RE: CVS delay filling immunos with Medicare B?

[Guest guest]

I run into the same problem last week with CVS and It was taking so long that we gave up and I end up enrolling the pt. in Caremark. No idea why this is happening. AyabarrenoFinancial CoordinatorHartford Hospital Transplant Program80 Seymour Street - Suite 321Hartford, CT 06102Email: Mayabar@...Tele# Fax# >>> "Battin, Daryl J." 9/8/2010 11:26 AM >>> Has anyone else run into this recently? CVS has a new (at least new to the pharmacies I am working with) form that we have to complete for patients to have immunos covered by Medicare B – form not a problem to complete (date of tx, discharge date, type of transplant, etc, etc) BUT the problem I am running into is that CVS is saying it is taking a few days to get the Medicare B coverage approved by Medicare so they are delaying filling the meds. Yes, I am able to get a few days supply (if the patient or the pharmacy calls me to tell me about the delay ....) while awaiting the Medicare okay. I then need to keep checking with the CVS to make sure all set so the patient can get his/her month’s supply of meds ..... Anyone else running into this? If yes, any suggestions on ways to expedite the process with Medicare so that CVS will fill the full prescription???Ms. Daryl Battin, MSW/LICSWFinancial Coordinator/Social WorkerDepartment of Transplantation Lahey Clinic, 41 Mall Road, Burlington MA 01805Ph: Page: FAX: Q Please consider the environment before printing this email See our web page at http://www.lahey.org for a full directory of Lahey sites, staff, services and career opportunities.THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS ADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records.

Attachment: vcard [not shown]

[Guest guest]

As least you had that option – I ran

into this yesterday and the patient went 3 days without immunos. This

patient has Medicare primary and Medicaid secondary so we had to wait for the

Medicare B to be approved for paying for immunos.

I don’t know if Medicare is trying

to become more clear that the patient did have Medicare at the time of the

transplant and if Medicare is primary or secondary.

Interestingly one of the questions on the

form from CVS asks “did Medicare pay for the transplant?”

There will be cases when a patient had commercial insurance and Medicare A at

the time of the transplant and there was no payment from Medicare – but

now Medicare primary. I wonder what Medicare will do with that

information???

Ms. Daryl

Battin, MSW/LICSW

Financial

Coordinator/Social Worker

Department of

Transplantation

Lahey Clinic, 41 Mall Road, Burlington

MA 01805

Ph:

Page:

FAX:

Q Please consider the environment before printing this email

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Ayabarreno

Sent: Wednesday, September 08, 2010

11:32 AM

To: TxFinancialCoordinators

Subject: Re:

CVS delay filling immunos withMedicare B?

Importance: Low

I run into the

same problem last week with CVS and It was taking so long that we gave up and I

end up enrolling the pt. in Caremark. No idea why this is happening.

Ayabarreno

Financial Coordinator

Hartford Hospital

Transplant Program

80 Seymour Street

- Suite 321

Hartford, CT

06102

Email: Mayabar@...

Tele#

Fax#

>>> " Battin, Daryl J. "

9/8/2010 11:26 AM >>>

Has anyone else run into this recently? CVS has a new

(at least new to the pharmacies I am working with) form that we have to

complete for patients to have immunos covered by Medicare B – form not a

problem to complete (date of tx, discharge date, type of transplant, etc, etc) BUT the problem I am running into is that

CVS is saying it is taking a few days to get

the Medicare B coverage approved by Medicare so they are delaying filling the

meds. Yes, I am able to get a few days supply (if the patient

or the pharmacy calls me to tell me about the delay ....) while awaiting the

Medicare okay. I then need to keep checking with the CVS to make sure all

set so the patient can get his/her month’s supply of meds .....

Anyone else running into this? If yes, any

suggestions on ways to expedite the process with Medicare so that CVS will fill

the full prescription???

Ms. Daryl Battin, MSW/LICSW

Financial Coordinator/Social Worker

Department of Transplantation

Lahey Clinic, 41 Mall Road, Burlington

MA 01805

Ph:

Page:

FAX:

Q Please consider the environment before printing this email

See

our web page at http://www.lahey.org for a full directory of Lahey sites,

staff, services and career opportunities.

