Medicaid PDL changes impacting ophthalmology. 
November 29, 2018 |  
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NCSEPS North Carolina Society of Eye Physicians & Surgeons

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In this edition:

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Stuart McCracken Recognized for Service on the Council of the American Academy of Ophthalmology

Dr. McCracken was recognized for his service on the Academy's Council at the AAO 2018 in Chicago. (L-R) NCSEPS Executive Director Alan Skipper, Dr. McCracken, and NCSEPS President Dr. Kathleen Gordon. 

The NCSEPS extends its appreciation to Dr. Stuart McCracken (Durham) whose term on the on the Council of the American Academy of Ophthalmology ends on December 31, 2018 following six years as councilor preceded by six years as vice councilor. A fixture within the NCSEPS community, Dr. McCracken’s membership and participation in the Society spans more than 35 years, during which time he has held numerous leadership positions, including 16 years as a member of the NCSEPS Board of Directors and NCSEPS President in 2004.

Thank you, Dr. McCracken!

Representatives to the Academy’s Council are elected by each state ophthalmology society and by ophthalmic subspecialty societies and specialized interest groups. Succeeding Dr. McCracken, NCSEPS Past President Dr. Sara Stoneburner (Greensboro) has been selected to represent the NCSEPS on the Academy’s Council. Her term begins on January 1, 2019. As Councilor, Dr. Stoneburner will participate at the spring Council Meeting in conjunction with the April 10-13, Mid-Year Forum 2019 in Washington, D.C. 

The Council serves as an advisory body to the Academy’s Board of Trustees. More than 100 Academy members serve on this body as liaisons between their society and the Academy. Councilors bring issues identified by their societies to the attention of the Academy’s Board of Trustees through Council Advisory Recommendations (CARs). CARs are debated annually during the Council’s spring meeting, and ultimately recommendations are formulated for Academy Board consideration.

This year, one of the Council recommendations that was forwarded to the Board of Trustees for consideration emphasized the importance of Patient Advocacy Via the AAO. At the state level, the Academy continues to partner with state ophthalmological societies to engage patients as needed where we face optometric surgery initiatives. Through state-specific social media pages and other digital platforms—including the Academy’s email advocacy tool “Voter Voice”—patients can connect directly with their state legislators.

(L-R) AAO Surgical Scope Fund Chair Dr. Ken Cheng, Dr. Sara Stoneburner, Vickie Clark and AAO Secretary for State Affairs Dr. Kurt Heitman.

Recently, the Academy’s State Affairs Secretariat established a new Citizen Advocate for Patient Safety and Quality Eye Care Award. It was presented this year 2017-18 to Vickie Clark, of Greensboro, NC. She was honored for helping ophthalmologists in North Carolina to defeat HB 36, a dangerous optometric surgical scope expansion proposal.

At the Federal level, the Academy just presented to a group of patient organizations on the practitioner’s perspective on the new “Step Therapy” authority for Medicare Advantage plans in the hope of building a broad coalition to ensure the best care for patients. The NCSEPS has engaged with the Academy on this issue at the federal level and has engaged in legislative debate at the NC General Assembly.

Another Council recommendation forwarded to the Board of Trustees for consideration proposed an AAO Policy on Sexual Harassment. At the time the CAR was proposed, the Board of Trustees had already approved a new policy on sexual harassment. The Academy’s new policy regarding sexual harassment was also included in the annual meeting section of the Academy’s web site under Academy Annual Meeting Policies and Disclaimers. In August 2018, the Academy finalized processes related to the reporting and follow-up of sexual harassment claims by members and non-members. American Academy of Ophthalmology Policies and Procedures Governing Sexual Harassment was presented to the Board of Trustees on Sept. 22 and was approved.

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NCSEPS, AAO Join Forces to Stop Step Therapy Policy

Aligned with the Trump administration’s goal of reducing drug costs, a proposed rule unveiled by CMS this week includes prior authorizations and step therapy for Part D drugs. The NCSEPS has joined forces with the American Academy of Ophthalmology (AAO) in opposition to its implementation.

