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November 29, 2023 · Clinical Team
In January, Optum clinical programs will adopt revised morphine equivalent dose (MED) conversion factors for the opioid analgesics hydromorphone, methadone, and tramadol to correlate with CDC Guidelines. However, these modifications are predicted to have little effect on Optum risk identification and clinical review programs. Read more...
November 17, 2023 · Clinical Team
Opvee® (nalmefene) nasal spray now available for emergency treatment of opioid overdoses, but currently non-formulary on all standard formularies until review by Optum P&T Committee. One unit of Opvee will likely be allotted per year by CMS. For WCMSAs, exposure for opioid antagonists like Opvee is unlikely to be significant. Read more...
November 15, 2023 · Public Policy & Regulatory Affairs Team
Brief notes include: Updated Washington workers’ comp outpatient formulary and mental health services provider list, updated Michigan workers’ comp health care rules, proposed New Mexico workers’ comp provider fee schedule and billing changes, updated Massachusetts workers’ comp hearing service rules, updated Maine workers’ comp reimbursement rates, and New York workers’ comp looks to update DMEPOS fee schedule. Read more...
October 25, 2023 · Public Policy & Regulatory Affairs Team
Brief updates in California workers’ comp PTSD presumption law amended and several other bill vetoed; Michigan legislation would significantly overhaul auto no-fault medical fee schedule law; Massachusetts to hold meetings on opioids; and Tennessee clarifies medical fee schedule updates. Read more...
October 12, 2023 · Clinical Team
The 3Q 2023 Brand-Generic Pipeline update Read more...
October 11, 2023 · Medicare Insights Team
On October 10, 2023, CMS finalized its Civil Monetary Penalty (CMP) rule for imposing penalties against Responsible Reporting Entities (RREs), which includes Group Health Plans (GHPs) and Non-Group Health Plans (NGHPs). Read more...
October 04, 2023 · Public Policy & Regulatory Affairs Team
Brief updates include Colorado furthering limits on physician dispensing in work comp, California work comp bill requiring in-state licensure for UR physicians on hold, Arizona Fee Schedule features new DMEPOS requirements, Tennessee activates Certified Physician Program and New York PTSD bill keeps moving. Read more...
September 20, 2023 · Clinical Team
Zavzpret – indicated for the acute treatment of migraine with or without aura in adults – is now available as a 10 mg nasal spray device. Read more...
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