CCRx Update Archives
February 24, 2006
| In this update: |
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| Community Care RxSM News |
| Time to Think About Medication Therapy Management Medication Therapy Management (MTM) is an important component of the Medicare Part D prescription drug benefit. Targeted to roll out in June, the CCRx MTM program stresses the important role pharmacists play in medication management. The pharmacist is in a strategic position to function in the role of a risk manager when it comes to medication compliance and cost. MTM and the role of the pharmacist as a risk manager takes community pharmacy to the next level and will be instrumental in helping to solidify its future. CCRx believes that high quality medication therapy management is best delivered face-to-face in the pharmacy setting. Select patients will qualify for an MTM session under the CCRx benefit design. Patients must meet all of the following criteria:
CCRx will notify pharmacists which patients meet the criteria for an MTM session. Pharmacists will utilize Community MTM, a Web-based application, to conduct medication therapy management sessions with their patients. The CCRx MTM program is scheduled for national roll out in June, and training will commence in the spring. We recommend that you have a computer with dedicated Internet access (128kbps speed) and a printer, so that you can print out a record of the visit and educational materials (included in the Web-based application) for your patients. To get started with the CCRx MTM program, you will need to sign a service agreement and an addendum to the network contract. Please e-mail tjones@communitymtm.com to request these materials and include the following information with your email:
Please note that some buying groups will be contracting for medication therapy management services on behalf of their pharmacies. |
| Remittance Advices for Feb. 1 Payments The remittance advice for the Feb. 1 CCRx payment (covering Jan. 1–20 billing) was mailed separately from the check. This was a one-time occurrence in order to get the checks to pharmacies faster. The remittance notice mentions that the payment is enclosed. Please disregard that statement as the Feb. 1 check for the Jan. 1-20 billing cycle arrived approximately one week before the remittance. |
| Electronic Funds Transfer (EFT) Letters to register for EFT for CCRx payments were mailed last week. Pharmacies that are currently reimbursed through a contracting organization or buying group will continue to receive payments in the usual manner and should disregard the letter. If you did not receive a letter and wish to register for EFT, please call the Pharmacy Tech Center (PTC) at 866-684-5395. |
| Therapeutic Interchange: Non-Steroidal Anti-Inflammatory Drugs The CCRx formulary offers many therapeutic equivalent medications to MOBIC (meloxicam), a drug that is not on the CCRx formulary and would require the physician to complete the exceptions form. By assuming the role of risk manager, pharmacists can help control drug spend and encourage the use of generics, which are a key aspect of the CCRx plan design. In the case of MOBIC, the CCRx formulary offers the following alternative medications:
The evaluation of patients receiving MOBIC reveals only a slight decrease in gastrointestinal events compared with traditional NSAIDs. An increased risk of toxicity exists with doses of MOBIC greater than 7.5 mg. There is no convincing evidence that the risk of the most severe adverse gastrointestinal events-namely peptic ulceration, perforation, and bleeding-is lower with meloxicam than with other NSAIDs when administered at equi-effective doses. A recent study suggest a relative reduction by 23 percent in the incidence of symptomatic (acid/peptic) GI events and a relative reduction by 44 percent in the incidence rate of complicated upper GI conditions such as perforations and bleeding for celecoxib compared with meloxicam. All NSAIDs should be prescribed with caution in elderly patients. Please note that oxaprozin, indomethacin, naproxen, and piroxicam meet Beer’s criteria as high risk drugs when used on the elderly. Avoid the use of these medications when possible. Because NSAIDs and Cox-2 agents are associated with gastrointestinal and cardiovascular risks, pharmacists should consider stratifying patients into appropriate risk categories. Traditional NSAIDs should be considered for patients without cardiovascular or gastrointestinal risk factors. There are a couple of recommendations for patients who do have a high gastrointestinal risk, including the elderly, chronic steroid users, and those with previous hospitalizations for GI bleeds or ulcers:
