Following is the 1st Quarter 2015 update to the Highmark Drug Formularies and pharmaceutical management procedures. The formularies and pharmaceutical management procedures are updated on a quarterly basis, and the enclosed changes reflect the decisions made in December 2014 by our Pharmacy and Therapeutics Committee.

Inside this issue:

Surescripts is expected to begin mailing rebate checks within the next two weeks to independent community pharmacies on its e-prescribing network. The rebates are calculated at 3-cents per billable transaction between Jan. 1 and Dec. 31, 2014. Surescripts also has announced that it will offer a similar rebate program for 2015 transactions, payable early in 2016.

Three bills have been introduced in Washington that are very important to independent pharmacy and APCI needs your help to encourage your members of Congress and U.S. Senators to support and sign-on as co-sponsors.  The following bills need to have the entire delegations from APCI member states on as co-sponsors:

Cigna-HealthSpring currently utilizes a clinical program which is designed to review a member’s prescription history for possible drug related concerns. The goal is to improve the quality and cost effectiveness of dispensed medications by ensuring adjudicated prescriptions are clinically appropriate. The edits in place can be easily overridden by using the appropriate DUR/PPS Reason and Result codes found below. This edit assesses the total daily dose based on FDA approved maximum dosing information. The edit identifies single incoming claims of concern as well as overlapping claims with the member’s history based on specific ingredients. The edit will be triggered if the total daily dose exceeds the FDA-defined maximum daily dose.