MEDICARE Part D (PDP) (MA-PD) PROGRAMS Assembled by PAAS National

Transcription

1 4D Management Systems Part D ( and Attachment) MEDICARE Part D (PDP) (MA-PD) PROGRAMS Brand: AWP-16%+$2.25 AWP-58% + $2.25 Tondra Pinson x 125 Fax Brand: AWP-22%+$0.00 AWP-58% + $0.00 4D is building a Michigan 4D will be supporting Midwest Health Plan in building their Medicare Part D and MAPD program may choose 34 day or 34 and 90 day supply options May 20, 2005 and Attachment Aetna Medicare and Medicare Contracting Requirements Argus Medicare Part D Appendix 1-Medicare Part D Regulatory Provisions (Retail Pharmacies) Certification Donald Amorosi Fax AetnaRxMedicare@aetna.com Argus Call Center Contracting Dept FAX No Medicare Reimbursement Schedule Noted Brand: AWP-15%+$2.00 MAC or AWP-20% + $2.25 Brand: AWP-21%+$0.50 AWP-50% + $0.50 Passive, must opt out to decline MA-PD and PDP Plans Sign and return by Fax or Mail Participation in the 84 Days or Greater program is optional Effective May 13, 2005 June 1, 2005, Appendix and Certification Caremark P.A. : Terms of Participation in Medicare Part D w/attachment A-LTC P.A. : Part D Retail 3/25/05 Caremark Part D Retail Enrollment Form 3/28/05 Caremark Retail Services Fax Caremark Retail Services Fax Retail Brand: AWP-16% + $1.50 AWP-16% +$2.00 LTC No Rates Published Retail Brand: AWP-13% + $2.50 AWP-13% +$2.50 LTC No Rates Published Pharmacies will be enrolled unless they opt out (Passive Acceptance) Silver Script (Caremark affiliate) is entity for Part D services LTC pharmacy requirements listed No separate LTC pharmacy compensation listed Must sign and return No separate LTC pharmacy compensation listed Decline by April 15, 2005 Two s & Attachment Enrollment Form C:\Documents and Settings\Maria\Local Settings\Temporary Internet Files\OLK19B\Part D (PDP) (MA-PD) Plan Table (3).docPage 1 of 7 PAAS 10/10/2005

2 Less Than 90 days Your current network rate Cigna Health Care Medicare Part D and LTC Community Care Rx (Member Health) Medicare Part D Schedules A & B Patty McLaurin ext 7538 Member Health Provider Enrollment days AWP-20% or MAC, + $1.50 Regional Rate A (106A) AWP-13.5%+$4.00 Non- AWP-14.5%+$2.00 AWP-20%+$4.00 or CCRx MAC + $4.00 AWP-15.5%+$5.00 Non- AWP-16.5%+$3.00 AWP-20%+$7.00 or CCRx MAC + $7.00 Regional Rate B (106B) AWP-14%+$4.00 Non- AWP-15%+$2.00 AWP-20%+$4.00 or CCRx MAC + $4.00 AWP-16%+$5.00 Non- AWP-16.5%+$3.00 AWP-20%+$7.00 or CCRx MAC + $7.00 Pharmacies will be enrolled unless they opt out in writing (Passive Acceptance) No separate LTC pharmacy compensation listed Sign and return by Fax or Mail Sole source generics paid at the brand name rate Additional compensation for generic substitution rate paid quarterly: 52-54% = $ % =$ % =$1.60 >59% =$1.80 Schedule 106A or 106B are dependant upon PDP Region Decline within 30 days of date of cover letter Sign & Return pages 1,5, and 6 As soon as possible and LTC and Two Schedules C:\Documents and Settings\Maria\Local Settings\Temporary Internet Files\OLK19B\Part D (PDP) (MA-PD) Plan Table (3).docPage 2 of 7 PAAS 10/10/2005