Pharmacists should attempt traditional NSAIDs or non-NSAIDs first for patients with cardiovascular risk factors such as prior myocardial infarction, hypertension, or congestive heart failure. Celebrex (celecoxib) should not be prescribed for patients with cardiovascular disease and is associated with the same rate of clinically significant GI events as diclofenac and ibuprofen. Celebrex 100 mg and 200 mg requires step therapy (previous trial of formulary NSAID). Celebrex 400 mg requires prior authorization. |
| Late Month Enrollments It is well past the middle of the month, and we’d like to remind you that while beneficiaries may continue to enroll in CCRx until Feb. 28 for a March 1 benefit effective date, it is highly unlikely that they will have their enrollment confirmation letters or appear in the eligibility system on March 1. CCRx strongly recommends that your patients enroll by the middle of the month to ensure that they receive their letters and are in the system by their effective date on the first of the following month. You may submit claims retroactively for any patients with March 1 effective dates who do have letters or appear in the eligibility system. Patients who pay for their medications because they did not appear in the system should call the Beneficiary Call Center at 866-684-5353 for assistance. |
| Coming Soon-Formulary Change Requests In our continuing effort to provide the most clinically appropriate and affordable medication therapy for patients, CCRx will soon be collaborating with physicians to request drug therapy changes for patients. CCRx will send a letter to the prescribing physician notifying him/her about the patient’s current drug regimen and recommending CCRx formulary medications that are therapeutically appropriate with noted cost savings. If the physician approves of the recommendations the letter is signed and faxed back to CCRx. The physician then completes a two-part form that is faxed to the pharmacy. The top half is the new prescription, and the bottom half is a letter the pharmacist will give to the patient notifying him/her about the medication change. |
| Medicare News |
| Medicare A,B,D-What’s the Difference? Medicare Part A and Part B generally do not cover outpatient prescription drugs, most of which are now covered under Part D. There are specific cases where Part A or Part B does cover medications. Part A-Hospital Insurance People with Medicare who are inpatients of hospitals or skilled nursing facilities (SNF) during covered stays may receive drugs as part of their treatment. Medicare Part A payments made to hospitals and skilled nursing facilities generally cover drugs provided during a covered stay. Part A stops paying for medications when the patient leaves the hospital or skilled nursing facility or when the benefit runs out, whichever occurs first. Part B-Medical Insurance Medicare Part B covers a limited set of drugs, including injectable and infusible drugs that are not self-administered and that are furnished or administered as part of a physician service. If the injection is usually self-administered (i.e., Imitrex) or is not furnished or administered as part of a physician service, it may not be covered by Part B. Any medications that a patient is currently taking under the Part B benefit will continue to be covered by Part B. Part D-Prescription Drug Insurance Part D-covered drugs are defined as: drugs available only by prescription, used and sold in the United States, and used for a medically accepted indication; biological products; insulin; and vaccines. The definition also includes medical supplies associated with the injection of insulin (syringes, needles, alcohol swabs, and gauze). Certain drugs or classes of drugs, or their medical uses, are excluded by law from Part D coverage. A listing of excluded drugs is available on Medicare's Web site. Under the Medicare hospice benefit, people receive drugs that are medically necessary for symptom control or pain relief. For hospice patients, Part D covers drugs unrelated to the patient’s terminal illness (i.e., medications prescribed for an infection). |
| Ask the Experts |
Q: Some of my full benefit, dual eligible CCRx patients have claims adjudicating at the $1/$3 copay while others are $2/$5. There must be an error in the system. How do I get it fixed? A: The system is correct. There are different levels of cost sharing for full benefit, dual eligible patients based on their incomes. Patients whose claims adjudicate at the $1/$3 level have incomes at or below the Federal Poverty Level (FPL). Full-benefit dual eligible patients with incomes above 100 percent of the FPL will pay $2/$5. Other Medicare beneficiaries with incomes up to 150 percent of the FPL may qualify for low income assistance, depending on the assets test in combination with the income level. If you believe a patient qualifies for the low income subsidy, encourage him/her to apply to the Social Security Administration. The application is available on the Social Security Administration’s Web site. If the patient is approved for the low income subsidy, CMS will notify CCRx, and the benefit level will be adjusted accordingly. |