340Better and the Medicare Drug Discount Card Program Stretching Your 340B Dollars

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340Better and the Medicare Drug Discount Card
Program Stretching Your 340B Dollars

• Community Care Rx
• Computer Sciences Corporation (CSC) and
  MemberHealth

Corpus Christi, TX October 26, 2004
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Introduction Community Care Rx (CCRx)

• Community Care Rx is a collaboration between
  Computer Sciences Corporation (CSC) and
  MemberHealth, Inc. (MH)
• CSC is the CMS Approved Sponsor for 5 Medicare
  Discount Drug Card Programs
• CSC and MH have partnered to administer the
  Community Care Rx Discount Drug Card Program
  nationally
• CCRx is the only nationally approved MDDC
  focusing on the 340B community

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Sponsor Introduction Computer Sciences
Corporation (CSC)

• Founded in 1959, CSC is a leading global
  information technology (IT) services company
• Headquartered in El Segundo, CA with
  approximately 90,000 employees worldwide CSC
  reported over 14 Billion in revenue for Fiscal
  Year 2004
• Provides innovative solutions for customers
  around the world
• Mission is to provide customers in industry and
  government with solutions crafted to meet their
  specific challenges and enable them to profit
  from the advanced use of technology
• Major CMS projects include Common Working File,
  Program Safeguard Integrity, Medicaid Architecture

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Sponsor Introduction MemberHealth, Inc. (MH)

• MemberHealth is headquartered in Solon
  (Cleveland), Ohio
• MemberHealth operates a number of national and
  state prescription benefit administration (PBM)
  programs, including insured, self-insured and
  discount prescription plans.
• MemberHealth is the PBM contractor for the CSC
  Medicare approved programs including Community
  Care Rx (CCRx), Criterion Advantage (CA), both
  nationwide programs, and the Golden Buckeye
  program in Ohio.
• Additionally, MemberHealth and CSC administer a
  growing list of state PAP/Medicare wraparound
  programs, including Connecticut, Ohio, North
  Carolina, and Mississippi
• MemberHealth and CSC manage two Special Endorsed
  Medicare programs, for Long Term Care and I/T/U
  (AI/AN).

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Committed to the Success of the 340Better Program

• Provide Medicare Wraparound Benefits to Your
  340B and FQHC Patients
• Use Medicare 600 Annual Credit with 5 or 10
  Copays to
• STRETCH Your Program Budget , and
• SAVE Your Patients Additional
• Act NOW to preserve 2004 600 credit and maximize
  2005 600 credit

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Provider Enrollment

• 340Better Medicare program is available now!
• All 340Better contracted pharmacies are eligible
• Clinic with In-house Pharmacy
• Dispensary Pharmacy (re-pack)
• Contract Pharmacy (Retail pharmacy)
• Class D Clinic Operations
• Fill out and submit provider agreement ASAP
• Remember 600 is on the table for every
  patient served

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Who Is Eligible?

• Patients of FQHCs or other 340B Eligible Entity
• Patients entitled to, or enrolling in, Medicare
  Part A and/or Part B
• Patients NOT receiving Medicaid prescription
  coverage at the time of enrollment
• Patients enrolled in Medicare Savings Program
  (MSP) as QMB, SLMB, or QI-1
• Patients living in the United States or District
  of Columbia
• Patients meeting annual income qualifications
  (for 600 credit)

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Enrollment

• Enroll online, by fax, phone or mail
• Check Enrollment Status Online
• Enroll Eligible Members by Working with Pharmacy
  staff, Patient Benefit Coordinators, Billing
  Offices, etc.
• Fill out and submit enrollment application
• There are two separate forms
• Enrollment form for the MedicareApproved Drug
  Discount Card
• Enrollment form for the MedicareApproved Drug
  Discount Card and 600 Credit in Paying for Your
  Prescription Drugs
• Make sure to complete and send in the correct
  form
• Only one form should be submitted do not submit
  both forms
• Do not omit or leave blank any fields of the form
  (ie member income, pharmacy NCPDP)

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Enrollment

• Enrollment fee is 30.00
• If applying for 600 Credit/Transitional
  Assistance (TA), Medicare will pay the enrollment
  fee
• If applying for discount drug card only, enrollee
  has to pay the enrollment fee
• Important to apply for 600 credit as soon as
  possible
• Beneficiaries who qualify for 600 credit and
  enroll in 2004 will receive 600 credit in 2004
  and 600 credit in 2005 to use towards their
  prescription drugs
• If do not enroll by end of December will lose the
  600 credit for 2004
• 600 credit will be prorated for anyone who
  enrolls after March 31, 2005 (losing 150 each
  quarter)

