruption in sleep, ultimately contributing to low energy levels, anxiety, and depression.

“Staying connected with others may help boost your mood and improve your overall well-being. Stay in touch with family and friends in person or over the phone. Scheduling time each day to connect with others can help you maintain connections. Meet new people by taking a class to learn something new or hone a skill you already have.” (From "What do we know about healthy aging?" - National Institute on Aging, Feb. 23, 2023.

Research shows that physical activity has been proven to reduce fatigue, allow us to better manage stress and improve our overall wellbeing. While outdoor exercise offers opportunities for socialization and exposure to natural light, there are easy ways to stay active indoors to avoid prolonged sitting when inclement weather limits outdoor activity.

There are many ways to find exercise and activities – and Independent Health makes it easier through our community partnerships that providers may suggest to their patients. 

Naturally, we encourage individuals to protect themselves during outdoor exercise and activity by dressing in layers, keeping skin dry and covered, staying hydrated and avoiding alcohol. We also encourage people to get their physician’s approval before doing any physical activity, be sure to get your physicians approval.

Exercises/Activities with friends

Outdoor

• Hiking/Walking
• Snowshoeing
• Sledding
• Skiing
• Ice skating/Ice hockey
• Curling

Indoor

• Join a gym
• Yoga
• Walk at the mall
• Zoom classes
• Indoor equipment
• Chores to music
• Dancing

Social

• Go to the movies
• Game night
• Cooking class
• Dinner party
• Book club
• Go for coffee
• Craft night
• Bowling
• Group tours
• Send regular texts/emails
• Volunteering
• Scavenger hunt

Requirement effective Jan. 1, 2024

No updates for January, but view our up-to-date policies online.

Local tech startup wellconnected lands multiyear deal with Independent Health - The Buffalo News, Nov. 28, 2023