THIS

MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS ADDRESSED. IT MAY

CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE

UNDER APPLICABLE LAW. If you are not the intended recipient, your use of this

message for any purpose is strictly prohibited. If you have received this

communication in error, please delete the message and notify the sender so that

we may correct our records.

[Guest guest]

Frustrating! As we know, the real questions are: 1) was pt a beneficiary at time of transplant (includes retroactive eligibility) and 2) did transplant take place at a Medicare-approved facility. I wonder if CVS' misstatement of the questions is slowing Medicare's ability to make what should be an easy determination?

-----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Battin, Daryl J.Sent: Wednesday, September 08, 2010 8:55 AMTo: TxFinancialCoordinators Subject: RE: CVS delay filling immunos with Medicare B?

As least you had that option – I ran into this yesterday and the patient went 3 days without immunos. This patient has Medicare primary and Medicaid secondary so we had to wait for the Medicare B to be approved for paying for immunos.

I don’t know if Medicare is trying to become more clear that the patient did have Medicare at the time of the transplant and if Medicare is primary or secondary.

Interestingly one of the questions on the form from CVS asks “did Medicare pay for the transplant?” There will be cases when a patient had commercial insurance and Medicare A at the time of the transplant and there was no payment from Medicare – but now Medicare primary. I wonder what Medicare will do with that information???

Ms. Daryl Battin, MSW/LICSW

Financial Coordinator/Social Worker

Department of Transplantation

Lahey Clinic, 41 Mall Road, Burlington MA 01805

Ph:

Page:

FAX:

Q Please consider the environment before printing this email

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of AyabarrenoSent: Wednesday, September 08, 2010 11:32 AMTo: TxFinancialCoordinators Subject: Re: CVS delay filling immunos withMedicare B?Importance: Low

I run into the same problem last week with CVS and It was taking so long that we gave up and I end up enrolling the pt. in Caremark. No idea why this is happening.

AyabarrenoFinancial CoordinatorHartford Hospital Transplant Program80 Seymour Street - Suite 321Hartford, CT 06102Email: Mayabar@...Tele# Fax# >>> "Battin, Daryl J." 9/8/2010 11:26 AM >>>

Has anyone else run into this recently? CVS has a new (at least new to the pharmacies I am working with) form that we have to complete for patients to have immunos covered by Medicare B – form not a problem to complete (date of tx, discharge date, type of transplant, etc, etc) BUT the problem I am running into is that CVS is saying it is taking a few days to get the Medicare B coverage approved by Medicare so they are delaying filling the meds. Yes, I am able to get a few days supply (if the patient or the pharmacy calls me to tell me about the delay ....) while awaiting the Medicare okay. I then need to keep checking with the CVS to make sure all set so the patient can get his/her month’s supply of meds .....

Anyone else running into this? If yes, any suggestions on ways to expedite the process with Medicare so that CVS will fill the full prescription???

Ms. Daryl Battin, MSW/LICSW

Financial Coordinator/Social Worker

Department of Transplantation

Lahey Clinic, 41 Mall Road, Burlington MA 01805

Ph:

Page:

FAX:

Q Please consider the environment before printing this email

See our web page at http://www.lahey.org for a full directory of Lahey sites, staff, services and career opportunities.

THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS ADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records.

[Guest guest]

Although I have not experienced difficulties for new transplant recipients

receiving their meds from CVS yet, is the form that they are requesting

information the DMERC Information Form: Immunosuppressant Drugs? If so many

providers ask for this form at the beginning of the medication regiment. My

question is if CVS is delaying filling the meds why not just go to another

provider? Their delay should be some one else's gain.

Julius C. Eason

Transplant Financial Coordinator

Multi-Organ Transplant

Beaumont Hosp., Royal Oak

(P) , (F)

jeason@...

