News & Updates
New Pharmacy Benefits Manager
We are delighted to announce that informedRx, a subsidiary of SXC Health Solutions, has been selected as our new pharmacy benefits manager (PBM) effective January 1, 2012. InformedRx won this contract because of their demonstrated ability to customize their processes to meet the unique needs of our members and our care model. Commonwealth Care Alliance will no longer be working with Express Scripts (ESI).
Due to this change, all of our Senior Care Options program members were mailed a new member ID card. The new card has updated billing codes that are critical for pharmacies to use in order to fill prescriptions and bill Commonwealth Care Alliance correctly. Please remind your patients to show their new ID cards to the pharmacy starting on January 1, 2012. If members did not receive a new card, they should be encouraged to contact Member Services at 1-866-610-2273.
Furthermore, we have launched a campaign to educate pharmacies of our PBM switch to informedRx. Attached is a copy of the document that was sent out to all pharmacies. While we have tried to preemptively address any issues related to this transition, should you learn of any delay in your patients' ability to fill their scripts, please call Member Services at 1-866-610-2273. They will help facilitate a resolution.
FAQs
Q. What happens if my patients go to the pharmacy on January 1 with their old Commonwealth Care Alliance ID card?
A. Patients who present their old cards after January 1 may not be able to fill their scripts. It is crucial that patients use the new member ID card we mailed to them. Pharmacies need the updated billing information on the new cards in order to fill scripts.
Q. What happens if my patient presents the new card, but the pharmacy is unable to fill the script?
A. If your patient presents the new card and the pharmacy is unable to fill the script, please contact our Member Services team immediately at 1-866-610-2273. We are available 24 hours a day/7 days a week. Also, the InformedRx Customer Service team is open 24 hours a day/7 days a week, including holidays and weekends.
Q. Is there any change to the pharmacy network?
A. All the pharmacies who are currently contracted and in our network will remain in our network after we switch to informedRx. Your patients can continue to go to the same pharmacy they have been filling their scripts at.
Q. Will our members still be able to get prescriptions filled at Walgreen's?
A. Walgreen's is a contracted pharmacy and will continue to fill our members' scripts as they have been. This will not change.
Q. Is Commonwealth Care Alliance making any drug formulary changes effective for 2012?
A. We have limited our formulary changes so that we minimize provider and member hassle. For the first time all of our members (Medicare duals as well as MassHealth only) will have the same formulary and drug benefits. Please visit our website current formulary and Clinical Programs.
Last Updated 1/1/12