In a recent letter to the editor, NCSEPS President Dr. Kathleen Gordon applauds US Representative George Holding for his position on step therapy. Holding, who represents the state’s 2nd Congressional District (southwest of Raleigh to just east of Rocky Mount), has called on the administration to halt implementation of the proposed plan. Holding expressed his opposition to moving forward with the proposed rule in a letter to CMS Administrator Seema Verma, writing, “Given the potential impact on patient access and care, I believe CMS should pause on moving forward with this policy in 2019.”

Dr. Gordon’s response, which was published in the print edition of Raleigh’s News & Observer on November 10, 2018, explains how step therapy policies impede the work of physicians and harm patients. “We applaud his stance, because as ophthalmologists, we know that sick patients – especially those facing permanent blindness – don’t have the time for wait-and-see treatment policies.”

The debate over step therapy (or "fail first") pharmaceutical coverage insurance policies is taking place at the state level as well. In recent years, the NC General Assembly has considered legislation to regulate step therapy policies, but none have advanced beyond the committee level. The NCSEPS has supported prior legislative attempts to reign in the use of step therapy policies, arguing that such policies adversely impact patient care and safety.

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Governor Cooper Applauds Post-Florence Volunteer Efforts, Including Vision Screening

Governor Roy Cooper visited the Word of Faith Ministries shelter on November 15, 2018 to thank the facility, staff and volunteers for their work to help those impacted by Hurricane Florence. In his remarks, Gov. Cooper made special mention of the volunteer support coordinated by the NC Society of Eye Physicians and Surgeons and the NC Medical Society in making the October 13th vision screening event at the shelter possible.

Dr. George Escaravage of Wilmington and Dr. Mike Geiger of Fayetteville volunteered their time and expertise at the event in Kenansville, NC. The two ophthalmologists screened over 60 shelter residents, and all who needed vision correction left with a pair of readers or a prescription that was filled at no cost by Centene, the event sponsor.

In welcoming the Governor, shelter director Patsy Quinn expressed her gratitude to the NCSEPS and NCMS and specifically to Drs. Escaravage and Geiger. The Governor added his appreciation for their volunteer service in his remarks.

Gov. Cooper, Shelter Director Patsy Smith, and NCSEPS Executive Director Alan Skipper at the Word of Faith Ministries shelter.

Alan Skipper, Dr. George Escaravage and Dr. J. Michael Geiger at the Oct. 13 vision screening event in Kenansville.

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Medicaid Preferred Drug List Updates

Effective December 3, 2018, NC Medicaid will make changes to the NC Medicaid and NC Health Choice Preferred Drug List (PDL). Pharmaceuticals of interest to ophthalmologists are listed below. The notice can be viewed on the NC Medicaid website.


Ophthalmic (Antibiotics)

  • Neomycin-bacitracin-polymyxin ophthalmic ointment (generic for Neosporin® Ophthalmic Ointment) will move from preferred to non-preferred status
  • Neomycin-bacitracin-gramicidin ophthalmic drops (generic for Neosporin® Ophthalmic Drops) will move from preferred to non-preferred status

Ophthalmic (Anti-Inflammatory)

  • FML® Forte Drops/S.O.P. Ointment will move from preferred to non-preferred status
  • Ilevro® Drops will move from non-preferred to preferred status
  • Maxidex® Drops will move from preferred to non-preferred status
  • Prednisolone sodium phosphate drops (generic for Inflamase Forte®) will move from preferred to non-preferred status

Ophthalmic (Beta Blocker Agents)

  • Carteolol drops (generic for Ocupress®) will move from preferred to non-preferred status
  • Istalol® Drops will move from preferred to non-preferred status
  • Levobunolol drops (generic for Betagan®) will move from preferred to non-preferred status

Ophthalmic (Carbonic Anhydrase Inhibitors)

  • Azopt® Drops from will move preferred to non-preferred status

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NCMS’s Bob Seligson on Fighting Physician Burnout

Physician burnout is a serious issue impacting more than 40 percent of physicians nationally, contributing to high suicide rates among doctors. Fighting physician burnout became a personal mission of NC Medical Society CEO Bob Seligson’s in 2016 when he learned that his personal physician of more than 20 years had committed suicide.