>>> " Battin, Daryl J. " 9/8/2010 11:54 AM >>>

As least you had that option - I ran into this yesterday and the patient

went 3 days without immunos. This patient has Medicare primary and

Medicaid secondary so we had to wait for the Medicare B to be approved

for paying for immunos.

I don't know if Medicare is trying to become more clear that the patient

did have Medicare at the time of the transplant and if Medicare is

primary or secondary.

Interestingly one of the questions on the form from CVS asks " did

Medicare pay for the transplant? " There will be cases when a patient

had commercial insurance and Medicare A at the time of the transplant

and there was no payment from Medicare - but now Medicare primary. I

wonder what Medicare will do with that information???

Ms. Daryl Battin, MSW/LICSW

Financial Coordinator/Social Worker

Department of Transplantation

Lahey Clinic, 41 Mall Road, Burlington MA 01805

Ph:

Page:

FAX:

Q Please consider the environment before printing this email

________________________________

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of

Ayabarreno

Sent: Wednesday, September 08, 2010 11:32 AM

To: TxFinancialCoordinators

Subject: Re: CVS delay filling immunos

withMedicare B?

Importance: Low

I run into the same problem last week with CVS and It was taking so long

that we gave up and I end up enrolling the pt. in Caremark. No idea why

this is happening.

Ayabarreno

Financial Coordinator

Hartford Hospital

Transplant Program

80 Seymour Street - Suite 321

Hartford, CT 06102

Email: Mayabar@...

Tele#

Fax#

>>> " Battin, Daryl J. " 9/8/2010 11:26 AM >>>

Has anyone else run into this recently? CVS has a new (at least new to

the pharmacies I am working with) form that we have to complete for

patients to have immunos covered by Medicare B - form not a problem to

complete (date of tx, discharge date, type of transplant, etc, etc) BUT

the problem I am running into is that CVS is saying it is taking a few

days to get the Medicare B coverage approved by Medicare so they are

delaying filling the meds. Yes, I am able to get a few days supply (if

the patient or the pharmacy calls me to tell me about the delay ....)

while awaiting the Medicare okay. I then need to keep checking with the

CVS to make sure all set so the patient can get his/her month's supply

of meds .....

Anyone else running into this? If yes, any suggestions on ways to

expedite the process with Medicare so that CVS will fill the full

prescription???

Ms. Daryl Battin, MSW/LICSW

Financial Coordinator/Social Worker

Department of Transplantation

Lahey Clinic, 41 Mall Road, Burlington MA 01805

Ph:

Page:

FAX:

Q Please consider the environment before printing this email

See our web page at http://www.lahey.org for a full directory of Lahey

sites, staff, services and career opportunities.

THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS

ADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL

AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not the

intended recipient, your use of this message for any purpose is strictly

prohibited. If you have received this communication in error, please

delete the message and notify the sender so that we may correct our

records.

[Guest guest]

