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Community CCRxSM PDP2010 Plan Year – Town Hall Update

Speakers:

Michael Bukach, RPh, SVP Pharmacy RelationsAmber Jones, RPh, Senior Manager Network OperationsMarc Bralts, Vice President, Network Operations

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Topics for Today’s Program

• 2010 Operational Changes• Member movement / LIS lives• AEP – Agents and Enrollment activity• Additional Targeted Medication Review Cases

available in 2009• 2010 Pharmacy Medication Management

Incentive Program

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2010 Operational Changes

• Quick Reference Guide to be delivered early December- handy reference guide for new plan year changes

• Prescription Origin Code – POC is required starting 1/1/2010

• FDA Non-Matched List to take effect on 1/1/2010– Claims will reject at point-of-sale– Exceptions will not be granted

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2010 Pharmacy Reimbursement

• No changes to core reimbursement• Mail Order – no mail order for Community CCRx in 2010

– Help us keep mail out- migrate patients to maintenance supplies

• Prompt Pay legislation requires payment of Part D claims within 14 days of a clean claim

– EFT is available for faster receipt of funds (Paymode)– Community CCRx including LTC in Prompt Payment

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Member movement / LIS

• More than 1.8 million LIS lives are in plans that will be over the benchmark in 2010 and WILL NOT automatically be moved

– These members will be notified via a TAN notice by early November

• Community CCRx LIS benchmark status for 2010:– Under LIS benchmark in all regions where under 2009 except NM– Back under benchmark: MA, RI, VT, CT, UT, ID– New under benchmark for 2010: AZ, NV

• LIS lives by Region, and plans where there will be a premium in 2010 is available on-line @ www.mhrx.com

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Annual Election Period Activities

For patients with questions on selecting a Community CCRx PDP plan that’s right for them, ℠have them call 1-877-545-3815

To request a Pharmacy Education Kit with information to provide your patients, please contact the PTC or email us at experts@mhrx.com

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Additional 2009 TMR Cases

• Focus is on Therapeutic Interchange• Flat fee paid for completing case• Approximately 47,000 cases releasing nationwide

– Planned to be released by November 23– Cases must be completed in 30 days to receive reimbursement

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2010 Pharmacy Medication Management Incentive Program

2010 Generic Dispensing RateLow High Fee*

0.00% 71.99% -$ 72.00% 76.99% 0.40$ 77.00% 81.99% 0.80$ 82.00% 1.50$

* = contract-priced generics only

2010 Maintenance Supply Dispensing RateLow High Fee**

0.00% 6.00% -$ 6.00% 7.99% 0.05$ 8.00% 9.99% 0.10$

10.00% 11.99% 0.15$ 12.00% 13.99% 0.20$ 14.00% 0.25$

** = contract-priced brands and generics

2010 MemberHealth, LLC Pharmacy Medication Management Incentive Program

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Communications

• Website: www.mhrx.com 2010 Formularies

60 Day Formulary Notices

Formulary Disruption – 2010 Impacted Patient Look-up Fraud Waste and Abuse Module PA Forms PA Criteria PA Status Search Pharmacy Scorecard

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2010 Part D: Community CCRx

Thank You for your continued Support.

Questions & Answers