Provider Digest | Volume 53
Date: 10/13/22
Trillium Medicaid: Additional Preferred Options for Gender-Affirming Hormonal Therapy
This year Trillium Medicaid has worked hard to listen to providers and members to ensure that we are providing appropriate and accessible gender-affirming hormonal therapy options for our members. Earlier this year Trillium removed the prior authorization requirement on generic testosterone gel and generic estradiol patches for members 17 years of age and older and as of September 1, 2022 estradiol valerate intramuscular oil has been added to the list of preferred agents. See the table below for a comprehensive list of the current preferred gender-affirming hormonal therapy options.
Preferred Gender-Affirming Hormonal Therapies
| Drug Name and Formulation | Strength | Applicable Quantity Limits |
|---|---|---|
| Estradiol Tablets | 0.5mg; 1mg; 2mg | None |
| Estradiol TD Biweekly Patch | 0.025mg/24HR; 0.05mg/24HR; 0.0375mg/24HR; 0.075mg/24HR; 0.1mg/24HR | 8 patches/28 days |
Estradiol TD Weekly Patch
| 0.025mg/24HR; 0.0375mg/24HR; 0.05mg/24HR; 0.06mg/24HR; 0.075mg/24HR, 0.1mg/24HR | 4 patches/28 days |
| Estradiol Valerate Intramuscular Oil | 20mg/ml; 40mg/ml | None |
| Testosterone Cypionate Intramuscular Oil | 100mg/ml; 200mg/ml | None |
| Testosterone Enanthate Intramuscular Oil | 200mg/ml | None |
Testosterone TD Gel | 1%; 1.62%; 2% | 1%: 300gm/30 days: 1.62%: 150gm/30 days; 2%: 120gm/30 days |
All gender-affirming hormonal therapy options have an age limit of at least 17 years old. Coverage for members less than 17 years old or for amounts exceeding applicable quantity limits require prior authorization.
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Coming Soon: New Health Net Commercial Provider Portal
We are excited to announce that we will be launching a new Health Net Commercial Provider Portal later this fall! The new portal has enhanced functionality and timesaving features to help you manage your patients’ health efficiently and effectively.
If you already use the Trillium Medicaid and/or Wellcare Provider Portals, you’ll find your Health Net Commercial Portal in the same place.
If you work with Health Net Commercial patients only, you will be able to log in on the Health Net Oregon website or through OHP.
We’ll share more information in upcoming issues of the Provider Digest.
Thank you for your partnership in helping our members stay healthy.
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Register Now: Wellcare Provider Virtual Forum on Transforming the Patient Experience
Join us for "Transforming the Patient Experience," a free Wellcare provider virtual forum and lunch with a special guest speaker from Press Ganey. In this interactive workshop, participants will engage in a collaborative discussion on the member experience and challenges faced with delivery of patient-centric care. Topics include:
- Improving communication with patients and developing rapport and trust among provider, patient, and health plan
- How CAHPS survey questions relate to everyday practice
- HEDIS and CAHPS connections in care gaps
- Current barriers in access to care for providers and patients
You can choose to attend one or more of the following sessions:
- 11/8/22, 9:00 a.m.
- 11/9/22, 10:00 a.m.
- 11/20/22, 12:00 p.m.
- Gift card for lunch provided
- Register here
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Start Smart for Your Baby® Program for Trillium Medicaid Members
Trillium has an exciting program for pregnant members and new parents called Start Smart for Your Baby (SSFB). Our care team works closely with the pregnant member's providers to support a healthy pregnancy and infant care. Services include connecting members to an in-network doula; help with quitting smoking, alcohol or drugs; breast/chest feeding support; and more.
Through the SSFB program, Trillium members can earn gift card rewards by attending all of their prenatal and postpartum appointments and engaging with their SSFB Care Management team. SSFB also has an opt in text messaging program that begins at 27-week gestation and lasts through 6 months postpartum. The text and email program aims to improve maternal and infant health by providing timely health information, resources, and reminders to members during their pregnancy and six months after birth with the goals of promoting breastfeeding and increasing prenatal, postpartum, and infant well-child visit compliance.
If you would like to learn more about Trillium's SSFB program, please contact your Provider Services Representative.
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