News & Updates
CMS directed NDC Changes
Please note this memo from Catamaran Provider Relations:
"Effective September 1, 2012, please be advised that due to changes in CMS guidance, Catamaran will reject products that are not listed in the FDA's Comprehensive NDC Structured Product Labeling (SPL) Data Elements file (NSDE). This will become effective September 1, 2012.
- These products will reject with reject code 54 and reject message "NDC not FDA listed."
For more information about the NSDE file, please visit this website*.
It is important to note that:
- Supplies associated with the injection of insulin will not be included in the non-matched NDC list and subsequently not reject.
Please be aware that Catamaran is proactively reaching out the drug wholesalers and manufacturers to ensure they have their products removed from this file to prevent rejections. If you encounter any rejection code 54 issues on or after September 1, 2012, please try an alternative product or contact the respective pharmacy helpdesk numbers on the member ID card for assistance with processing the claims."
Name Change for Pharmacy Benefit Manager
Commonwealth Care Alliance's pharmacy benefit manager (PBM) company, informedRx/SXC, has merged with another PBM, called Catalyst Health Solutions. The merger was effective July 2, 2012 following overwhelming approval by SXC and Catalyst stockholders.
As a result of the merger, the combined PBMs will have a new name -- Catamaran. The names SXC and informedRx will no longer be used. We will be updating our member and provider materials soon to reflect the change, however, this is the only impact Commonwealth Care Alliance will experience in response to the merger. Everything else will remain the same, including phone/fax numbers, contact information, etc.
The merger creates the fourth largest PBM by prescription volume, with an annual prescription volume of more than 200 million adjusted PBM scripts. With combined annual revenues of approximately $13 billion, the combined company is expected to cover approximately 25 million members, of which 4,000 are Commonwealth Care Alliance's Senior Care Options Program members.
If you have any questions about this change, please do not hesitate to contact Basem Shebli, Pharmacy Director.
Administration of Vaccines
The Massachusetts Board of Registration in Pharmacy has recently expanded the list of vaccines that qualified pharmacists are authorized to administer to patients who are 18 years of age and older. The list of included vaccines is:
- Tetanus, diphtheria, pertussis (Td/Tdap)
- Human papillomavirus (HPV)
- Measles, mumps, rubella (MMR)
- Pneumococcal polysaccharide vaccine (PSV23)
- Hepatitis A
- Hepatitis B
- Inactivated Polio Vaccine (IPV)
These vaccines are covered per Commonwealth Care Alliance's formulary. Participating pharmacies may bill Commonwealth Care Alliance's pharmacy benefit manager, Catamaran; however, a prescription for the vaccine is required in order to be reimbursed.
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.
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 9/1/12