Julius,And thats exactly what I did!>>> "Julius Eason" 9/8/2010 1:45 PM >>> Although I have not experienced difficulties for new transplant recipients receiving their meds from CVS yet, is the form that they are requesting information the DMERC Information Form: Immunosuppressant Drugs? If so many providers ask for this form at the beginning of the medication regiment. My question is if CVS is delaying filling the meds why not just go to another provider? Their delay should be some one else's gain. Julius C. EasonTransplant Financial CoordinatorMulti-Organ Transplant Beaumont Hosp., Royal Oak(P) , (F) jeason@...>>> "Battin, Daryl J." 9/8/2010 11:54 AM >>>As least you had that option - I ran into this yesterday and the patientwent 3 days without immunos. This patient has Medicare primary andMedicaid secondary so we had to wait for the Medicare B to be approvedfor paying for immunos.I don't know if Medicare is trying to become more clear that the patientdid have Medicare at the time of the transplant and if Medicare isprimary or secondary.Interestingly one of the questions on the form from CVS asks "didMedicare pay for the transplant?" There will be cases when a patienthad commercial insurance and Medicare A at the time of the transplantand there was no payment from Medicare - but now Medicare primary. Iwonder what Medicare will do with that information???Ms. Daryl Battin, MSW/LICSWFinancial Coordinator/Social WorkerDepartment of Transplantation Lahey Clinic, 41 Mall Road, Burlington MA 01805Ph: Page: FAX: Q Please consider the environment before printing this email ________________________________From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of AyabarrenoSent: Wednesday, September 08, 2010 11:32 AMTo: TxFinancialCoordinators Subject: Re: CVS delay filling immunoswithMedicare B?Importance: LowI run into the same problem last week with CVS and It was taking so longthat we gave up and I end up enrolling the pt. in Caremark. No idea whythis is happening. AyabarrenoFinancial CoordinatorHartford Hospital Transplant Program80 Seymour Street - Suite 321Hartford, CT 06102Email: Mayabar@... Tele# Fax# >>> "Battin, Daryl J." 9/8/2010 11:26 AM >>>Has anyone else run into this recently? CVS has a new (at least new tothe pharmacies I am working with) form that we have to complete forpatients to have immunos covered by Medicare B - form not a problem tocomplete (date of tx, discharge date, type of transplant, etc, etc) BUTthe problem I am running into is that CVS is saying it is taking a fewdays to get the Medicare B coverage approved by Medicare so they aredelaying filling the meds. Yes, I am able to get a few days supply (ifthe patient or the pharmacy calls me to tell me about the delay ....)while awaiting the Medicare okay. I then need to keep checking with theCVS to make sure all set so the patient can get his/her month's supplyof meds ..... Anyone else running into this? If yes, any suggestions on ways toexpedite the process with Medicare so that CVS will fill the fullprescription???Ms. Daryl Battin, MSW/LICSWFinancial Coordinator/Social WorkerDepartment of Transplantation Lahey Clinic, 41 Mall Road, Burlington MA 01805Ph: Page: FAX: Q Please consider the environment before printing this email See our web page at http://www.lahey.org for a full directory of Laheysites, staff, services and career opportunities. THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT ISADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIALAND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not theintended recipient, your use of this message for any purpose is strictlyprohibited. If you have received this communication in error, pleasedelete the message and notify the sender so that we may correct ourrecords.

[Guest guest]

As someone who previously worked in a specialty pharmacy- they probably need the form filled out b/c they aren't getting paid from Medicare b/c they didnt ask for that form previously and they're losing money on everything they fill. So they have to have the form filled out and send it to the company who processes claims for Medicare which understandably takes a few days. Also, regular CVS pharmacy's have very few transplant patients so they may not know how to handle the billing properly. You did the best thing for the patient and sent them to Caremark (which by the way is still CVS- they are the same company).

Maybe this helps a bit!

Leah Knowles,TFC

CMC

Subject: RE: CVS delay filling immunos with Medicare B?To: TxFinancialCoordinators Date: Wednesday, September 8, 2010, 2:42 PM

Julius,

And thats exactly what I did!>>> "Julius Eason" 9/8/2010 1:45 PM >>>

Although I have not experienced difficulties for new transplant recipients receiving their meds from CVS yet, is the form that they are requesting information the DMERC Information Form: Immunosuppressant Drugs? If so many providers ask for this form at the beginning of the medication regiment. My question is if CVS is delaying filling the meds why not just go to another provider? Their delay should be some one else's gain. Julius C. EasonTransplant Financial CoordinatorMulti-Organ Transplant Beaumont Hosp., Royal Oak(P) , (F) jeason@...>>> "Battin, Daryl J." 9/8/2010 11:54 AM >>>As least you had that option - I ran into this yesterday and the patientwent 3 days without immunos. This patient has Medicare primary andMedicaid secondary so we had to wait for the Medicare B to be approvedfor paying for immunos.I don't know if Medicare is trying to become more clear that the patientdid have Medicare at the time of the transplant and if Medicare isprimary or secondary.Interestingly one of the questions on the form from CVS asks "didMedicare pay for the transplant?" There will be cases when a patienthad commercial insurance and Medicare A at the time of the transplantand there was no payment from Medicare - but now Medicare primary. Iwonder what Medicare will do with that information???Ms. Daryl Battin, MSW/LICSWFinancial Coordinator/Social

