Transcript Document

Community CCRxSM PDP
2010 Plan Year – Stakeholder Call
Speakers:
Marc Bralts, Vice President, Network Operations
Michael Bukach, RPh, Senior V.P. Pharmacy Network and Clinical Operations
Amber Jones, RPh, Sr. Manager, Pharmacy Relations
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Topics for Today’s Program
• Overall 2010 Medicare
Part D Changes
• 2010 Formulary Update
• 2010 MTM Program
• 2010 Bid Results
• 2010 PDP Plan Design
• MA-PD Overview
• Agent-Pharmacy
Partnership Program
• CMS Compliance &
Community CCRxSM Tools
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Medicare Part D Updates
• Annual bidding continues to drive change each plan year.
• Nationally, there are approximately 800k auto-assigned
duals being moved due to plans missing the benchmark.
– “choosers” will not be automatically reassigned
• They can choose to switch plans or pay the difference (between plan
premium and benchmark)
• Part D members being moved will be notified via:
– ANOC – late October
– Letter notifying them of reassignment for upcoming year
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Community CCRx Bid Results
• Remained under LIS benchmark for 2010 in every current region with
the exception of New Mexico
• States back under LIS benchmark for 2010:
– MA, RI, VT, CT, UT, ID
• States new under benchmark for 2010:
– AZ, NV
• Merging of PDPs to conclude in 2012
– PrescribaRxSM Platinum (PDP) Community CCRxSM Gold (PDP) in 2010
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2010 Plan Design Changes
Basic
• $310 deductible
• Copays (30-day supply)
– Generics: $0
– Preferred Brand :
25-30%
– Non-Preferred
Brand: 50-75%
– No specialty
• No Gap Coverage
Choice
• $150 deductible
• Copays (30-day supply)
Gold
• $0 deductible
• Copays (30-day supply)
– Generics: $5
– Preferred Brand:
$35
– Non-Preferred
Brand: $65
– Specialty: 29%
– Generics: $6
– Preferred Brand:
$35
– Non-Preferred
Brand: $65
– Specialty: 33%
• No Gap Coverage
• Gap Coverage:
Generic Tier
Drugs Only
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Agent Program
• Agent Partnership for 2010 selling season
– Additional training to improve field results
– In-store agent opportunities (pending agent availability
in certain regions)
– Strong support from 800# call-center
• Highly trained, fully-licensed agents
• Available for all stores
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Pharmacy Education Kits
• Education kits should arrive by 10/1
• Kits include:
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Pre-enrollment packets
Cover letter with CMS guidelines
Town Hall flyer
Calendar with Marketing dates
- Formulary flyer
- Tear sheets
- Plan Comparison Guide
• Request a Pharmacy Education kit or additional pre-enrollment
packets:
– Email: [email protected]
– Call: 866-684-3057
– Online at: (www.mhrx.com)
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2010 Formulary Update: Tier Changes
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Tier Changes
Actos, ActoPlus Met, Duetact
Aromasin
Asacol
Hectorol
Invega
Pentasa
Sanctura, Sanctura XR
VESIcare
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2010 Formulary Update: Deletions
Deletion
Deletion
Alternative
Alternative
Prevacid Solutab
omeprazole (G), Nexium Oral Packets (PB), Zegerid Oral Packets (PB)
Aciphex
omeprazole (G), Nexium (PB)
Amitiza
lactulose (G)
Ranitidine Caps
ranitidine tabs (G)
Catapres-TTS Patches
any oral antihypertensive
Atacand, Atacand HCT
Cozaar, Hyzaar, Diovan, Diovan HCT (PB)
Asmanex
Flovent, Pulmicort Flexhaler, QVAR (PB)
Rhinocort Aqua
Fluticasoen (G), Nasonex (PB), Vermayst (PB)
Oxytrol
Detrol, Detrol LA, Toviaz, Enablex (PB)
Nitrolingual
Nitrostat (NPB)
Antara
fenofibrate (G), Tricor (PB), Trilipix (PB)
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2010 Formulary Update: Deletions
(Beers List)
Deletion
Deletion
Alternative
Alternative
Diphenhydramine caps/tabs
fexofenadine (G), Xyzal (NPB)
Meperidine tablets
acetaminophen with codeine (G), acetaminophen with hydrocodone (G), morphine (G)
Butalbital-ASA-Caffeine-Codeine
acetaminophen with codeine (G), acetaminophen with hydrocodone (G)
Meprobamate
buspirone, sertraline
Pentazocine-Naloxone
acetaminophenwith codeine (G), acetaminophen with hydrocodone (G)
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2010 Formulary Update: Step Therapy
Step Therapy
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VESIcare
Actos, Actos PlusMet, Duetact
Abilify, Invega
AVINza
BuPROPion HCl &
Budeprion XL 24-hr ER tablets
– Aromasin, Femara
View formulary alternatives and step therapy
criteria at:
www.mhrx.com/providers
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Formulary Updates
• Group Plans move from Alliance and Alliance Plus
formularies to Optimal Med formulary – starting
1/1/2010.