3 Brand: Coventry Purchased First Health AWP-16% + $1.75 or January In March an entirely New Provider Shaun Henry new Provider Agreement (includes Agreement MAC or AWP-16% + $2.00 or Medicare PDP & MA-PD) was sent to April 29, 2005 w/exhibit replace First Health Agreement Coventry Health Care (Former First Health) Exhibit 5 (Medicare Part D) to National Retail Provider Agreement Express Scripts to the Express Scripts Provider Agreement: Medicare Part D Health Trans Services Agreement Including Medicare Prescription Drug Plan Part D Express Scripts Care/Recruitment Provider Services Representative Fax Brand: AWP-16%+$2.00 PDP 30 MAC + $2.00 Extended Days Supply (>35- <90-Days Supply): Brand: AWP-22%+ $0.00 Medicare Part D EDS MAC + $0.00 Up to 83 days supply Brand: AWP-15% +$2.00 MAC or AWP-30% +$ to 90 days supply Brand: AWP-22% +$0.00 MAC or AWP-55% +$0.00 If a pharmacy participates in multiple ESI networks, then the individual client s network might apply LTC pharmacies should ask for separate contract Extended Days Supply network is optional Agreement includes Funded, CASH, Worker s compensation and/or Medicare Part D s April 19,2005 Sign & Fax at your earliest convenience Services Agreement, two exhibits Humana Inc. Provider Agreement and Exhibit E: Medicare Prescription Drug Plan Provisions Exhibit F: Performance Criteria for NLTCPs Amy Schulten s Project Coordinator No Medicare Reimbursement Schedule Noted Exhibit E describes pharmacy requirements for Humana s Medicare Prescription Drug Plan Exhibit F lists Performance and Service Criteria for Long Term Care Pharmacies (NLTCPs) Sign and Mail Provider Agreement, two exhibits C:\Documents and Settings\Maria\Local Settings\Temporary Internet Files\OLK19B\Part D (PDP) (MA-PD) Plan Table (3).docPage 3 of 7 PAAS 10/10/2005

4 Medco intends to participate in MMA < 34-Days Supply Part D-PDP and Part C-MA-PD plans Brand: AWP-15% + $2.00 Specialty medications include MAC or AWP-15% injectables to treat DVT/ Anticoagulation, +$2.00 Immune Deficiency, >34 <90-Days Supply Impotency, MS, Arthritis, Hepatitis Fax & Return by Brand: AWP-18% + $4.00 and others. April 29, 2005 Agreement Fax: MAC or AWP-18% +$4.00 Specialty Medications < 34 Day Brand: AWP-17% + $2.00 MAC or AWP-17% +$2.00 Schedule AD-2006: Medicare Part D Wisconsin Physicians Service Insurance Corporation (WPS) Schedule A-456 BCBSNC and PARTNERS Schedule A-464 Preferred Care, Inc. Schedule A Fax: Fax: Fax: <34-Days Supply No change from current terms >34 <90-Days Supply Brand: AWP-18% + $4.00 MAC or AWP-18% +$4.00 <34-Days Supply No change from current terms >34 <90-Days Supply Brand: AWP-18% + $4.00 MAC or AWP-18% +$4.00 <34-Days Supply No change from current terms >34 <90-Days Supply Brand: AWP-22% + $0.30 MAC or AWP-22% + $0.30 Medco s network for WPS Part D PDP plan Becomes part of the Participating Agreement Medco s network for BCBSNC and PARTNERS Part D PDP plan Becomes part of the Participating Agreement Medco s network for Preferred Care, Inc. Part D MA-PD Plan Becomes part of the Participating Agreement Fax & Return by April 29, 2005 Fax & Return by May 20, 2005 Fax & Return by June 10, 2005 C:\Documents and Settings\Maria\Local Settings\Temporary Internet Files\OLK19B\Part D (PDP) (MA-PD) Plan Table (3).docPage 4 of 7 PAAS 10/10/2005