WorkerDepartment of Transplantation Lahey Clinic, 41 Mall Road, Burlington MA 01805Ph: Page: FAX: Q Please consider the environment before printing this email ________________________________From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of AyabarrenoSent: Wednesday, September 08, 2010 11:32 AMTo: TxFinancialCoordinators Subject: Re: CVS delay filling immunoswithMedicare B?Importance: LowI run into the same problem last week with CVS and It was taking so longthat we gave up and I end up enrolling the pt. in Caremark. No idea whythis is happening. AyabarrenoFinancial CoordinatorHartford Hospital Transplant Program80 Seymour Street - Suite 321Hartford, CT 06102Email: Mayabar@... Tele# Fax# >>> "Battin, Daryl J." 9/8/2010 11:26 AM >>>Has anyone else run into this recently? CVS has a new (at least new tothe pharmacies I am working with) form that we have to complete forpatients to have immunos covered by Medicare B - form not a problem tocomplete (date of tx, discharge date, type of transplant, etc, etc) BUTthe problem I am running into is that CVS is saying it is taking a fewdays to get the Medicare B coverage approved by Medicare so they aredelaying filling the meds. Yes, I am able to get a few days supply (ifthe patient or the pharmacy calls me to tell me about the delay ....)while awaiting the Medicare okay. I then need to keep checking with theCVS to make sure all set so the patient can get his/her month's supplyof meds ..... Anyone else running into this? If yes, any suggestions on ways toexpedite the process

with Medicare so that CVS will fill the fullprescription???Ms. Daryl Battin, MSW/LICSWFinancial Coordinator/Social WorkerDepartment of Transplantation Lahey Clinic, 41 Mall Road, Burlington MA 01805Ph: Page: FAX: Q Please consider the environment before printing this email See our web page at http://www.lahey.org for a full directory of Laheysites, staff, services and career opportunities. THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT ISADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIALAND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not theintended recipient, your use of this message for any purpose is strictlyprohibited. If you have received this communication in error, pleasedelete the message and

notify the sender so that we may correct ourrecords.

[Guest guest]

But some plans require that you use that particular pharmacy. My own personal plan requires I use CVS/Caremark or I pay a hefty premium on top of the copay. And you can't wait but so long for the mail order delivery if it's immunos. We have another plan in town that requires they use a local grocery store chain pharmacy only and they have no mail order.

Ruth

Ruth Wilhelm Financial Coordinator/Business Manager The Virginia Transplant Center Henrico Doctors' Hospital Richmond, VA phone fax Ruth.Wilhelm@... Treasurer, Transplant Financial Coordinators Association

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of lmk_276@...Sent: Wednesday, September 08, 2010 3:01 PMTo: TxFinancialCoordinators Subject: RE: CVS delay filling immunos with Medicare B?

As someone who previously worked in a specialty pharmacy- they probably need the form filled out b/c they aren't getting paid from Medicare b/c they didnt ask for that form previously and they're losing money on everything they fill. So they have to have the form filled out and send it to the company who processes claims for Medicare which understandably takes a few days. Also, regular CVS pharmacy's have very few transplant patients so they may not know how to handle the billing properly. You did the best thing for the patient and sent them to Caremark (which by the way is still CVS- they are the same company).

Maybe this helps a bit!

Leah Knowles,TFC

CMC

Subject: RE: CVS delay filling immunos with Medicare B?To: TxFinancialCoordinators Date: Wednesday, September 8, 2010, 2:42 PM

