On Friday, December 15, the Centers for Medicare and Medicaid Services (CMS) announced proposed changes in the payment for certain prescription drugs in the Medicaid program. These changes implement provisions of the Deficit Reduction Act of 2005 (DRA). The DRA changes how the federal government limits payments to state Medicaid agencies for the aggregate costs of prescription drugs when a generic substitute is available. The DRA establishes a new FUL calculation that is based on 250% of the lowest Average Manufacturers' Price (AMP) in a drug class.  Complete article (TPA username and password required)

Dr. Loveless joins Drs. Tim Tucker (President-Elect) and Dick Gourley (Board of Trustees) as Tennesseans elected to APhA offices this year.  All will be installed at the 2007 APhA Annual Meeting in Atlanta, March 16-19, 2007. 

Tim Tucker, Pharm.D., has been elected APhA President-Elect! 
mailto:tltucker@aeneas.net, P.O. Box 189, Huntingdon, TN 38344

Dick Gourley, Pharm.D., has been elected to the APhA Board of Trustees!
mailto:dgourley@utmem.edu, 847 Monroe Avenue, Suite 226, Memphis, TN 38163

UML Survey Ends Thursday, August 31

In June, TPA’s Continuum of Care Committee posted an online survey seeking the advice of pharmacists and other healthcare providers to guide the development of a Universal Medication List (UML) form for patient use in Tennessee.  The ultimate goal is to have an electronic system available to access the patient information needed for appropriate medication management across the continuum of care.  The last day to complete the survey is this Thursday, August 31, 2006. If you have not already done so, please read the letter located at  www.tnpharm.org/UML_SurveyInvitation.pdf and complete the survey by following the link provided.

BCBST Announces Annual Pharmacy Workshop Schedule (TPA username and password required)

SouthEastern College of Anticoagulation / Antithrombotic Providers (SECAPS) Annual Conference - Sept. 22-23 in Nashville (TPA username and password required)

The requirements for filing claims are very  specific, and providers must follow them to the letter in order to receive  funds.  Please read the Information and Instructions and follow them exactly. Note that the TPA website documents referenced in this message are not  password-protected. 

Four additional documents have been provided, three of which must be completed by pharmacies seeking reimbursement  and submitted to TPA no later than June 16, 2006 .  All of the  documents are available on the TPA website:

• "TennCare Proposal - Hurricane Katrina Uncompensated Care Pool (UCCP) As Amended on March 16, 2006" (PDF  document).  Please review this document prior to submitting your claims  information; submission not required.
• "Agreement Regarding Submissions for Hurricane Katrina Uncompensated Care Pool Plan" (PDF document).  Original signed hard copy must be submitted by mail or delivery service  to TPA, 500 Church Street, Suite 650, Nashville, TN 37219.
• "Claims Submission Worksheet" (MS Excel document).  Must be completed and submitted in electronic format via  e-mail to TPA's accountant, slightfoot@tnpharm.org.
• "Required Attestations for Each Individual Receiving Services" (PDF document).  Original signed hard copy(ies) must be submitted by mail or delivery service to TPA, 500 Church Street, Suite 650, Nashville, TN 37219.

The Centers for Medicare and Medicaid Services (CMS) has released a proposed regulation to implement a competitive bidding program for durable medical equipment(DME). TPA has reviewed information currently available on this important issue and has found the information produced by APhA to be succinct and easy to access and use. TPA is therefore providing the APhA information to members for your use in preparing your comments. TPA will be submitting comments to CMS on behalf of TPA members. If you have thoughts or comments you want to be certain are included in TPA's comments, please send them to mailto:tpa@tnpharm.org. Comments to CMS are due by June 30, 2006...  Complete information (TPA username and password required)

2.16.06

February NEWStream (TPA username and password required)

2.14.06

Update MedicareRx: "Transition Must Be Meaningful... and That Takes Time... and Engagement" (TPA username and password required)

Includes a discussion about transition issues, a CMS "Request for Medicare Prescription Drug Coverage Determination" form, as well as a Pharmacy Notice that can be posted in pharmacies and provided to pharmacists in lieu of individual notices from each plan, which would otherwise be required. Also covered are tips for smoother enrollments in March, questions-and-answers about co-branding and the Wellpoint POS process, a table that provides Part D coverage clarifications for specific products/drugs/drug categories, the extension of billing limits to 90 days, CCRx implementation of EFT, and CMMR's response to President Bush's comment that "it's not immoral to make sure that prescription drug pharmacists don't overcharge the system." Provides information for accessing all documents referenced.

