Writing Scripts for Bug Spray? Zika and CMS Change the Game

Monday, July 18, 2016

On June 1, the Centers for Medicare and Medicaid Services (CMS) responded to the growing threat of Zika virus by creating an option for states to cover mosquito repellents under Medicaid. In states that chose to do so, all health plans that provide pharmacy benefit services for Medicaid clients were required to begin covering the approved mosquito repellents as a pharmacy benefit on July 15, 2016, with coverage through October 31, 2016.

The catch: To be covered, insect repellents — usually a casual, commercial purchase — need to prescribed by an authorized health professional.

Wolters Kluwer Clinical Drug Information has added insect repellents to its embedded drug file and ramped up Zika-related information in its Lexicomp drug references to support these new Medicaid options and any healthcare professionals engaged in preventing the spread of the virus.

Preventing and Treating Zika

Zika has primarily been a concern in Africa, the South Pacific, and South America, but states like Texas, where there is a notable presence of the species of mosquitoes that are carriers, are mobilizing to prevent infection. There is no vaccine.

According to the Centers for Disease Control and Prevention (CDC), Zika virus is spread by the bite of infected Aedes mosquitoes. It can also be spread during sex by an infected man. Its greatest threat is to pregnant women, as the infection can be passed to fetuses and cause microcephaly and other birth defects.

Zika presents like other mosquito-borne illnesses dengue and chickungunya, with symptoms including fever, headache, rash, joint pain, and conjunctivitis. Addressing these symptoms is the only treatment the CDC advises for Zika: Rest, fluids, acetaminophen (or paracetamol) to reduce pain and fever, and avoiding NSAIDs to reduce bleeding risk.

As CMS notes in its guidance, the most effective way to combat Zika is to avoid mosquito bites in the first place. That’s where repellents come in.

Medicaid Coverage

Even though over-the-counter repellents aren’t usually the sort of thing for which CMS provides coverage, during the Zika outbreak, CMS is allowing states to elect to cover EPA-registered insect repellents with one of the following active ingredients:

  • DEET
  • Picaridin
  • IR3535
  • Oil of lemon eucalyptus
  • Para-menthane-diol

In order for Medicaid patients to receive reimbursement for an insect repellent, they must submit an approved prescription to the pharmacy. Each state manages its Medicaid communications differently, but it is likely many will contact beneficiaries through the mail to inform them of this new opportunity to receive coverage for repellents. Nonetheless, it may fall to pharmacists and other healthcare providers to spread the word to patients and customers that this coverage is available and to encourage them to request prescriptions for insect repellents.

For more information, refer to the CMS informational bulletin on Zika response.

Clinical Drug Information Zika Resources

Responding quickly to the attention on Zika virus and the repellent announcement from CMS, Wolters Kluwer Clinical Drug Information enhanced its solutions to provide data and resources professionals may seek to help process prescriptions and educate patients.

Medi-Span MED-File core drug file

As early as July 10, the core drug file of our Medi-Span embedded drug data solution was live with new insect repellent information. Data for approved repellents, such as UPCs and pricing, were added to assist customers in processing these prescriptions.

Clinical Drug Information worked directly with the manufacturers to acquire the necessary data, but because repellents are over-the-counter non-drug products, many of the manufacturers either did not have a wholesale price (AWP or WAC) to provide or were unwilling to provide it. In those cases, pricing was determined from other methods, with those sources indicated, per our Medi-Span U.S. drug price data policy.

Lexicomp drug information and patient education

Lexicomp online and mobile drug references have been updated throughout 2016 to enhance information on Zika. Available information includes:

  • Infectious Diseases database — Zika virus monograph features information on microbiology, epidemiology, clinical syndromes, diagnosis, and treatment, with links to selected readings.
  • Lab Tests & Diagnostic Procedures database — Recently updated Zikus Virus Diagnostic Procedures monograph includes information on which tests to use for diagnosis, specimen collection, methodology, normal values, interpretive information, and diagnostic pearls.
  • Patient Education — Recently updated Zika patient education leaflet features content from our Wolters Kluwer affiliate UpToDate. In patient-friendly language, it covers the basics about Zika and answers to frequently asked questions about treatment, pregnancy issues, sexual transmission, and prevention. It is available in English and Spanish

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