Release 8.11

Release date: August 19, 2022

Pharmacy Benefit Management (PBM) Carve Out Drugs

  • Added a configuration to identify drugs as PBM Carve Out (#122943). The Ohio Department of Medicaid (ODM) system will manage these drugs.
  • Modified the Connect workflow to handle the PBM Carve Out Chemotherapy and PBM Carve Out Supportive drugs (#118398 & 122954). The system will collect and analyze against drug details, and display and analyze against drug-level justification questions, but will not allow the medical office to approve or reject these drugs.
  • Modified the Treatment Plan Summary to support the PBM Carve Out drugs. The drugs will appear in the Other Drugs as Part of Your Treatment section of the summary along with the associated icons (#122854).
  • Removed the original PBM Carve Out Drug configuration (#125104).

No Authorization Required Drugs

  • Added a configuration to identify drugs as No Authorization Required (#122943). These drugs do not require prior authorization, per the payer/LOB.
  • Modified the Connect workflow to handle No Authorization Required Chemotherapy and Supportive drugs (#118398 & 122954).
    • No Authorization Required Chemotherapy: The system will collect and analyze against drug details, and display and analyze against drug-level justification questions, but will not allow the medical office to approve or reject these drugs.
    • No Authorization Required/Supportive: The system will not do the following: collect or analyze against drug details, display or analyze against drug-level justification questions, or allow the medical office to approve or reject these drugs.
  • Modified the Treatment Plan Summary to support drugs configured for No Authorization Required. The drugs will appear in the Other Drugs as Part of Your Treatment section of the summary along with the associated icons (#122854).
  • Removed the original No Authorization Required configuration (#125104).

Partially Approved Treatment Plans

  • Added a new Partial Approval action and screen to let Eviti and the health plan approve and reject drugs associated to a treatment plan (#123946).
  • Updated the Treatment Plan Summary to support approved and rejected drugs within a treatment plan (#123955).
  • Added a Partial Approval tab to the Patient Management and Payer Dashboards (#123949 & #123950).
  • Modified the Provider Dashboards (#123951).
  • Modified the Reconsideration process to support partially approved treatment plans (123954).
  • Automated emails will be sent to users to notify them when drugs were approved or rejected via partial approval (#127060).

Miscellaneous

  • Added a new configuration to prevent a user from initiating an Add Drug workflow (#123947).
  • Added the physician drop-down list to the Complete Appeals screen (#123237).
  • We now display patient friendly and citation labels for Denials only (#123880).

Resolved issues

  • Unable to deactivate drug family due to calendar error (#124937).
  • TxPlan Creation Error: System.ArgumentException: An item with the same key has already been added (#123922).