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Weekly Update
Care January
Managed Care
PBM and Plan Updates
Court Blocks AWP Settlement
Nationwide Updates
Federal Judge Patti Saris has rejected the proposed American Health Care
AWP settlement; this settlement would have caused $4 • Effective 02/01/08, American Health Care will begin to billion being cut from pharmacy drug payments. process claims for Rutherford Hospital, Inc. BIN #: 610118, The proposed settlement would mean that First Databank and Medi-Span would reduce the AWP to 120% of the WAC and eventually stop publishing the Effective immediately, please verify the members ID number for Affiliated Physicians Health Plan (MEWA) claims. No person code is needed when submitting these claims, submit the number as it appears on the card. BIN #: 600428, This lawsuit stated that the health plans are paying too much for drugs and the AWP price has risen to unrealistic prices that do not reflect what wholesalers • NOTICE: January 9, 2008, from 3:00 a.m. – 11:00 a.m. CST,
pay for the drugs and what they charge retail Argus Health Systems was returning to pharmacies a Total Paid Amount of zero for some non-Part D claims. • Argus will work with customers to review and re-adjudicate Economic analysis and briefs were filed jointly in court by NACDS and FMI in objection to the anticipated AWP • All adjustments should be completed by 01/31/08. settlement. Both organizations noted that the • Questions - contact the Argus Help Desk at 800.522.7487 settlements would cause economic hardship to the pharmacies and this hardship would be passed onto Caremark
• Effective immediately, Caremark has begun to process claims for the McDonalds Corporation. Note that the members ID Jud ge Saris reviewed the detailed information and numbers start with MCQ these letters should not be entered. noted that pharmacies would be treated unfairly by the BIN #: 610415, PCN#: PCS, Group #: 33729999, M2419999 Catalyst Rx
For more information on this case, please see: E fective 02/01/08 Catalyst will begin processing claims for Alliant Health Plans BIN#: 005947, PCN #: CLAIMCR, Opus Health
MAC SUCCESS
• Effective 02/01/08, Opus Health will be participating in the Premarin Family Brands Co-Pay Assistance program. BIN #: 601341, PCN #: OHCP, Group #: OH6002051, OH6002061, Fexofenadine 180mg
Dexamethasone Elixir
0.5mg/5ml
State/Region Updates
Express Scripts
• Effective immediately, Express Scripts has begun to process claims for University Physician’s Health Plan Medicare Part D members BIN#: 003858, PCN #: A4, Group #: A7EA Express Scripts
Sierra Health
Continued on Page 2 of this Managed Care Weekly Update
For questions and additional information, please contact the Managed Care Connection Help Desk at 877.292.3196 Weekly Update
Care Page 2
Medicare
PBM and Plan Updates
SENIOR WHOLE HEALTH SELECTS OUTCOMES® FOR
2008 MEDICARE MTM PROGRAM
State/Region Updates
Senior Whole Health has selected Outcomes to administer the M component of their Medicare Advantage Prescription Effective 02/01/08, WellCare of Connecticut Inc. (WCCT) will no longer be responsible for prescription benefits for HUSKY A and ior Whole Health members will be eligible for MTM services from Personal Pharmacists™, who will help the HUSKY B members enrolled in our PreferredOne product. members control and manage their medications as well as • Claims processed through BIN #: 603286, PCN #: 01410000, educate them. This education is part of the one-on-one Group #: 866257 will be processed and paid for by the Connecticut program called Medication Check-Up™, in this program Department of Social Services Medicaid Pharmacy Program. members and their pharmacist review the patient’s medications to make sure there are no duplications, or KY, MI, OH
• Effective 02/01/08, 4D will begin to process claims for Black River Senior Whole Health offers health insurance and Manufacturing Inc, and Husky Envelope, Inc. BIN #: 600428, istrative services to individuals in Connecticut, For more information on Senior Whole Health plea Rx America
• Effective 02.01.08, Molina Healthcare of MI will begin processing claims for Midland County. If a member does not have an ID card, eligibility can be verified by calling 888.696.3510 BIN #: 610473, PCN#: 0506 In the Know…
Wal-Mart to Become a PBM?
Express Scripts
• Effective immediately, Medicare members of New Mexico Retiree Chief Executive H Lee Scott Jr., announced that Wal-Mart Health Care Authority have a new group number and new ID card. will be launching a pilot program to "select employers . Please use the correct number when submitting claims BIN #: manage how they process and pay prescription claims”. By doing this Wal-Mart will be stepping into a very lucrative arena and a field that has been mainly dominated by three Catalyst Rx
• Effective immediately, Catalyst had begun to process claims for Wal-Mart could be a formidable company among the major Disability Rx - Medicare D Wrap. BIN#: 005947, PBMs, as they are the third largest pharmacy in the United States. David Veal, a Morgan Stanley analyst states, “Wal- Wal-Mart currently offers more than 350 generic drugs to • Effective immediately, Geisinger Health Plan has expanded into the public for $4 each; this move has caused several Lehigh, Northampton, York, and Lancaster counties in Pennsylvania. companies in the industry to find creative ways to compete BIN# 600428 (non Med D) ; BIN#:012353 (Med D members), PCN #: At this time, Wal-Mart is not definitely stating that they will enter the PBM business; however, they are exploring ways RxAmerica
to lower health-care cost. For more information, please Effective immediately, RxAmerica is processing online COB Claim For questions and additional information, please contact the Managed Care Connection Help Desk at 877.292.3196

Source: http://www.cardinal.net/us/en/pharmacies/offerings/mcareconnect/pdf/MCC%20Weekly%20Update%2020080128.pdf