2.3.06

Update MedicareRx, "Medicare Part D Mobile Office Tour in  Tennessee" (TPA username and password required)

Lists the dates and locations for Part D enrollment events being held  across the state, February 7 through February 10, 2006.   Also included are instructions for accessing a press release issued by HHS Secretary Leavitt yesterday, in which he commends  Tennessee's pharmacists.

2.2.06

TennCare: ICD-9 Code Prior Authorization Override

First Health disseminated two TennCare documents today: 1) a provider letter that describes a process effective March 1, 2006, for using ICD-9 codes for processing selected pharmacy claims, as well as other general information; and 2) "Appropriate Diagnosis for Prior Authorization Bypass" - a table of selected ICD-9 codes with a description of their diagnoses.

Regarding the new process described for using ICD-9 codes, be aware that potential problems exist with the fields identified by TennCare...   Complete article and links to the two documents (TPA username and password required)

2.2.06

Update MedicareRx: "Secretary Leavitt Visits Pharmacies... and Issues His Findings" (TPA Username and Password Required)

Includes link to 1-month progress report on the Medicare Prescription Drug Benefit and information about extension of the 30-day transitional coverage period for an additional 60 days.

2.1.06

CMS Conference Call Recording - New Information

On January 30, TPA sent members information from the Centers for Medicare and Medicaid Services (CMS) regarding conference calls held on January 31. CMS has provided updated information about how to access a recording of the second call... These calls provided specific information and tips about using the E1 and Point of Sale facilitated enrollment solutions. Complete article (TPA username and password required)

1.30.06

Update MedicareRx: "Tuesday, Jan. 31: Conference Calls on E1 & POS Facilitated Enrollment" (TPA Username and Password Required)

Also included in this issue is information about Pharmaceutical Company Patient Assistance Programs, how to assist beneficiaries with appeals, coverage determinations and exceptions, and Humana updates regarding their transition policy extension and automated eligibility verification system.

1.27.06

Deadline Extended for MidYear Hotel & Early Registration

1.26.06

Medicare Part D Formularies Available via Epocrates (TPA Username and Password Required)

1.26.06

Contact US Representatives on Budget Bill (TPA Username and Password Required)

1.25.06

January NEWStream (TPA Username and Password Required)

1.25.06

Important Information Regarding New TennCare Pharmacy Agreement

A number of TPA members have contacted the office regarding the new Pharmacy Participation Agreement that is being circulated by the Bureau of TennCare. Several of these inquiries have involved the new Conflict of Interest provision found at Section 10.9 and the new Lobbying provision found at Section 10.11.  Complete article (TPA Username and Password Required)

1.25.06

Revised CCRx Communication: 1) Beneficiary Letters, 2) MTM Program
--Clarification of Error in Jan. 24 Communication
(TPA username and password required)

1.23.06

CMS Conference Call: January 24, 2006 (TPA username and password required)

-- Medicare Part B drugs as it relates to Medicare Part D
-- Drugs excluded from coverage under Part D
-- Link to a summary of the issue, which may be used as a reference guide on Part B vs. Part D drugs for pharmacists

1.20.06

Take Action on Medicaid Cuts Today

The Tennessee Pharmacists Association has received information from the National Community Pharmacists Association (NCPA) regarding its Action Alert, "Take Action on Medicaid Cuts."  According to NCPA, "The U.S. House of Representatives will have one final vote on the Budget Reconciliation package which contains billions in cuts to  pharmacy reimbursement in Medicaid. Call your Representative's office today.  Updates, talking points and contact information are all part of our latest Action Alert [http://capwiz.com/ncpa/callalert/index.tt?alertid=8392491&type=CO]." To locate your Representative's contact information, please enter your zip code in the "Call Now" box that appears in the Action Alert.

1.20.06

Tim Tucker Represents Pharmacists in Washington Today

The Tennessee Pharmacists Association was contacted by the Tennessee Commission on Aging & Disability, about an opportunity for a pharmacist to testify today in a hearing in Washington, D.C., with Rep. Henry Waxman, to address the challenges faced by low-income consumers and pharmacists under Medicare Part D.

