VA Pharmacy Benefit Program for Job Injured Employees (First Script) By: Office of...
-
Upload
allan-pearson -
Category
Documents
-
view
216 -
download
0
Transcript of VA Pharmacy Benefit Program for Job Injured Employees (First Script) By: Office of...
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.
2
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
3
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
5
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.
6
7
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.
8
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
9
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
staff10
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
11
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
12
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 [email protected]
Account ManagerCara [email protected]
Director of Account Management Susan [email protected]
15