Humana Star Ratings Program Re-launched!

 Up to $40 for Achieving Adherence Goals

Mirixa will soon re-launch an updated Humana Star Ratings Program. The goal of this program is to improve patients' adherence to target medications, by ensuring that patients have a sufficient quantity of each medication to achieve a Proportion of Days Covered ("PDC") greater than 80%, and by counseling patients on the importance of adherence.

Cases will be presented with "General Adherence Counseling Alerts," and/or "Conversion Counseling Alerts." The Conversion Counseling Alerts encourage pharmacists to fill a patient's prescription with a 90-day supply of medication rather than a 30-day supply, as a means of improving the patient's adherence. 

Mirixa will pay the pharmacy up to $40.00 per alert, payable in one or two installments per the terms below. To receive payment, pharmacists are required to resolve each alert by:

• Delivering the service and filling the resulting prescription before the case due date,
• Filling the targeted medication with either a 90-day supply of medication or a 30-day supply of medication,
• Providing subsequent refill(s) as needed in a timely manner for the remainder of the year,
• Processing all prescriptions through Humana so that they appear in claims data, and
• Ensuring the PDC for the target medication is greater than 80% at the end of the year.

Immediate attention to these cases is important!

Performance Based Payment Terms:

General Adherence Counseling

For each alert resolved, pharmacies will be paid a $40.00 adherence payment after the end of the year if:

• Resolving the alert resulted in a timely fill of either a 30-day or 90-day supply of the medication, and
• Subsequent refill(s) are provided to the patient in a timely manner for the remainder of the year, so
• The PDC for the target medication is greater than 80% at the end of the year. 

Conversion Counseling

Ideally (Switching from 30-day supply to 90-day supply)

For each alert resolved, pharmacies will be paid a $30.00 conversion payment before the end of the year if:

• Resolving the alert resulted in a fill of a 90-day supply of the medication before the case due date.

Pharmacies will be paid an additional $10.00 adherence payment after the end of the year for each alert resolved if:

• When applicable, subsequent refill(s) are also provided to the patient in a timely manner for the remainder of the year, so
• The PDC for the target medication is greater than 80% at the end of the year.

Alternatively, (Not switching from 30-day supply to 90-day supply but still improving adherence), 

For each alert resolved, pharmacies will be paid a $40.00 adherence payment after the end of the year if:

• Resolving the alert resulted in a timely fill of a 30-day supply of the medication, and
• Subsequent refill(s) are provided to the patient in a timely manner for the remainder of the year, so
• The PDC for the target medication is greater than 80% at the end of the year.

Please refer to the Program Service Description on the MirixaProSM platform for further details.

Please note that all Mirixa programs are voluntary for patients.