October 2024

 Pre-Exposure Prophylaxis (PrEP) is an effective tool in reducing the risk of HIV; PCPs can help.

Primary Care Providers (PCPs) are the front line for detecting and preventing the transmission of HIV. According to the CDC’s recommendations, and those of the US Preventive Services Task Force (USPSTF), PCPs should conduct routine HIV screening at least once for all patients older than 13 years of age, and more frequent testing should be offered to those with ongoing risk (i.e. new sexual partners). In the event of a positive test result, early detection and referral to a provider with experience treating HIV is vital to optimizing individual patient outcomes, and also in reducing transmission within the community. 

Evidence suggests many patients who are at high risk and who are being seen by their PCPs are NOT being offered HIV testing (and in many cases are not having a comprehensive sexual history conducted). HIV testing should be offered as part of routine bloodwork, which includes cholesterol and diabetes screening and basic metabolic panels. 

For front line providers, it is essential to at least offer HIV testing and/or initiate conversations about Pre-Exposure Prophylaxis (PrEP) to patients at greatest risk of HIV transmission during routine office visits. In fact, the USPSTF recommends HIV testing (and counseling about pre-exposure prophylaxis) as grade A recommendations. These are stronger recommendations than even their recommendations for biannual mammography in women over 40 years of age.  

Evidence suggests that while PrEP can be costly, in populations with both a high risk and a high prevalence for infection, e.g. adolescent men who have sex with men, and transgender women of color, use of this biomedical intervention can be cost effective. In fact, for people insured by NY State, all forms of PrEP are covered by their insurance.  Most people do not take these prescriptions for long periods of time as they can discontinue it when their life circumstances change. 

In keeping with Independent Health’s priority to “End the Epidemic” and optimize health outcomes for all of our members, regardless of race, ethnicity, age, gender, or sexual orientation, Independent Health has created a “PrEP Provider Toolkit” to serve as a vital resource to prevent your patients from becoming infected with HIV. 

HIV does not discriminate; any patient can be living with the virus or be infected with it. Unfortunately, several marginalized patients, including people of color, transgender people, and men who have sex with men, are disproportionately affected by this blood borne infection. 

There are more than 100,000 people living with HIV in New York State, including more than 3,000 people in Erie County alone. A startling truth is that approximately one in seven patients living with HIV does not know their HIV status. These patients are more likely to continue unsafe sexual or needle sharing practices, thus infecting their partners. 

The stigma surrounding HIV is the primary reason that so many people do not know their status. But prescribers and their clinical staff can help to reduce this barrier to optimal health outcomes. The toolkit provides many valuable resources for prescribers who feel unprepared or who feel that they do not have the time to tackle this important health topic.

What can you do?

1. Work with all your patients to “Expect the Test.” New York State, in accordance with recommendations from the Centers for Disease Control and Prevention (CDC) and US Preventive Services Task Force (USPSTF) require HIV testing be added to all routine bloodwork as the standard of care for all people aged 13 and older. Additional tests should be offered for those with ongoing risk (ie each time they have a new sexual partner).
2. De-stigmatize all aspects of human sexuality. The toolkit provides resources on how to conduct routine sexual history and risk assessments for all your patients, regardless of age, race, gender, or sexual orientation. We understand that this may feel uncomfortable at first. The toolkit provides resources on how to normalize these conversations across populations, and helps clarify why asking these questions is important. Make your office a “safe space” for all sexual or gender minorities. The toolkit offers examples of nonjudgmental questions to ask, and works to make these histories complete and concise.
   
3. Learn More about Pre-Exposure Prophylaxis (PrEP). The toolkit walks prescribers who are unfamiliar with PrEP step by step through the entire process, from taking a sexual history to what to do if a patient tests positive for HIV. It offers advise on how to determine which patients might benefit from PrEP, as well as how to discuss prevention alternatives with your patients. It reviews the known data regarding risks versus benefits of PrEP prescriptions, and reviews how to approach stopping these therapies when appropriate. The toolkit also clearly details the questions that should be asked, what should be monitored, and the labs that should be drawn at every three-month visit.
   