TPA is proud to announce that our own Tim Tucker, Pharm.D., was selected for this opportunity. TPA and APhA, in which Tim is an active member, were instrumental in arranging for him to represent pharmacists in this national arena. All national pharmacy organizations were contacted by TPA for their input. Read Dr. Tucker's testimony...

1.19.06

Improving Access to Health Info: Please Complete Survey

1.18.06

Update MedicareRx: "Addressing Implementation Issues" (TPA username and password required)

1.18.06

CDC: Don't Use Amantadine & Rimandatine for Flu this Year (TPA username and password required)

1.18.06

TennCare Safety Net: 1) Home Oxygen Program, 2) FQHC Success (TPA username and password required)

1.17.06

CMS Administrator Commits to Solving Problems (TPA username and password required)

1.17.06

TennCare:  Provider Disclosure Requirements Clarified

...when providers receive notification from MCCs requesting disclosure, it is not necessary to disclose membership dues paid to the Tennessee Pharmacists Association or contributions to the Tennessee PharmPAC or Tennessee Pharmacy Practice Preservation Fund (PPPF).  Complete article

1.12.06

URGENT! Information Needed for Katrina Reimbursement

Late yesterday, the Tennessee Pharmacists Association and other health care associations received a memo from J. D. Hickey, Deputy Commissioner, Bureau of TennCare, requesting information regarding uncompensated care costs for medically necessary services and supplies for Hurricane Katrina evacuees who did not have other coverage. This information was requested in November, however, the State has asked us to request it a second time. We apologize, but we must ask you to submit the requested information now, whether or not you did so in November.

View Mr. Hickey's memo here. Note that the State is asking for estimates of the NUMBER OF PERSONS (not number of prescriptions) and TOTAL COSTS. Please provide your pharmacy's numbers to date, whether or not they have changed from the information you submitted previously. Your data needs to be provided to TPA no later than 9:00 a.m. CST, Tuesday, January 17. TPA will compile the information from pharmacists and forward it to the State, which will then forward it to the Centers for Medicare and Medicaid Services (CMS). The intention is to effect some level of reimbursement to providers for these uncompensated care costs.

Please submit your information to communications@tnpharm.org, or fax it to 615-255-3528, by 9:00 a.m. CST, Tuesday, January 17. Thank you very much for your cooperation.

1.12.06

Medicare-TennCare Crossover Payments (TPA username and password required)

1.12.06

Update MedicareRx: "Pharmacy Support... Is Customer Support" (TPA username and password required)

Includes tips from NDCHealth (now Per-Se Technologies) to help pharmacists optimize their use of the E1 enrollment query

1.10.06

Live CMS Conference Call for Pharmacy TODAY (TPA username and password required)

1.9.06

Update MedicareRx: "Providing Solutions and Moving Forward"

Details the improvements made by the Centers for Medicare and Medicaid Services (CMS) in response to the problems that have arisen during Medicare Part D implementation. Several documents are referenced, which are available for download on the Medicare News page.  (TPA username and password required)

1.9.06

CMS Tells Part D Plans:  Fix Transition Problems

...Centers for Medicare and Medicaid Services (CMS)...has sent a memo to all plan sponsors, emphasizing the necessity of their upholding transition  policy requirements to ensure that "enrolled beneficiaries get their needed first prescriptions filled at the point of sale."  Complete article includes links to CMS memo to plans and CCRx 1/8/06 Daily Update. (TPA username and password required)

1.6.06

CCRx Makes Progress with Part D Problems

Includes links to today's CCRx Daily Update, ID Request Form, and Transition Request Form. (TPA username and password required)

1.6.06

Medicare Part D: 1) CMS Phone Help Goes 24/7  2) MTM Contact List (TPA username and password required)

1.5.06

Synopsis of Medicare Part D Conference Call

Includes CMS e-mail address for pharmacists' use in reporting problems and asking questions. (TPA username and password required) 

1.5.06

Update MedicareRx: "Conference Call TODAY" (TPA username and password required)

1.4.06

Medicare Part D Problems

Not surprisingly, pharmacists are experiencing a multitude of problems as a result of Medicare Part D implementation. Many members have called the Tennessee Pharmacists Association to report these problems, and TPA is working with the Centers for Medicare and Medicaid Services (CMS) to resolve them. The problems we are aware of are shown below... Complete article (TPA username and password required)

1.3.06

Stolen Rx Pads (TPA username and password required)

ALSO VISIT:
News at a Glance - Current
News at a Glance - 2007
News at a Glance - 2005
News at a Glance - 2004