Medicare Part D Pharmacy Updates

2008 Prime Formulary Transition Updates:
Prescribers may notice significant changes to the Prime Therapeutics Medicare Part D formulary in 2008 due to Centers for Medicare and Medicaid Services (CMS) mandated changes (safety concerns, drugs that do not meet CMS’ definition of a Part D medication, etc.) and a migration to one standard formulary. Member letters were mailed in November 2007 alerting them of 2008 formulary changes (removals, tier changes, addition of step therapy edits, etc.) affecting them. Coverage determinations for changes can be submitted by the prescribing physician after December 17, 2007, for an effective date of January 1, 2008. To view the Medicare Part D formulary changes and access a PDF of the 2008 formularies, visit Prime’s Web site at www.primetherapeutics.com/pharmacists.htm. Prime Therapeutics provides pharmacy benefit management services to Blue Cross and Blue Shield of Illinois Medicare Part D plans and is a separate company.

Below you will find a list of 16 medications that have been removed from the 2008 formulary. These 16 medications are believed to have the most potential to affect current members. As a result, these medications will continue to be covered for members currently prescribed these medications, and who do not change their Medicare Part D plan, until December 31, 2008 at the third tier co-pay. Please note: These medications will not be listed on the 2008 formulary.

Reminder: eDispense – ZOSTAVAX vaccine
In order to prevent possible time delays with paper claims and incorrect reimbursement for administration fees, physicians now have an option for easy on-line access to submit claims for ZOSTAVAX (when administered from their office supply) to Prime Therapeutics for Medicare Part D coverage. This new service, called eDispense Medicare Part D Vaccine Manager, allows physicians to submit a real time claim from their office computer system. The process allows office staff to verify a member’s coverage and coverage level prior to administering the vaccine. This service, which is administered by Dispensing Solutions, Inc (DSI, a separate company), is currently available only for ZOSTAVAX, due to its unique storage requirements. Physicians can participate by enrolling in the eDispense network at: http://enroll.edispense.com and completing the brief enrollment process. Physicians can also contact DSI directly with any questions at 1-866-522-3386.