On April 1, 2017, UnitedHealthcare Community Plan in Mississippi changed how it reimbursed
all contracted pharmacies for covered outpatient drugs to be compliant with the Mississippi
Division of Medicaid (DOM) reimbursement requirements. During the implementation of the
new pricing change, OptumRx, our pharmacy benefits manager, processed approximately 5
percent of pharmacy claims for drugs with invaild reimbursement rates.
Here’s What the Issue Is:
* Some pharmacy claims may have been reimbursed with expired National Average Drug
Acquisition Cost (NADAC) pricing.
* Some pharmacy claims may have been reimbursed incorrectly due to gaps in NADAC
pricing.
* Some pharmacy claims were inadvertently paid that should not have been paid, resulting
in pharmacy overpayment.
Here’s What We’re Doing to Correct the Issue
*OptumRx is working to identify and correct the pricing history for drugs found to be
impacted by this issue.
* In the coming weeks, the affected pharmacy claims will be reprocessed using the correct
Medicaid Fee-for-Services fee schedule.
* There may be an increase or decrease in reimbursement, depending on the claim.
*Please see attached for more information.