Effective 10/01/2016, the APNS agreement with ESI renewed for the next contract cycle period.   The rates offered were far more aggressive than previous years. However, when attempting to negotiate these rates, APNS was informed there was no room for negotiation.  The contract renewal was a “take it or leave it” situation.  APNS was informed that all PSAOs would be under the same contract arrangement as each of their cycles comes up for renewal.

ESI is a major contract held by APNS and not one that we felt could be termed on behalf of the entire membership.  We did request and confirm with ESI that an individual pharmacy could choose to term participation on their own if so desired.  Reporting on ESI reimbursement is available upon request from APNS.

In conjunction with the ESI contract renewal, APNS discovered and ESI confirmed that they made an error in their reimbursement system and pharmacies located outside of Ohio were paid at a deep contracted Ohio generic rate instead of at MAC –timeline: 9/30 – 10/7.  ESI has stated that they will automatically rebill the claims that were paid incorrectly.

APNS has requested on numerous occasions a list of pharmacies and claims related to ESI’s reimbursement error.  We are still waiting and have informed ESI that this matter will be reported to insurance commissioners in states where pharmacies are involved if information is not soon provided.  We have further stated that if roles were reversed a pharmacy would not be granted the same leniency that ESI has afforded themselves for such an error.