August 2023
SoonerCare eligibility reviews are ongoing. Those members who are no longer eligible are having their coverage ended in phases over the next 6 months.
It is important that you continue to check eligibility for your patients. Eligibility must be verified on the service date before services are rendered. When checking eligibility on the provider portal, a single service date must be used; date span searches will not provide accurate information. If further education is needed or questions arise, please call the Provider Helpline at 800-522-0114 or email us at SoonerCareEducation@okhca.org.
OHCA will host town hall meetings throughout the state to answer provider and stakeholder questions about our new delivery reform program, SoonerSelect. An event in Enid has already been held and new dates will be announced soon for Oklahoma City, Tulsa and Poteau. The SoonerSelect Town Hall page will be updated with dates and registration information as it becomes available.
To learn more about SoonerSelect — who the contracted entities are, when the plans begin and what populations are affected — visit OHCA's SoonerSelect page. Also, be sure and browse the Provider FAQ page and download the guide.
Effective Feb. 1, 2023, SoonerCare added coverage of over-the-counter (OTC) low-dose aspirin as a pharmacy benefit without a prior authorization (PA) for pregnant members who are at high risk for preeclampsia. Patients with one or more moderate risk factors should be on low-dose aspirin.
A prescription is required for coverage, and pharmacy claims for OTC aspirin 81mg will count toward the member’s monthly prescription limit. Prescriptions may be filled for up to a quantity of 100 tablets for a 100-day supply and may be written for “low-dose aspirin” or “aspirin 81mg”.
OTC aspirin is not currently covered by SoonerCare for male members or for other indications. Information regarding coverage of OTC low-dose aspirin, including an updated list of covered NDCs, can be accessed on the OHCA website.
Learn more about the low-dose aspirin preeclampsia prevention campaign.
Research shows that helping patients quit smoking is an impactful clinical intervention. SoonerCare supports this by reimbursing providers using the “Five A’s” approach to tobacco cessation. Payments for these services are made in addition to other services rendered on the same day. Each SoonerCare member can access up to eight sessions yearly.
Did you know that SoonerCare also covers all seven FDA-approved tobacco cessation products with no copay, and they do not count against monthly prescription limits? Let’s work together in promoting a healthier future. Check out this flyer for more information.
Are your patients scratching their heads? If not, they may be soon! Every year, there is a surge in head lice cases as kids head back to school. But SoonerCare is ready! We cover several treatment options without prior authorization, but with a prescription needed:
- Members 20 years of age and younger: over-the-counter (OTC) lice treatments
- Members of all ages: brand name Natroba™ (spinosad)
Additional prescription lice treatments for children and adults requiring both prescription and prior authorization include:
- Ivermectin lotion (Sklice®)
- Lindane shampoo
- Malathion lotion (Ovide)
This month’s member newsletter includes links to the American Academy of Pediatrics (AAP), the Centers for Disease Control and Prevention (CDC) and the U.S. Food & Drug Administration (FDA). You can reinforce these recommendations when your patients ask about treatment and prevention options. In particular, patients may need help remembering:
- Children found with lice at school should finish the school day, then be treated and return to school the next day.
- Treatments should only be applied by an adult.
- Never put a plastic bag on a child's head while using treatments.
- Do not use home remedies such as petroleum jelly, mayonnaise, margarine, herbal oils or olive oil as they are not evidence-based treatment options.
- Never use dangerous products like gasoline or kerosene or medicines made for use on animals!
If you have questions about lice treatment coverage, call the pharmacy help desk at 405-522-6205, option 4, or toll-free 800-522-0114, option 4.
Patients who have diabetes and smoke are more likely to have complications that are worse than people who have diabetes but don’t smoke. SoonerCare offers two benefits to assist members with these challenges:
Click the links above to learn more and refer your patients today.
One of the many ways Oklahoma ABLE Tech serves individuals with disabilities in the state of Oklahoma is through the Device Reutilization Program. In partnership with OHCA, this program provides durable medical equipment (DME) and assistive technology (AT) that are collected and distributed to individuals in need at no out-of-pocket cost to them.
The waitlist is longer than ever, and your help is needed! Equipment needed includes:
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• Bath Benches
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• CPAPs
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• Knee Walkers
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• Standers
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• BiPAPs
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• Crutches
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• Pediatric DME
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• Temporary Ramps,
Pathways and
Thresholds
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• Blood Pressure
Monitors
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• Gait Trainers
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• Quad Canes
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• Walkers
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• Braces
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• Grab Bars
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• Raised Toilet Seats
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• Walking Boot
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• Commodes
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• Hospital Beds
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• Shower Chairs
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• Wheelchairs
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If you have gently used DME to be donated, you can contact Oklahoma ABLE Tech at 405-967-6010 or visit their How to Donate page for a list of drop-off locations.
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