OHCA Provider Newsletter

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SoonerCare Provider Memo

April 2022

Included in This Edition

SoonerCare Member Eligibility

During the public health emergency (PHE) period, some SoonerCare members have received extended eligibility. To avoid eligibility from expiring once the PHE ends, OHCA requests providers relay an important message to certain members. When verifying eligibility, if there is a red notice displayed on the eligibility screen, it is imperative that members contact us to confirm their eligibility. Please have the member contact the SoonerCare helpline at 800-987-7767.

SoonerCare is also encouraging providers to help remind members they can log in to their account at www.mysoonercare.org to read related messages and update their information.

Remote Area Medical 2022 Needs Your Help

Southwestern Oklahoma State University is hosting Remote Area Medical 2022 July 16-17 and are looking for medical professionals willing to volunteer. RAM is a free medical care clinic that provides help to those in need, no questions asked. The are in need of dentists, dental hygienists, dental assistants, doctors, PAs, NPAs, nurses, optometrists, pharmacists and general support personnel.

To sign up or find more information about RAM, visit RAMUSA.org. You may also contact Dr. Randy Curry from Southwestern Oklahoma State University at randy.curry@swosu.edu with any questions.

Provider Training Page

To see a list of upcoming trainings, previous webinars or other training materials, please visit our provider training page.

Consider Prescribing NARCAN® to Patients Taking Opioids

NARCAN® is a potentially lifesaving medication designed to help reverse the effects of an opioid overdose in minutesOHCA continues to cover naloxone products for SoonerCare members. NARCAN® is the preferred brand name naloxone product and does not count against the six prescription limit or have a copay for SoonerCare members.

SoonerCare Adult Dental Benefits

Prior to July 1, 2021, dental care for adult SoonerCare members was limited to emergency care, which often resulted in tooth extractions without replacements. SoonerCare adults are now eligible for preventive, periodontal, restorative and prosthetic dental care. This includes dental cleanings, non-surgical treatment of periodontal disease, fillings and dentures.

Dental care, especially preventive care, improves overall health and quality of life. When adults receive regular dental care, they are more likely to experience general wellness and control of systemic diseases such as diabetes, have greater confidence and employment opportunities, and their children are more likely to have healthy dental care habits.

PA Update

SoonerCare provides multiple Tier-1 options when possible, and the covered Tier-1 medications have well-documented clinical efficacy and cost-effectiveness. Most Tier-1 medications are available for most members without prior authorization; however, age restrictions, quantity limitations, or special criteria may apply to some Tier-1 medications.

Members who do not achieve clinical success with Tier-1 medication trials may qualify to obtain a higher-tiered medication. Approval requires completion of a PA form, usually PHARM-04: Petition for Medication Prior Authorization. A link to this form is below the approval criteria for each therapeutic category. Some medications have their own specific form in place of PHARM-04. Using these forms is the most effective method for submitting PA requests. Using external platforms (e.g. Cover My Meds) typically slows the process for providers, pharmacies, and SoonerCare.

The majority of electronic health record or electronic medical record (EHR/EMR) programs have SoonerCare medication tier information embedded in their electronic prescribing software package (E-script). If your E-script package does not provide current SoonerCare tier information, please contact your EHR/EMR vendor.

Providers or staff may request additional information and receive personalized, medication-related PA training by contacting Jacki Travers, Pharm.D. by phone at 405-271-5935 or by email at jacki-travers@ouhsc.edu.

Collaboration Between Medical and Dental Providers Improves Overall Health Outcomes

Poor oral health negatively affects overall health. Untreated dental decay will progress to infection and pain, which can become fatal. Dental pain negatively impacts blood pressure and periodontal disease negatively impacts several systemic conditions such as diabetes, heart disease, and pre-term and low birth weight deliveries.

Health providers can greatly improve both oral and general health outcomes by addressing oral health. How can you help? Get to know a contracted dental provider, ask members about oral health, and refer members to a contracted SoonerCare dental provider when needed.

Quality Improvement to the PA Amendment Process

A prior authorization (PA) request is submitted via the OHCA provider portal, goes into the PA workflow, and is then reviewed by the medical, nursing and therapy staff. Changes to a PA (referred to as amendments) have had to be faxed to an external source then end up in a holding folder to be distributed to other folders for review.

But the PA amendment process is getting an upgrade and moving to the provider portal as well. Once the upgrade is complete, PA amendments will be submitted via the provider portal, sent directly to the PA workflow for review, and can be tracked by the submitting provider. By using the provider portal, the PA process is consistent, initial requests and amendments flow through the same system, providers can check the status any time, the review process is uninterrupted, and SoonerCare members will continue to get the care they need.

COVID-19 Vaccines

COVID-19 cases in Oklahoma are trending downwards. However, we have not reached the end of the pandemic yet. Please keep this in mind when seeing patients who qualify for the COVID-19 vaccine and boosters but have not yet received them. OHCA is working to ensure easy access is available for all SoonerCare members who want to get vaccinated.

Help SoonerCare Members Quit Tobacco Products


Oklahoma Tobacco Helpline

The Oklahoma Tobacco Helpline offers FREE 24/7 support, quit coaching calls, nicotine replacement therapy (NRT) and more. SoonerCare members get additional benefits from the helpline such as additional quit coach calls and additional weeks of free NRT.

Talk with your patients about their tobacco use and encourage them to call 1-800-QUIT NOW or visit OKhelpline.com.

Free Medications for SoonerCare Members

SoonerCare members can access the following FDA-approved medications for FREE: patches, gum, lozenges, nasal sprays, inhalers, Bupropion SR (Zyban/Wellbutrin) and Varenicline (Chantix).These products do not count against SoonerCare's six prescriptions per month limit and combining these products may increase the chances of quitting.

Order TSET Materials

Materials such as information on adult and youth tobacco cessation programs, guidance on addressing obesity with nutrition and physical activity, and more are available for order at tset.ok.gov/order.


Have questions about SoonerCare’s tobacco cessation benefits or implementing tobacco cessation best practices with your patients? Contact SoonerQuit@okhca.org.


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