In an article published this summer in Forbes Magazine, "Physicians Are Humans Too," Bob details how that experience opened his eyes to a staggering problem in the physician community, and what he is doing to combat physician burnout and restore joy in practice for physicians in North Carolina and across the county. Bob’s work on combatting burnout was featured last month in an article published by Spaugh Dameron Tenny, “Physician Burnout: 6 Leaders Making a Difference.”

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AAO Mid-Year Forum and Congressional Advocacy Day, April 10-13

Each year during the American Academy of Ophthalmology's Mid-Year Forum in Washington, D.C., Academy members and other ophthalmic leaders gather to discuss critical issues facing ophthalmology. The annual event includes Congressional Advocacy Day - when a delegation from our state will go to Capitol Hill to meet with our members of Congress and their staff - and the spring meeting of the Academy's Council.

We are hoping for another great turnout from North Carolina, so please be sure to mark your calendar and make plans now to attend. Registration will open in late January 2019. For more details, visit the Academy website.

Key issues discussed with US House Representatives and Senators during the 2018 Congressional Advocacy Day meetings on the Hill included technology-based eye care services for veterans, prior authorizations, NIH research funding, incentive based payment programs, Department of Defense Vision Research Program, and compounded drugs. 

Thank you to our 2018 Congressional Advocacy Day delegation:

  • Faith Birnbaum, MD (Durham)
  • Michael W. Brennan, MD (Burlington)
  • Donald L. Budenz, MD, MPH (Chapel Hill)
  • Tanya Glaser, MD (Durham)
  • Divakar Gupta, MD (Durham)
  • Lauren C. Rushing, MD (Durham)
  • Dianna L. Seldomridge, MD (Mooresville)
  • Sara E. Stoneburner, MD (Greensboro)
  • Katherine A. Tsamis, MD (Winston Salem)
  • Robert E. Wiggins, MD, MHA (Asheville)
  • W. Alan Skipper, CAE (Raleigh)

NCSEPS members met with US Senator Thom Tillis during the
2018 AAO Congressional Advocacy Day in Washington, DC.

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2019 NCSEPS Annual Meeting, Sept. 6-8

Planning is underway for the 2019 NCSEPS Annual Meeting, scheduled for September 6-8, at the Omni Grove Park Inn in Asheville, NC. The Grove Park Inn is a favorite meeting destination among NCSEPS members and we're excited to be returning to the historic resort. The meeting program will again feature educational sessions, social and professional networking opportunities, and an exhibit hall showcasing the latest products and services of interest to ophthalmologists.  

Save the date and start planning now!

  • Accommodations: For room reservations, call the Omni Grove Park Inn at 1-800-438-5800 and request the NCSEPS group rate of $289/night plus taxes and fees. 
  • Exhibiting Opportunities: Please help ensure a successful meeting by sharing the Exhibitor Prospectus with the product and service representatives who call on your practice. 

2018 NCSEPS Annual Meeting Wrap-Up
One hundred ophthalmologists attended the 2018 NCSEPS Annual Meeting in Greensboro over the weekend of Sept. 21-22. The educational program featured 9.75 hours of CME-accredited sessions, including Oculoplastics and Retina Case Conferences. Participants enjoyed opportunities to renew old acquaintances and make new ones, and learned about new product and service offerings from vendors in the Exhibit Hall. NCSEPS President Dr. Kathleen Gordon presided over the Annual Business Meeting where she reported on the state of the Society and expressed gratitude for Dr. Stuart McCracken's service to the Society as Councilor to the AAO. Prizes were awarded to this year's Poster Competition winners:

  • 1st place - Wajiha Kheir, MD, Fellow, Duke
  • 2nd place - Kathy Tsamis, MD, Resident, Wake
  • 3rd place - Brent Kramer, MD, Resident, UNC

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AAO 2019, Oct. 12-15

Save the date for AAO 2019, scheduled for October 12-15, at the Moscone Center in San Francisco, CA. Subspecialty Day will be held October 11-12. The AAOE/Practice Management Program will be held October 11-15.

In the meantime, check out this fun video featuring highlights from the AAO 2018 in Chicago. 

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Ophthalmic Coding Course 
CodequestTM 2019
February 2, 2019 
Grandover Resort, Greensboro, NC

Program & Online Registration

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