5 MedImpact Medicare Part D & MedPref2 Brand: AWP-15% + $2.00 or Includes a Most Favored Nations Provision Appendix A New MedCare, National Choice 90 AWP-27% or MMC3 Agreement was included with the MedImpact Help Appendix +$2.00 or Medicare materials Desk And Choice 90 > 83-Days Supply MA-PD and PDP Plans May 15, Choice 90 Brand: AWP-21% + $.00 Part D allows pharmacy Enrollment AWP-50% = $.00 to participate in 30 days supply Part D Choice 90 participation is Optional National Pharmaceutical Services/ Pharmaceutical Technologies, Inc. Universal Medicare Part D Navitus Health Solutions, LLC, Reimbursement, LTC, and Home Infusion Exhibits NMHC Rx and Annex A for LTC Pharmacies Pharmacare LTC Medicare Part D PTI-NPS Provider Relations Navitus Health Solutions 5 Innovation Court Appleton, WI Fax NMHC Rx Provider Relations Department Fax Ms. Michelle Moore Administrator x 7210 Provider Paid according to the terms of the Agreement Brand: AWP-15% + $2.00 AWP-25% + $2.50 or MAC + $2.50 No Medicare Reimbursement Schedule Noted Brand: AWP-15% + $2.00 AWP-40% + $2.00 or MAC + $ Claims Processing Fee and allows 83 to 90 days supply MA-PD and PDP Plans PDP for Region 16 Wisconsin LTC Pharmacies must sign and return Exhibit A Home Infusion Pharmacies must sign and return Exhibit B (refer to Participatign Agreement for pricing information) Includes Annex A Performance and Service Criteria for Long Term Care (LTC) Pharmacies Includes Tribal Indian Health MA-PD and PDP Plans for American Progressive Life and Health and Pyramid Life Insurance Company MA-PD and PDP Plans must indicate which LTC facilities it services April 22,2005 Sign & Fax by June 10, 2005 April 15, 2005 June 1,2005, Exhibit A LTC, Exhibit B Home Infusion, Exhibit C Reimbursement and Annex C:\Documents and Settings\Maria\Local Settings\Temporary Internet Files\OLK19B\Part D (PDP) (MA-PD) Plan Table (3).docPage 5 of 7 PAAS 10/10/2005

6 PrimeStandard and If not signed and returned you will PrimeExtended be enrolled (Passive acceptance) Prime Contact Center Decline or You must participate in both the & Brand: AWP-16% + $1.40 PrimeStandard and PrimeExtended Three Exhibits June 17, 2005 AWP-25% + $1.65 or s to participate in Medicare Prime Medicare MAC + $1.65 Programs Prime Therapeutics New Participation Agreement, Medicare Exhibits, Prime Plus Exhibit Regence Rx New Provider Agreement and addendums for Medicare Part D RxAmerica Medicare to Agreement RxSolutions/ Prescription Solutions Medicare Prescription Drug Benefit Susan Hines Coordinator RxAmerica Customer Service Desk Linda Hayes RxAmerica Provider Relations Contract Dept Brand: AWP-14% + $2.00 or MAC or AWP-14% + $ Claims Processing Fee 30-Day Supply Brand: AWP-15% +$2.00 MAC or AWP-25% +$ to 90-Day Supply Brand: AWP-21% + $0.00 AWP-55% + $0.00 Brand: AWP-16% + $2.00 or MAC or AWP-16% + $2.00 or Notice to terminate existing Provider Agreement 6/30/2005 Must sign new agreement to continue as a Provider Service Area OR, WA, ID, UT LTC pharmacies should request LTC contract by fax to Rates Apply for < 34-Days Supply Zero Balance Copay MA-PD and PDP Plans June 21, 2005 Sign & Fax by May 1, 2005 June 1, 2004 & Contract C:\Documents and Settings\Maria\Local Settings\Temporary Internet Files\OLK19B\Part D (PDP) (MA-PD) Plan Table (3).docPage 6 of 7 PAAS 10/10/2005

7 Rate Sheet A-1 Sign and return via Fax or Mail Rate LTC Pharmacies should request Brand: AWP-15%+$1.75 additional contract AWP-20%+$2.25 Must indicate if participating in MAC Brand and Extended Days Supply WHI MAC+$2.25 Extended Days Supply Brand: AWP-21%+$0.00 AWP-50%+$0.00 MAC Brand and WHI MAC+$0.00 WHI (Walgreens Health Initiatives, Inc.) Medicare Part D Rate Sheet U-1 (UHC) Rate Sheet A-1 WHI Provider Relations Rate Sheet U-1 Rate Brand: AWP-15.5%+$1.60 AWP-25%+$2.00 MAC Brand and WHI MAC+$2.00 Extended Days Supply Brand: AWP-21%+$0.00 AWP-50%+$0.00 MAC Brand and WHI MAC+$0.00 Sign and return by June 3, 2005 and Two Attachments The information contained herein is as current and complete to the extent of Medicare Part D (PDP) (MA-PD) Program documents supplied to PAAS and reviewed. All pharmacies are cautioned to carefully review each plan and its impact on their pharmacy s business before accepting or rejecting the plan. Nonparticipation in a Medicare should not affect participation in any other network from that entity. For a detailed Contract Review contact PAAS National at or info@paasnational.com. C:\Documents and Settings\Maria\Local Settings\Temporary Internet Files\OLK19B\Part D (PDP) (MA-PD) Plan Table (3).docPage 7 of 7 PAAS 10/10/2005