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:

Texas Children’s Health Insurance Program

Effective November 1, 2016, CVS Caremark® will begin to administer the prescription benefits for Aetna Better Health of Texas STAR Kids. Please update or create plan member profiles to reflect the changes regarding the following new plan adjudicating through CVS Caremark.

*Please see attached PDF for more information.

As a reminder, CVS Caremark® is dedicated to assisting Providers and Eligible Persons in response to emergencies resulting from natural disasters, severe weather, etc. where medical records are either destroyed or not accessible. In the event of a presidential (or other governmental) emergency declaration, CVS Caremark will allow an override code to override the refill-too-soon edit. Allowances for non-Medicare Part D plans may vary by Plan Sponsor.

By calling the Pharmacy Help Desk, Provider will be connected to the appropriate staff member who can provide:

• An emergency override code per claim for an excessive utilization, or "refill-too-soon" reject when a beneficiary does not have a recently filled medication due to loss from severe weather or other emergency

• The type of medication a beneficiary was taking prior to the emergency and other pertinent information, such as prescribing physician, dosage, quantity, days supply, etc.

Call the appropriate Pharmacy Help Desk number provided on the left or other plan-specific Pharmacy Help Desk number as indicated on the back of the member’s ID card.

Inside this Express Scripts Pharmacy Weekly you will find the following:

• External Code List (ECL) Update Reminder
• DSNP Member Part B Claims Submission

*Please see attached PDF for more information.

Dear Provider:

This notification is to inform you of formulary changes for all Medicare Part D plans processed by EnvisionRxOptions. Attached is a formulary change addendum (by plan) with the effective dates of the changes.

Should you need to view a complete Medicare formulary, they are available on the various Part D Plan websites. For your convenience, the plan websites are listed below. (Your pharmacies may not be participating in all plans listed.)

*Please see attached PDF for more information.