Mirixa is pleased to announce the return of Star Ratings program offerings with CVS Caremark in 2015. CVS Caremark is offering two SSI Star Ratings programs in 2015 to engage pharmacists with patients in the SilverScript prescription drug coverage plan and their prescribers to improve quality of care delivered to patients. Please review the below program list carefully as there have been changes to the SSI program names, alert types, expiration dates, and reimbursement structure.   SSI – Retail Stars Adherence Intervention Program

• Scheduled launch on February 1st, 2015.
• Adherence alerts only (no 'Omission in Care' gaps) for Cholesterol (Statins), Hypertension (ACE-I/ARB/DRI), and Diabetes medications. Note: These adherence alerts will be tied to a specific medication. Alerts may potentially be resolved by claims data at any time; should all alerts within a case become resolved, the case will no longer be reimbursable.
• Pharmacy will have 10 days from assignment to place the case into an 'in progress' status in MirixaPro℠; after 10 days any cases that are not 'in progress' will be removed. Pharmacy will have 21 days (overall) from assignment to submit the case for billing.

A case may be placed into progress by scheduling an appointment with the patient in the MirixaPro platform, printing the patient’s chart, or partially documenting and saving any actions taken on the case in MirixaPro.

• Reimbursement will be $12 per alert (flag) served and $2 per case declined. There is no reimbursement for cases without any active alerts; these cases should be declined with the reason of 'No Alerts Present'.  

SSI – Retail Star Drug Therapy Intervention Program

• Scheduled to launch March 1st, 2015.
• At launch, this program will only contain 'Omission in Care' gaps for a Diabetes treatment measure.

Patient appears to have diabetes and hypertension, but appears not to be taking an Angiotensin Converting Enzyme Inhibitor (ACE-I), Angiotensin Receptor Blocker (ARB), or a Direct Renin Inhibitor (DRI).

• There is the potential for adherence alerts at a later date for Cholesterol, Hypertension, and Diabetes medications.
• Pharmacy will have 60 days to complete and submit these opportunities. Alerts are static and will not resolve themselves.
• Reimbursement is $12 per alert (flag) served and $2 per case declined.  

CVS Caremark Star Ratings Program (no changes from 2014)

• This program is primarily available only in Washington, Idaho, and Utah.
• Scheduled to launch on January 20th, 2015.
• Both 'Omission in Care' and adherence alerts will be featured. Alerts may potentially be resolved by claims data at any time; should all alerts within a case become resolved, the case will no longer be reimbursable.
• Pharmacy will have 7 days from assignment to place the case into an 'in progress' status in MirixaPro; after 7 days any cases that are not 'in progress' will be removed. Pharmacy will have 21 days (overall) from assignment to submit the case for billing.
• Reimbursement: Pharmacies will be paid $20 for each initial case and $10 for each follow-up case served in accordance with the Program Services Description (PSD). A case declined per the decline policy in the PSD will result in a payment of $2.50. There is no reimbursement for cases without any active alerts. 

Please download the PDF file listed below for details.