Who you Gonna Call?
This is what "MTM" stands for in managed care
What is Medication Therapy Management?
This is what the acronym "UM" stands for in managed care
What is Utilization Management?
What is CVS Caremark?
During this year Healthfirst was established by a group of hospitals in the New York metropolitan area to help provide managed care options for underserved communities
What is 1993?
This federal Agency enforces the Controlled Substances Act and regulates the legal use of narcotics and other scheduled drugs on the federal level
What is the DEA (Drug Enforcement Administration)?
A core component of MTM that reviews all medications including prescriptions, OTC drugs and supplements
What is a Comprehensive Medication Review (CMR)?
This formulary tier is reserved for drugs that are for non preferred brands
What is tier 4?
This 2022 Act was signed into federal law which aims to reduce the federal government budget deficit, lower prescription drug prices, and invest in domestic energy production while promoting clean energy
What is the The Inflation Reduction Act (IRA)?
Healthfirst offers this type of special needs plan for individuals who qualify for both Medicare and Medicaid
What is Dual Eligible Special Needs Plan (D-SNP)?
This federal law passed in 1996, protects the privacy of patient Health information, including prescription records.
What is HIPAA (Health Insurance Portability and Accountability Act)
This statin is preferred for those who may be on multiple other drugs needing CYP3A4 metabolism
What is Pravastatin?
This type of UM tool is when a member must trial and fail other lower tier medications before progressing to higher cost drugs for the same condition
What is step therapy?
This clinically focused advisory body creates and updates PBM's formularies
What is a Pharmacy and Therapeutic (P&T) Committee?
This is a Healthfirst Plan that is a low cost health insurance option for adults who don't quality for Medicaid but still need affordable coverage
What is Essential Plan?
This federal law requires pharmacists to offer counseling to Medicaid patients receiving new prescriptions
What is OBRA-90 (Omnibus Budget Reconciliation Act of 1990)?
This condition is an exclusion for the SUPD measure that often results in weight gain and infertility in young women
What is Polycystic ovarian syndrome (PCOS)?
This prospective UM tool assesses a members match to set clinical criteria for drug access
What is PA (Prior Authorization)?
This term describes the maximum amount a PBM will reimburse a pharmacy for a generic drug, regardless of acquisition cost
What is Maximum Allowable Cost (MAC)?
Healthfirst operates in NYC five broughs, Long Island, Hudson Valley and this location that is known for the American Helicopter Museum
What is Westchester?
This is the federal controlled substance schedule classification for hydrocodone/acetaminophen
What is Schedule II?
MTM was officially recognized by the federal government in this 2003 Act which requires Medicare Part D plans that offer prescription drug coverage to establish MTM program for eligible beneficiaries
What is the Medicare Prescription Drug, Improvement, and Modernization Act?
When a Medicare members medication is denied the member is entitled to multi-level appeals process which includes how many levels?
What is 5 levels?
This federal Agency has launched multiple investigations into the PBM pricing practices and their role in rising drug costs
What is the Federal Trade Commission (FTC)?
Healthfirst is considered a health plan that is " by the people, for the people" due to its creation by these healthcare centers
What is Hospitals?
Under the Combat Methamphetamine Epidemic Act, this daily and 30 day purchase limit applies to products containing this ingredient
What is pseudoephedrine?