OHCA Provider Checkup

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April 2021

April 2021

Provider Notes

What You Need to Know About Medicaid Expansion

On June 30, 2020, the Oklahoma Medicaid Expansion Initiative, State Question 802, passed by a majority vote to expand Medicaid eligibility to adults ages 19-64 whose income is 138% (133% with a 5% disregard) of the federal poverty level or lower. This equates to an estimated annual income of $17,796 for an individual or $36,588 for a family of four. The application process for Medicaid expansion opens on June 1. Those who qualify will receive coverage on July 1.

Visit https://oklahoma.gov/ohca/about/medicaid-expansion/expansion.html for more information.

What You Need to Know About Managed Medicaid (SoonerSelect)

OHCA is transitioning to a managed care model in partnership with four medical plan organizations and three dental plan organizations. SoonerCare members will be able to select whichever plan they prefer for their coverage.

When Will SoonerSelect Go Into Effect? Oct. 1, 2021

How Does This Impact Providers Who See SoonerCare Members? Providers must contract with at least one of the four health plans to continue serving SoonerCare members.

How Can I Learn More? Visit https://oklahoma.gov/ohca/about/soonerselect.html for more information. We are also hosting SoonerSelect town halls (see below).

SoonerSelect Town Halls

If you have been unable to attend one of our SoonerSelect town halls discussing managed care either in person or virtually, we will hold one on April 15 in Kingfisher and another on April 19 in Oklahoma City, and are planning more. To stay up-to-date, register for future town halls or watch replays of previous ones, visit oklahoma.gov/ohca/townhall.

Adolescent Health Summit

The Oklahoma State Health Department of Health, in collaboration with its community partners, is hosting a training event for youth-serving professionals.

Event Name: Adolescent Health Summit

Date/Time: June 23-24 from 1-5 p.m. each day

Location: Virtual

Key Note Speakers: Dr. Niobe Way, Dr. Miguel Vazquez-Rivera, Youth Panel

Registration Information: Registration is not yet available, but will be accessible from the OSDH website once it is.

Questions: Contact kamishaB@health.ok.gov with any questions.

SoonerCare Coverage of Naloxone and Medication Assisted Treatment

Did You Know?

  • Patients covered through Medicaid are at a higher risk of opioid overdose than non-Medicaid patients. SoonerCare covers products and services to help treat substance use disorders, also known as medication assisted treatment (MAT).
  • MAT medications have a $0 copay for all SoonerCare members. Some specific products may still require a prior authorization. SoonerCare also covers naloxone products with a $0 copay that does not count towards the member’s monthly prescription limit. To prescribe buprenorphine MAT medications for your patients, you will need a DEA X waiver.
  • Methadone is also approved by the FDA to treat opioid use disorder (OUD). By law, only a Substance Abuse and Mental Health Services (SAMHSA) treatment program can dispense methadone for the treatment of OUD. There are multiple SAMHSA programs located throughout Oklahoma providing methadone treatment.

How to Obtain a DEA X Waiver:

  • Qualified practitioners with a DEA X waiver can administer, prescribe and dispense MAT medications. Information on obtaining a DEA X waiver can be found here. Oklahoma-specific information and training dates can be found here. The trainings are free and CMEs are available.

How to Administer or Prescribe Naloxone:

  • The American Medical Association has created a video providing naloxone administration instructions. A multi-state public health coalition has also provided assistance in prescribing the most appropriate naloxone formulation. They have paired the provider information with patient information for both the nasal spray and injection.  

SAMHSA National Helpline:

1-800-662-HELP (4357) or TTY 1-800-487-4889

The SAMHSA helpline provides 24/7, free and confidential mental and substance use disorder information and treatment referrals in both English and Spanish. This service provides referrals to local treatment facilities, support groups and community-based organizations. Callers can also order free publications and other information

Latest FDA Updated Medication Labeling and Warnings

Because some adverse drug reactions are not identified until a product is used in wider, more diverse populations, the FDA maintains a monitoring and reporting system. When problems are identified, medications may require updated labeling or warnings. In the most serious situations, the medication may be removed from the market. The table below lists recent alerts made by the FDA:


Using NSAIDs (non-steroidal anti-inflammatory drugs) in pregnancy at 20 weeks or later can result in low amniotic fluid


Social media "challenges" lead to serious problems with high doses of diphenhydramine (Benadryl®)


Risk of benzodiazepine misuse, abuse, and addiction is still elevated despite previous warnings


Risk of amputation associated with canagliflozin (Invokana®, Invokamet®, Invokamet XR®) is lower than previously described


Hydrochlorothiazide is associated with a small increased risk of non-melanoma skin cancer


Co-prescribing of naloxone is recommended for patients receiving opioid pain relievers or medicines to treat opioid use disorder


