VA Pharmacy Benefit Program for Job Injured Employees

(First Script)

By: Office of Administration/Office of Occupational Safety and Health July 15, 2010

VA Pharmacy Benefit Program(First Script )

• First Script is a pharmacy benefit management (PBM)

system designed exclusively for the workers’

compensation program.

• First Script is a voluntary program which represents a

new benefit for the injured worker that provides a more

efficient way to obtain prescriptions for their work related

injuries.

• First Script provides a nationwide network of pharmacies

as well as a mail order program.

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Current Prescription ProcessEmployee experiences traumatic injury – obtains

prescription from doctorEmployee takes prescription to retail pharmacyFirst fill - employee pays out-of-pocket

Claim accepted – employee submits claim for reimbursement

Claim denied – employee absorbs costRecurring Prescriptions – requires OWCP

authorization – filled only at a retail pharmacyExceptions require pharmacy phone call to OWCP

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First Script Prescription Card ProcessEmployee experiences traumatic injury – obtains

prescription from doctor – Takes prescription and temporary prescription drug

card or First Script Help Line telephone number to choice of pharmacy

First Fill – no out of pocket costs for the injured employee, First Script pays pharmacy directlyClaim accepted – First Script bills OWCP electronicallyClaim denied – First Script absorbs the cost

Recurring Prescriptions – Fill at First Script’s Retail Pharmacy Network or by

Mail Order Program 4

First Script Enrollment ProcessFirst Script Enrollment ProcessIdentify eligible claims based on our VA/OWCP

dataEligible claimants will receive by mail:

Postcard announcing the program Injured worker communication kitPersonalized prescription benefit card

First Script invoices electronicallyAlready an enrolled providerOnline eligibility check via ACS

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First Script’s Enrollment Process(Continued)

For employees who suffer traumatic injuries temporary prescription drug cards will be available at the facility where the accident occurred and provided to the employee

If an employee suffers an occupational illness, a personalized prescription card will be mailed to the employee once the claim has been accepted by OWCP.

Periodic Roll Claimants will have the option to receive their prescriptions by mail order.

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Instructions: Prescription Drug Card CA-1VA injured workers who file a CA-1 for traumatic injury will

take the First Script initial prescription drug card to their pharmacy with their prescription.

Or VA injured workers may take their prescription and the dedicated First Script number 1-877-203-8966, to their pharmacy.

A list of network pharmacies is included on the initial prescription drug card or pharmacies can be located by zip code at www.firstscript.com.

Personalized prescription cards will be mailed to the injured worker when the claim has been accepted by OWCP.

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Program SafeguardsPharmacy card only valid for medications

prescribed for a work-related injuryControlled enrollment based on VA/OWCP data

Only injured worker with an approved claim receives personalized card by mail

Enrollments are terminated if a valid claim number is not identified within 60 days (First Script absorbs cost of prescriptions filled during this time frame)

Pharmacy requires photo ID to pick up prescriptions

Card expires if claim is closed or there is no prescription activity for 3 months

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Program BenefitsReduction in number of claims for

reimbursement – reduces VA administrative workload

First Script pays pharmacy direct – no provider pay issues

First Script absorbs cost of denied claimsElectronic billing – more cost efficient, more

accurate

First Script Help Desk resolves processing

issues reducing calls from pharmacies to VA

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Program Benefits (continued)

Easy access to obtain medication during

acute phase – 62,000 pharmacies nationwide

No out of pocket cost for injured employee,

including first prescription fills:

No cash flow issue for injured worker

Promotes compliance with physician orders

Mail order option available

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Program Benefits(continued)

Reduction in medical costs on VA ChargebackPrescription Drug costs to VA totaled $12 million in

FY 2008First Script savings average 10-15% nationwide

Increased savings with increased participationFirst Script implemented at no cost to the VAIncreased Employee Satisfaction

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First Script Implementation First Script initial enrollment begins– 8/16

VA injured workers take the First Script temporary prescription card sheet to their pharmacy with their work related prescription

Or VA injured workers may take their prescriptions and the dedicated First Script number 1-877-203-8966 to their pharmacy

Announcement Post Card mailed to eligible VA injured workers on 8/25

First Script Implementation8/26 & 8/27 First Script personalized prescription card

mailed to all eligible VA injured workersVA injured workers will call First Script to activate their

cardFirst Script will capture the employee’s choice of

pharmacy First Script will ensure the pharmacy has billing

informationUpon receipt of the First Script Pharmacy Card the VA

injured workers my receive their work related prescriptions through First Script with no out of pocket expense.

First Script Contact List:24/7 Toll Free Number1-877-203-8966VA Call Center Manager

Jeanne Johnson520-434-5355jdjohnson@cvty.com

Account ManagerCara Williams520-202-1259cbwilliams@cvty.com

Director of Account Management Susan Keating520-202-1226smkeating@cvty.com

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Contact Information

Danna CorbellProgram Manager

danna.corbell@va.gov

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