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Disenrollment from another MDDC Card to enroll in
the CCRx Card

• If a beneficiary is currently enrolled in another
  MDDC Card, the beneficiary may elect to disenroll
  from their current card and enroll in the CCRx
  card
• DURING THE OPEN ENROLLMENT PERIOD ONLY!
• NOVEMBER 15 until DECEMBER 31, 2004

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Timeline to Receive a Medicare Card

• Application received by website, fax or mail
• 24hr turnaround for Application review and input
  process
• Daily file transmission of complete applications
  to CMS
• 1 to 3 Days for CMS response to application
• 5 Days - to mail ID card/enrollment kit
• 7 days to mail denial letter
• Typical turnaround 8 to 10 business days from
  receipt of complete application
• Can be delayed by numerous issues, primarily
  incomplete or inaccurate enrollment forms

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Formulary

• Use your facilitys current formulary
• Open Formulary for retail pharmacies
• ALL brand and generic drugs are covered under the
  program except those federally excluded (next
  slide)

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Discount Drug List Federally Excluded Drugs

• Drugs not covered under the Medicare Discount
  Card are
• Anorexia, weight loss, or weight gain
• Fertility Drugs
• Cosmetic purposes or hair growth
• Drugs to relieve coughs or colds
• Prescription vitamins and mineral products
  (except prenatal)
• Nonprescription drugs (Over-the-counter drugs)
• Barbiturates
• Benzodiazepines
• Drugs that could be covered under Medicare Part B

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Example Community Care Rx Card
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Prescription Claim Submission

• Pharmacies with electronic billing capability
  will submit claims electronically and they will
  be adjudicated online
• Pharmacies without electronic billing capability
  will submit paper claims
• Pharmacy calls the helpdesk to obtain the
  transitional assistance balance remaining
• If a balance remains, pharmacy faxes a Universal
  Claim Form to MemberHealth for reimbursement
• MemberHealth will enter the claim online upon
  receipt of the claim form during hours of
  operation (M-F 800am-500pm EST)
• Pharmacy may also call the helpdesk to provide
  the claim information by phone for online entry,
  but will still be required to fax a Universal
  Claim Form to MemberHealth
• Payment is not guaranteed until the online claim
  has been successfully processed

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Copayments Prescription Filled at 340Better
Pharmacies

• The prescription will be adjudicated online based
  on the patients income. The clinic may override
  the copay to meet their normal program copay
  structure
• The Clinic may waive /or modify the copay based
  on income or other parameters established by the
  Clinic
• The drug cost will be applied toward the 600
  annual credit

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Copayments Prescription Filled at Retail Pharmacy

• If beneficiary has qualified for the 600 credit
  and fills prescriptions at a retail pharmacy,
  s/he will pay a copay at the pharmacy for each
  prescription drug, until the credit of up to
  600.00 is used, based on the income level as
  follows
• Single, 12,569 or less, 10 copay (up to
  135 FPL)
• Single, 9,310 or less, 5 copay (up to
  100 FPL)
• Married, 16,862 or less, 10 copay (up to
  135 FPL)
• Married, 12,490 or less, 5 copay (up to
  100 FPL)

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Benefits to 340Better Providers

• Up to 600 paid to network pharmacies to
  reimburse for prescriptions that they fill for
  each eligible beneficiary
• Stretches Your 340Better Dollars!
• Saves Clinic funds
• If beneficiary has prescriptions filled at a
  retail pharmacy, the 600 credit will be used to
  pay for the drugs at the retail pharmacy
• Positions 340B and FQHC facilities to be a part
  of 2006 Medicare Part D Program

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Benefits to 340Better Clinic Beneficiaries

• Beneficiaries who qualify for 600 credit and
  enroll in 2004 will receive 600 credit in 2004
  and 600 credit in 2005 to use towards their
  prescription drugs
• Any unused portion of the 600 credit that is not
  used in 2004 will roll over to 2005
• Beneficiaries who do not qualify for the 600
  credit will receive prescription drug discounts,
  especially if prescriptions are being filled at a
  retail pharmacy

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Contact Information

• Scott G. Hughes R.Ph.
• MemberHealth Inc.
• 888-868-5854
• shughes_at_mhrx.com

• Louis Hogan
• Computer Sciences Corporation
• 443-436-6620
• lhogan2_at_csc.com

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Questions?