April 2021

Hemlibra (emicizumab-kxwh)

Starting May 1, 2021, Neighborhood will exclusively cover Hemlibra for Medicaid members through the Pharmacy Benefit.

• To obtain paid claims for Hemlibra products for Neighborhood Medicaid members on or after May 1^, 2021, please submit claims under the Pharmacy Benefit.

Utilization management protocols for Medicaid, Commercial and INTEGRITY remain unchanged and authorization must be requested prior to dispensing Hemlibra.  For Medicaid members with active Hemlibra authorizations, their authorization will carry over to the pharmacy benefit for the remainder of the authorization duration.

Long Acting Insulin – Semglee (Insulin Glargine)

Starting July 1, 2021, Neighborhood will prefer Semglee (Insulin Glargine) on the Medicaid Pharmacy Benefit and will remove Basaglar (Insulin Glargine) from the formulary.

• As a reminder, as of November 1, 2020, Semglee (pens and vials) was added to the Medicaid Pharmacy Benefit formulary to ensure Medicaid members would have access and a smooth transition from Basaglar to Semglee.

The Pharmacy Department will be notifying providers with Neighborhood members currently being prescribed Basaglar, so that a new prescription can be written for Semglee.