Posted in MVP (NY/VT) Insurance Payer, Pharmacy (Various Insurance Payers), Prior Authorization Insurance Carrier Updates, Training, Updates

MVP NY Medicaid Patients: coverage for Farxiga tablets

If you are a physician prescribing Farxiga for any of your patients that have NY MVP Medicaid Coverage, this blog post is for you!


Farxiga may be considered for coverage when used for one of the applicable FDA-approved indications including:

  1. For the reduction of heart failure hospitalizations in adults with Type 2 diabetes mellitus and
    established cardiovascular (CV) disease or multiple CV risk factors
  2. For the treatment of heart failure with reduced ejection fraction (NYHA classes II to IV) to
    reduce the risk of cardiovascular death and hospitalization for heart failure
  3. For the treatment of chronic kidney disease to reduce the risk of sustained eGFR decline, endstage kidney disease, cardiovascular death, and hospitalization for heart failure in those at-risk
    of disease progression

There are 2 other medications that are on the MVP Formulary that do not require prior authorization (such as Segluromet and Steglatro).


If the patient requires Farxiga then the physician needs to obtain a prior authorization.

Please follow the steps: (ALL requests have to have documentation submitted to support the use of Farxiga)

A. Visit mvphealthcare.com/Providers and Sign In to your Provider online account to use the new electronic prior authorization tool powered by Novologix®.
B. Complete the appropriate MVP prior authorization form, which can be accessed at
mvphealthcare.com/Providers, then select Forms, then under Prior Authorization, select the appropriate form in the Pharmacy section. Then, fax completed request form to MVP at 1-800-376-6373.
C. Submit a request through Surescripts.com or CoverMyMeds.com. ( covermymeds is also available on NAVINET)


Find this type of information useful? Follow my blog for more medical billing and coding guideline updates, medical policy/reimbursement changes and anything else related to healthcare!


Recent Blog Posts:

#farxiga, #mvpmedicaidplans, #priorauthorization, #MVP, #type2diabetes

Author:

My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s