Blue Cross Idaho Medicaid Plus Pharmacy Dispense Fee

Pharmacy

VDP Pharmacy Reenrollment Update

All pharmacies are required to reenroll with the Vendor Drug Program (VDP) to continue receiving payment in fee-for-service and managed care. The Affordable Care Act requires all pharmacies, including those who enrolled with VDP prior to Nov. 2, 2015, to reenroll using the new VDP Pharmacy Provider Enrollment Application. Pharmacies also must submit an application fee, as required by federal law. Some pharmacies may be exempt from the application fee if fees are paid in another state or paid for enrollment as a pharmacy in Medicare.

Pharmacy staff is strongly encouraged to begin filling out the new application now, as it is longer than the previous application and includes new questions. Please submit your completed application, the agreement, the application fee, and all other required documentation by June 17, 2016, to ensure the reenrollment process is completed by September 24, 2016 to avoid potential disruption in payment.

The application, agreement, and other required documents can be downloaded from the VDP website.

Blue Cross and Blue Shield of Texas (BCBSTX) is a managed care plan that serves Texas STAR, CHIP, and CHIP Perinate members in the Texas Travis Service Area and STAR Kids in the Texas Travis and MRSA Central Service Area.

BCBSTX uses a Preferred Drug List (PDL), which is a list of preferred drugs for physicians to prescribe. The goal of our pharmacy benefit is ensure that members receive therapeutically appropriate drug therapy. Our ability to review both medical and pharmacy claims allows for integrated clinical programs that help facilitate comprehensive disease state management programs. Select drugs may require prior authorization.

Where Prescriptions Are Filled

Prescriptions can be filled at retail pharmacies servicing the Travis Service Area, and a listing of these pharmacies (pharmacy network) can be found in our Provider Directory or search the Provider Finder. To verify pharmacy network participation or BCBSTX drug coverage, please call Prime Therapeutics Pharmacy Help Desk, a separate company that provides pharmacy benefit management services for BCBSTX.

• STAR Pharmacy Help Desk, call 1-855-457-0405
• CHIP Pharmacy Help Desk, call 1-855-457-0403
• STAR Kids Pharmacy Help Desk (Travis service area), call 1-855-457-0757
• STAR Kids Pharmacy Help Desk (MRSA Central service area), call 1-855-457-0758

Retail pharmacies can dispense no more than a 34 day supply, but most prescriptions can be written with refills.

DME and CCP

• Pharmacies in the BCBSTX/Prime Therapeutics network that wish to provide DME services, and are enrolled on the TMHP website as DME providers, may complete a DME Provider Contract with BCBSTX to provide these services.
• CCP is an expansion of the Texas Health Steps program and includes items like medical supplies and DME.
• Pharmacy providers are eligible to enroll in Medicaid Children's Services (CCP). To enroll in Medicaid Children's Services (CCP), the pharmacy must first enroll in the Medicaid Vendor Drug Program (VDP).
• For clients 20 years old and younger, Medicaid Children's Services (CCP) may cover some OTC drugs and disposable or expendable medical supplies that are available in pharmacies but not covered by VDP.

Pharmacy Prior Authorization Timeframe

Prior Authorization request received by Prime Therapeutics are date stamped and have a timeframe to process prior authorization:

• STAR and STAR Kids – 24 hours
• CHIP – three days (Business Days)

• If the prescriber's office calls the BCBSTX Prior Authorization call center, we must provide prior authorization approval or denial immediately.
• For all other prior authorization requests, we must notify the prescriber's office of a prior authorization denial or approval no later than 24 hours after receipt.
• If BCBSTX cannot provide a response to the prior authorization request within 24 hours after receipt or the prescriber is not available to make a prior authorization request because it is after the prescriber's office hours and the dispense pharmacist determines it is an emergency situation, BCBSTX must allow the pharmacy to dispense a 72-hour supply of the drug.

For more information about prior authorizations visit out Utilization Management page.

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Source: https://publicsitestx.hcsc.net/provider/medicaid/pharmacy.html

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