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To: IPA Members From: Heather Rodgers 9/11/071. CAREMARK NPI CHARGE RESOLUTION (achieved by NCPA) As many of you know, Caremark was charging $0.99 per claim for all claims submitted without NPI numbers. Tom Ryan, CEO of CVS/Caremark, said these charges would be removed before the payment aged. So, ultimately no pharmacy should have been charged. Please review your statements and make sure you were not charged this fee. If you believe that you were charged, please contact Stacey.Swartz@ncpanet.org for assistance. 2. PRESCRIPTION COVERAGE FOR LTC PATIENTS If you receive a “refill too soon” rejection on a patient that was just admitted or discharged from a LTC (long-term care) facility, you may now call the patient’s plan and obtain an override to ensure these patients have access to their medications. (This policy does not apply to vacation or short term discharge medication supplies).
3. Aetna & BlueCross/BlueShield Cease Coverage Of Certain Compounded Drugs
Aetna will cease coverage of bioidentical hormones and thyroid compounded drugs as of October 1, 2007. After that point, Aetna customers will have to pay out of pocket for the medicines their doctor has determined that they need. In May, BlueCross/BlueShield changed its reimbursement policy for compounded medications, calling drug compounding “experimental, investigational and unproven.” This action is based upon the results of an unscientific 2001 FDA study that even the FDA does not support.
Encourage your Aetna and BlueCross BlueShield customers to contact their employer’s HR department and ask them to petition their health insurance company to reinstate coverage of bioidentical hormones and other compounded medicines. Please go to www.pharmacistsonline.com for more information.
If you have any questions or third party issues, please contact Heather Rodgers at 800-575-2667. |