Julius,

And thats exactly what I did!>>> "Julius Eason" 9/8/2010 1:45 PM >>>

Although I have not experienced difficulties for new transplant recipients receiving their meds from CVS yet, is the form that they are requesting information the DMERC Information Form: Immunosuppressant Drugs? If so many providers ask for this form at the beginning of the medication regiment. My question is if CVS is delaying filling the meds why not just go to another provider? Their delay should be some one else's gain. Julius C. EasonTransplant Financial CoordinatorMulti-Organ Transplant Beaumont Hosp., Royal Oak(P) , (F) jeason@...>>> "Battin, Daryl J." 9/8/2010 11:54 AM >>>As least you had that option - I ran into this yesterday and the patientwent 3 days without immunos. This patient has Medicare primary andMedicaid secondary so we had to wait for the Medicare B to be approvedfor paying for immunos.I don't know if Medicare is trying to become more clear that the patientdid have Medicare at the time of the transplant and if Medicare isprimary or secondary.Interestingly one of the questions on the form from CVS asks "didMedicare pay for the transplant?" There will be cases when a patienthad commercial insurance and Medicare A at the time of the transplantand there was no payment from Medicare - but now Medicare primary. Iwonder what Medicare will do with that information???Ms. Daryl Battin, MSW/LICSWFinancial Coordinator/Social WorkerDepartment of Transplantation Lahey Clinic, 41 Mall Road, Burlington MA 01805Ph: Page: FAX: Q Please consider the environment before printing this email ________________________________From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of AyabarrenoSent: Wednesday, September 08, 2010 11:32 AMTo: TxFinancialCoordinators Subject: Re: CVS delay filling immunoswithMedicare B?Importance: LowI run into the same problem last week with CVS and It was taking so longthat we gave up and I end up enrolling the pt. in Caremark. No idea whythis is happening. AyabarrenoFinancial CoordinatorHartford Hospital Transplant Program80 Seymour Street - Suite 321Hartford, CT 06102Email: Mayabar@... Tele# Fax# >>> "Battin, Daryl J." 9/8/2010 11:26 AM >>>Has anyone else run into this recently? CVS has a new (at least new tothe pharmacies I am working with) form that we have to complete forpatients to have immunos covered by Medicare B - form not a problem tocomplete (date of tx, discharge date, type of transplant, etc, etc) BUTthe problem I am running into is that CVS is saying it is taking a fewdays to get the Medicare B coverage approved by Medicare so they aredelaying filling the meds. Yes, I am able to get a few days supply (ifthe patient or the pharmacy calls me to tell me about the delay ....)while awaiting the Medicare okay. I then need to keep checking with theCVS to make sure all set so the patient can get his/her month's supplyof meds ..... Anyone else running into this? If yes, any suggestions on ways toexpedite the process with Medicare so that CVS will fill the fullprescription???Ms. Daryl Battin, MSW/LICSWFinancial Coordinator/Social WorkerDepartment of Transplantation Lahey Clinic, 41 Mall Road, Burlington MA 01805Ph: Page: FAX: Q Please consider the environment before printing this email See our web page at http://www.lahey.org for a full directory of Laheysites, staff, services and career opportunities. THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT ISADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIALAND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not theintended recipient, your use of this message for any purpose is strictlyprohibited. If you have received this communication in error, pleasedelete the message and notify the sender so that we may correct ourrecords.

[Guest guest]

Has anyone had any issues with pharmacies requiring any written documentation from providers, in addition to the completed DMERC information form? The DMERC information form has to be completed by the billing entity, but typically, the ordering provider has

to complete the written order.

Fox-

Reimbursement Manager

Clarian Health

From: TxFinancialCoordinators [TxFinancialCoordinators ] On Behalf Of Ruth.Wilhelm@... [Ruth.Wilhelm@...]

Sent: Wednesday, September 08, 2010 1:33 PM

To: TxFinancialCoordinators

Subject: RE: CVS delay filling immunos with Medicare B?

But some plans require that you use that particular pharmacy. My own personal plan requires I use CVS/Caremark or I pay a hefty premium on top of the copay. And you can't wait but so long for

the mail order delivery if it's immunos. We have another plan in town that requires they use a local grocery store chain pharmacy only and they have no mail order.

Ruth

Ruth Wilhelm

Financial Coordinator/Business Manager

The Virginia Transplant Center

Henrico Doctors' Hospital

Richmond, VA

phone

fax

Ruth.Wilhelm@...