• Communication
– Member
• Formulary change letters
• ANOC
• EOB
– Pharmacist
• Fax
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2010 Updates
• Payer Sheet – no significant changes
– “Prescription Origin” code
• Mail Order – no mail order for Community CCRx in 2010
• 2010 Incentive Program
– MTM – new eligibility criteria
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Medicare Advantage Prescription Drug
Plans (MA-PD)
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Private Fee-For-Service (PFFS)
Preferred Provider Organizations (PPO)
Health Maintenance Organizations (HMO)
Most Universal American MA-PD plans are “powered by
CCRx” drug benefit
• Extended enrollment period through March 31st.
• Online: www.UniversalAmerican.com
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Fraud, Waste and Abuse
• CMS Regulation
• Attestation is not required
• Conducted in 2009 calendar year
– Universal American Part D Fraud, Waste and Abuse training
module
– Alternative Training Programs must address specific topics at a
minimum
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Alternative Training Requirements
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Compliance with Federal statutes (i.e., False Claims Act, Anti-Kickback Statute,
HIPAA, etc.)
Requirement to have appropriate policies and procedures to address fraud,
waste and abuse
Types of fraud, waste and abuse that can occur, including but not limited to:
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Inappropriate billing practices
Bait and switch pricing
Prescription altering
Dispensing expired or altered prescription drugs
Illegal remuneration
True Out of Pocket (TrOOP) manipulation
Incorrect or misleading notices to employees
U.S. Office of Inspector General (OIG) exclusion list
Process for reporting fraud, waste and abuse
Protections in non retaliation for employees who report suspected fraud,
waste and abuse
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Providers Can:
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Distribute CMS- approved Plan Finder information.
Display promotional materials that announce your relationship with a plan.
Make available printed information provided by a plan sponsor to your
patients, as long as there is no “ranking,” “highlighting” or comparison of
specific plans.
Provide contact information for any plan which a beneficiary expresses an
interest and requests such contact information from you.
Make available PDP marketing materials and enrollment applications.
Use direct mail and/or e-mail to announce a new plan affiliation
Provide information and assistance to your patients in applying for the low
income subsidy.
For additional information, see the Medicare Marketing Guidelines, available at:
http://www.cms.hhs.gov/ManagedCareMarketing/Downloads/R91MCM.pdf
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Providers Cannot
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Direct, urge, persuade, steer or offer inducements to join a particular plan.
Compare plan benefits against other health plans, unless the materials were written or
approved by CMS
Make available PDP enrollment forms at the counter.
Collect or accept Medicare enrollment applications of any kind.
Offer sales or appointment forms.
Mail marketing materials on behalf of a plan.
Make available third party sales or plan promotional materials that are not CMS approved.
Expect or accept compensation for conducting enrollment or marketing activities.
Suggest that a particular plan is approved, endorsed or authorized by Medicare.
Make or distribute plan information, including PDP enrollment forms, during health
screenings.
For additional information, see the Medicare Marketing Guidelines, available at:
http://www.cms.hhs.gov/ManagedCareMarketing/Downloads/R91MCM.pdf
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Tools and Resources
• Website: www.mhrx.com
 2010 Formularies
 60 Day Formulary Notices
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Drug Search Tool
Fraud Waste and Abuse Module
PA Forms
PA Criteria
PA Status Search
Pharmacy Scorecard
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2010 Part D: Community CCRx
Thank You for your continued Support.
Questions & Answers
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