September 2022

• Hepatitis C Drug Changes
• Pregnancy Services
• Nutrition Counseling
• Covered Dental Benefits
• Cost Sharing and Copays
• Public Health Emergency (PHE)
• You Can Afford to Quit Tobacco
• COVID Tests for SoonerCare Members
• Requesting a Call Back from SoonerCare?
• About OHCA

Hepatitis C Drug Changes

SoonerCare is changing the preferred drug used to treat hepatitis C in an effort to cure hepatitis C for our SoonerCare population. The new preferred drug is MAVYRET^® (glecaprevir/pibrentasvir). It is available without prior authorization, but does count toward your monthly script limit. If you are already taking a different hepatitis C drug, you can keep taking your current drug. For adults, MAVYRET is taken as 3 tablets once daily with food. For children 3 years of age and older, MAVYRET pellets can be sprinkled on soft food. Each child’s dose is based on their weight.

MAVYRET treats most types of hepatitis C, usually in 8 weeks. Some people may need 12 or 16 weeks of treatment. Talk to your health care provider to see if you are at risk of getting hepatitis C. They can help you decide if you need to be tested for hepatitis C and if you need to be treated with MAVYRET. If you are treated with MAVYRET or another hepatitis C drug, it is very important to remember to take it every day. Doses must not be skipped.

You can call the SoonerCare Pharmacy Help Desk at (405) 522-6205, option 4, or toll-free (800) 522-0114, option 4, if you have questions about a particular drug’s coverage or if you have other pharmacy benefit questions.

Pregnancy Services

Did you know Sooner​Care covers pregnancy services? There are no copays or referral needed to see an OB doctor. Some covered services include prenatal care, medically necessary ultrasound​(s), delivery​ and postpartum ​

Note: For Soon-to-be-Sooners, refer to guidelines on OHCA website. ​Expansion members and members in ​the ABD program are also eligible to receive pregnancy-related services.

Nutrition Counseling

Is eating healthy a challenge while caring for loved ones? We understand that this unselfish task takes time, effort and commitment and we want to help. If you qualify, you can receive up to six hours a year of nutrition counseling from an expert. Learn more here.

Covered Dental Benefits

Need a refresher on your dental benefits? Review the chart below to see what services are covered by SoonerCare.

Dental Services                  Children (birth though age 20)     Adults 21 +

Some covered services require a prior authorization. Please call the SoonerCare helpline at 800-987-7767 if you have questions about your coverage or benefits.

Cost Sharing and Copays

Cost sharing is the monthly limit of total copays you will pay. A copay is the small fee you pay to a provider or a pharmacy at the time you get the service. Cost sharing is not a bill. The cost sharing limit is set at 5% of your total income reported to SoonerCare for all members of the household. This is the monthly amount and you don’t pay until you have a service with a copayment, then you pay the provider. Once the household cost sharing limit is reached for the month, your household should not be charged a copay in that month. Cost sharing starts over every month.

Public Health Emergency (PHE)

At the beginning of the COVID-19 pandemic, the federal government declared a public health emergency (PHE). During the PHE, we are required to continue SoonerCare coverage for all members even though there are some members who no longer qualify for benefits.

Example of reasons why a member may no longer qualify for benefits:

• Your salary is now higher than the required amount to receive SoonerCare benefits.
• Someone has moved in or out of your household.
• Your contact information and/or documents are not updated at mysoonercare.org.

It was recently announced the PHE is extended another 90 days. This means members, who typically wouldn’t qualify for benefits possibly due to the reasons above, will continue to receive their SoonerCare benefits until October 31^st.

There will come a time when the PHE will end. Once we know the day, we will send notifications to those people who no longer will receive SoonerCare benefits. Those members determined to be ineligible for benefits will be removed from SoonerCare in phases focusing on the member’s benefit utilization and critical health issues.

Members who are ineligible will receive three notices:

• An initial notification letter will be mailed once the end of the PHE is announced. This notification letter will detail the specific end date of benefits for those determined ineligible. It is important you update your mailing address at mysoonercare.org as soon as possible, so you receive this notification.
• A second notice will be sent to ineligible members 45 days prior to their scheduled end date to inform them of the reason for loss of eligibility, potentially missing documents to verify eligibility, and appeal rights.
• A third notice will then go out 10 days before the ineligible member loses eligibility.

Members should take time to think about their health care needs and plan in case their SoonerCare coverage ends. Please go to mysoonercare.org to learn more.

You Can Afford to Quit Tobacco

You can afford to quit tobacco! SoonerCare covers tobacco cessation counseling and all seven FDA approved medications, including an inhaler, nasal spray, gum and more. All the medications and aids can be obtained with a prescription from your provider. SoonerCare does not require a copayment for any tobacco cessation prescriptions, and these prescriptions are not included in the six monthly prescription cap. For more information about the tobacco cessation benefit, click here.

COVID Tests for SoonerCare Members

The free COVID tests that were made available by mail are no longer available, but SoonerCare members can still get these FDA authorized tests from pharmacies.

Requesting a Call Back from SoonerCare?

For SoonerCare to fulfill your request, please make sure spam blocking is turned off on your phone. Sometimes when we return a call, it can show up as spam. Our phone number may also come up as a Colorado or Florida number on your caller ID.

About OHCA

Please call the SoonerCare helpline at 800-987-7767 if you have questions about your coverage or benefits. For updates on new policies, health tips, helpful resources and more, follow OHCA on Facebook and/or Twitter. The Oklahoma Health Care Authority does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or the provision of services.