Treasurer, Transplant Financial Coordinators Association

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]

On Behalf Of lmk_276@...

Sent: Wednesday, September 08, 2010 3:01 PM

To: TxFinancialCoordinators

Subject: RE: CVS delay filling immunos with Medicare B?

As someone who previously worked in a specialty pharmacy- they probably need the form filled out b/c they aren't getting paid from Medicare b/c

they didnt ask for that form previously and they're losing money on everything they fill. So they have to have the form filled out and send it to the company who processes claims for Medicare which understandably takes a few days. Also, regular CVS pharmacy's

have very few transplant patients so they may not know how to handle the billing properly. You did the best thing for the patient and sent them to Caremark (which by the way is still CVS- they are the same company).

Maybe this helps a bit!

Leah Knowles,TFC

CMC

Subject: RE: CVS delay filling immunos with Medicare B?

To: TxFinancialCoordinators

Date: Wednesday, September 8, 2010, 2:42 PM

Julius,

And thats exactly what I did!

>>> " Julius Eason " 9/8/2010 1:45 PM >>>

Although I have not experienced difficulties for new transplant recipients receiving their meds from CVS yet, is the form that they are requesting information the DMERC Information Form: Immunosuppressant Drugs? If so many providers ask for this form at

the beginning of the medication regiment. My question is if CVS is delaying filling the meds why not just go to another provider? Their delay should be some one else's gain.

Julius C. Eason

Transplant Financial Coordinator

Multi-Organ Transplant

Beaumont Hosp., Royal Oak

(P) , (F)

jeason@...

>>> " Battin, Daryl J. " 9/8/2010 11:54 AM >>>

As least you had that option - I ran into this yesterday and the patient

went 3 days without immunos. This patient has Medicare primary and

Medicaid secondary so we had to wait for the Medicare B to be approved

for paying for immunos.

I don't know if Medicare is trying to become more clear that the patient

did have Medicare at the time of the transplant and if Medicare is

primary or secondary.

Interestingly one of the questions on the form from CVS asks " did

Medicare pay for the transplant? " There will be cases when a patient

had commercial insurance and Medicare A at the time of the transplant

and there was no payment from Medicare - but now Medicare primary. I

wonder what Medicare will do with that information???

Ms. Daryl Battin, MSW/LICSW

Financial Coordinator/Social Worker

Department of Transplantation

Lahey Clinic, 41 Mall Road, Burlington MA 01805

Ph:

Page:

FAX:

Q Please consider the environment before printing this email

________________________________

From:

TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of

Ayabarreno

Sent: Wednesday, September 08, 2010 11:32 AM

To:

TxFinancialCoordinators

Subject: Re: CVS delay filling immunos

withMedicare B?

Importance: Low

I run into the same problem last week with CVS and It was taking so long

that we gave up and I end up enrolling the pt. in Caremark. No idea why

this is happening.

Ayabarreno

Financial Coordinator

Hartford Hospital

Transplant Program

80 Seymour Street - Suite 321

Hartford, CT 06102

Email:

Mayabar@...

Tele#

Fax#

>>> " Battin, Daryl J. " 9/8/2010 11:26 AM >>>

Has anyone else run into this recently? CVS has a new (at least new to

the pharmacies I am working with) form that we have to complete for

patients to have immunos covered by Medicare B - form not a problem to

complete (date of tx, discharge date, type of transplant, etc, etc) BUT

the problem I am running into is that CVS is saying it is taking a few

days to get the Medicare B coverage approved by Medicare so they are

delaying filling the meds. Yes, I am able to get a few days supply (if

the patient or the pharmacy calls me to tell me about the delay ....)

while awaiting the Medicare okay. I then need to keep checking with the

CVS to make sure all set so the patient can get his/her month's supply

of meds .....

Anyone else running into this? If yes, any suggestions on ways to

expedite the process with Medicare so that CVS will fill the full

prescription???

Ms. Daryl Battin, MSW/LICSW

Financial Coordinator/Social Worker

Department of Transplantation

Lahey Clinic, 41 Mall Road, Burlington MA 01805

Ph:

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