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
Attitudes and experiences with levonorgestrel 100 g/ethinyl estradiol20 g among women during a 3-month trialYolanda H. Wimberlya, Sian Cottona, Abbey M. Wanchicka, Paul A. Succopb,a Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA b Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA c Departm
FILE: Trauma Handbook/ stress ulcer prophylaxis UCSD MEDICAL CENTER ADULT AND PEDIATRIC GUIDELINES FOR USE OF STRESS ULCER PROPHYLAXIS* *Developed by the Stress Ulcer Prophylaxis Process Action Team Based on clinical studies, the indications for stress ulcer prophylaxis will be graded according to the following scale: Convincing evidence, indicated Some evidence, probably ind
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