Hydroxychloroquine or chloroquine for COVID-19 is not recommended outside of the hospital setting or a clinical trial due to risk of heart rhythm problems


All formulations of prescription and over-the-counter ranitidine have been removed from the market due to the presence of N-nitrosodimethylamine (NDMA), which may increase the risk of cancer


Serious mental health side effects can happen with montelukast (Singulair®), and its use as monotherapy for allergic rhinitis is discouraged


The weight-loss drug lorcaserin (Belviq®, Belviq XR®) has been removed from the market due to risk of cancer


Risk of untreated constipation leading to serious bowel problems in patients using clozapine (Clozaril®) is still elevated despite previous warning


Serious breathing problems have been identified with gabapentin (Neurontin®, Gralise®, Horizant®) and pregabalin (Lyrica®, Lyrica CR®), especially for patients with underlying lung conditions or when used with drugs that contribute to respiratory depression




National Drug Take Back Day

April 24 is National Take Back Day! Encourage your patients and anyone you know with drug addition issues or excess drugs in their home they do not need to take advantage of this opportunity. They can learn more, including finding drop off locations near them, at takebackday.dea.gov.

Montelukast Safety Warning

The FDA recently issued a safety alert for montelukast based on safety concerns and the increased risk of potential for misuse.

During an FDA review, additional neuropsychiatric adverse event terms were added to the existing warnings and precautions for montelukast. Despite previous FDA communication efforts and information in the product label, concerns were raised that many physicians and patients are not aware of the risk for neuropsychiatric events. 

The FDA recommends providers treating allergic rhinitis use montelukast only when patients are unable to use other approved treatments. It is recommended that providers assess medication efficacy, adverse events and the need for continued montelukast therapy. Many safe and effective allergy medications are widely available, including over-the-counter (OTC) medications.

All patients should be counseled about the potential mental health side effects of montelukast and should be advised to contact a health care professional immediately if changes in behavior or new neuropsychiatric symptoms occur.

BZD Safety Alert

The FDA recently updated the boxed warning for benzodiazepines (BZDs) due to safety concerns. These changes further strengthen existing warnings for combining BZDs with opioid medications, including those for cough suppression and medication-assisted therapy (MAT). The National Institute on Drug Abuse reports more than 30% of opioid overdoses also involve BZDs.

For each patient receiving BZDs, the FDA advises health care providers to:

  • Assess the risk of drug abuse, addiction, physical dependence and withdrawal reactions. Physical dependence can occur in less than seven days of use.
  • Advise patients to seek immediate medical attention for difficulty breathing.
  • Gradually taper to discontinuation of BZDs whenever possible. Sudden discontinuation may be life-threatening.
  • Limit the dose and duration of BZDs to the minimum needed to achieve clinical improvement.
  • Refer patients for substance abuse treatment when appropriate.
  • Strongly consider prescribing naloxone when patients are receiving opioids and BZDs concomitantly.

BZD medications include:

Generic Name

Brand Name(s)


Xanax®, Xanax XR®

chlordiazepoxide HCl/clidinium bromide


chlordiazepoxide HCI


chlordiazepoxide HCI/amitriptyline HCl

Limbitrol®, Limbitrol DS®






Gen-Xene®, Tranxene®


Diastat®, Diastat® Acudial®, Valium®, Valtoco®


No brand name currently marketed


No brand name currently marketed




Nayzilam®, Seizalam®


No brand name currently marketed







Dental Checkup

Dental Reminders

  • Dental prophylaxis and topical fluoride applications are allowed once every 184 days.
  • Routine build-up(s) are included in the fee of an approved crown per policy and are not normally approved when requested with a crown code.
  • Be sure to check member’s eligibility and treatment history before preforming any dental services.
Tobacco CessationTSET

450,000 Patients Helped and Counting

The Oklahoma Tobacco Helpline offers the following services for FREE:

  • 24/7 web support
  • Customized quit coaching
  • At least a two-week supply of nicotine replacement therapy (NRT)

Patients can pick from three different plans:

  • All Access - FREE NRT, coaching calls, supportive texts, quite guides and more
  • Web Coach - Same as All Access but without coaching calls
  • Individual Services - FREE NRT and whichever additional services the patient selects

Let your patients know that combining NRT with quit coach support greatly increases their chances of success.

SoonerCare Members
Did you know SoonerCare members may qualify for additional benefits? Benefits include counseling as well as prescriptions and over-the-counter medications to quit tobacco. With a doctor’s prescription, SoonerCare members have access to patches, gum, lozenges, nasal spray, inhalers, Zyban and Chantix.

FREE Office Materials
Get FREE helpline materials for your office. They keep the helpline top-of-mind and encourage your patients to quit. Free materials include brochures, pens, posters and tip cards. To order your materials, go to OKhelpline.com.

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