4. Remember to utilize community resources. Patients who utilize PrEP do not need to be seen in the office every three months. Labs can be drawn at external sites, and upon review, any prescriptions can be electronically prescribed. Utilize your staff, including clinical pharmacists or nurses, to follow up with patients regarding adherence or adverse event management. The toolkit also provides information about other clinics in the area that are prescribing PrEP, and these prescribers can serve as “PrEP mentors”, or as referral sites.
   
5. When in doubt, ask! Independent Health works closely with the New York State AIDS Institute and local Ending the Epidemic committees, and our team can work with you to create streamlined protocols surrounding sexual history taking, risk assessment, or PrEP prescription. We can also address any clinical or psychosocial questions or concerns you have regarding the information in the toolkit. Our clinical pharmacy and case management teams are here to help!
   

Drug used to treat hot flashes due to menopause has new warning

By Christopher Brighton, PharmD, Clinical Pharmacist, Independent Health

The U.S. Food and Drug Administration (FDA) has recently announced a warning that Veozah (fezolinetant), a medication used to treat hot flashes due to menopause, can lead to rare but serious liver injury. A post marketing case of serious drug-induced liver injury that occurred in a patient who received Veozah was reported to the FDA Adverse Event Reporting System (FAERS) database as follows:

BACKGROUND-Before starting Veozah, the patient’s liver blood test levels were normal. Within 40 days of starting the medication, several liver blood tests values were significantly elevated: alanine transaminase, more than 10 times of normal level; alkaline phosphatase, more than four times of normal level; and total bilirubin, more than 3 times of normal level. The patient reported symptoms of liver injury, including fatigue, nausea, decreased appetite, itching of hands and feet that later spread to the entire body, jaundice, pale feces, and dark urine. The patient’s prescriber found no abnormalities when checking for other causes of liver injury, using ultrasonography of the liver and blood tests for viral hepatitis. After subsequent discontinuation of Veozah, the signs and symptoms gradually resolved, and liver blood test values returned to normal. 

WARNING- A warning about the risk of serious liver injury has been added to the existing warning about elevated liver blood test values and required liver blood testing in the prescribing information for Veozah (Veozah PI). The updated prescribing information also instructs patients to stop the medication immediately and contact the health care professional who prescribed the medicine if signs and symptoms of liver injury occur. Stopping the medicine in a timely manner could prevent worsening liver injury and potentially return liver function to normal.

ACTION- Steps to reduce the risk of liver injury cited in the prescribing information include the following:

• Before starting Veozah, perform baseline liver blood tests to assess liver function, including serum ALT, serum AST, serum ALP, and serum bilirubin (total and direct). During treatment, perform follow-up liver blood tests every month for the first three months, and then again at months 6 and 9.
• Do not start Veozah if the concentration of ALT, AST, or total bilirubin is equal to or exceeds two times the upper limit of normal (ULN).
• Stop Veozah if transaminases exceed five times the ULN, or if transaminases exceed three times the ULN and total bilirubin is more than two times the ULN.
• Perform more frequent follow-up liver blood tests if the transaminases exceed three times the ULN, but the total bilirubin is not more than two times the ULN. If the liver blood test values are elevated, exclude alternative causes of liver injury. 

Please visit the MedWatch program to help the FDA track safety issues with medications or report adverse events. 

For more information regarding the drug safety announcement for Veozah, please visit the FDA website.  

With the end of the year approaching, it is time for our participating providers to complete their annual required training if they haven’t done so already. 

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

Results of a telephone survey with participating practices to gauge their compliance with New York State's access and availability standards are in. How did provider offices do?

New process enhances security measures aimed to protect Independent Health and providers from unauthorized and nefarious actors.

As health care providers continue to face challenges with claims submissions, Independent Health has extended timely filing deadlines through Oct. 31, 2024.

VaxCare makes it easier for providers by managing the vaccination purchasing and billing process. 

Beneficiaries begin receiving their 2025 information this week. 

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

Especially important for GLP-1s indicated for type 2 diabetes management

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