Medicare: High risk meds not covered in 2012
Effective Jan. 1, 2012, high-risk medications (HRMs) will be removed from the Priority Health Medicare formulary. This decision is based on recommendations from:
- The Agency for Healthcare Research and Quality
- Healthcare Effectiveness Data and Information Set (HEDIS)
- Centers for Medicare and Medicaid Services 5-star quality initiative
Which meds are considered "high risk"?
View the list of high-risk medications and potential alternatives.
Letters informing members
In May we mailed a letter to providers of Medicare patients on HRMs. The letter included a list of the patients taking high-risk medications. Similar letters were sent to our members as well.
In November we mailed letters to Medicare members informing them that high-risk medications will not be covered effective Jan. 1, 2012. In the letter, we encouraged them to discuss covered alternatives with their provider.
Get a list of affected Medicare members
If you would like an updated list of your Medicare patients who are taking high-risk medications, contact your provider account representative directly or through the Provider Helpline at 800 942-4765.
Topics: Priority Health updates
