• This issue of CAPS Newsletter discusses the following topics:

  
  

  • X-DEA Prescription Requirements
  • Prescriptions Written by a Nurse Practitioner (NP) or Physician Assistant (PA)
  • Insulin Part B vs. Part D Billing
  • Issuance of Multiple Schedule II Prescriptions
  • Biennial Controlled Substance Inventory Count
  • “Use as Directed”, “As Directed”, “Per Sliding Scale” Directions
  • Multiple Physicians Listed on a Prescription
  • Humana Audit $5 Penalty Fee
  • OIG/SAM Monthly Exclusion Checks 
  • Meet your CAPS Team

Kaiser Permanente Part D Plans

Catamaran, an OptumRx Company, will manage claims processing for members of Kaiser Permanente Part D plans.

Medicare Part D Open Enrollment starts in just over three weeks! Check out APCI's Part D Marketing Materials to help promote your pharmacy's Part D services!

As of January 1, 2016, claims for Multi-Ingredient Compounds (MICs) will process according to the Cigna- HealthSpring Medicare Part D Formularies.  This means that each ingredient within a compound will pay or reject based on the specific ingredient‟s Formulary status. Part D products with Prior Authorization (PA), including B vs. D and Step Therapy (ST) will be subject to Formulary rules. Non-Formulary (NF) ingredients will reject as such. o The pharmacy will have the option to:  Submit a coverage determination for the rejected ingredients (PA, ST or NF); or  Resubmit a MIC claim with the rejected ingredients (PA, ST or NF) by submitting a submission clarification code (SCC) value of „08‟. This means that the non-covered drugs will process at $0 and by submitting the „08‟ that you are accepting payment for this amount as the entire payment. CMS does not allow pharmacies to charge the beneficiaries any more than their adjudicated co-payment. 