November 20, 2020 ncpharmacists.org
E-News ENews Advancing Pharmacy. Improving Health.
General News
• PHP Provider Manual updates • Key dates for transitioning to Medicaid Managed Care
Medicaid Managed Care Update Published
NC DHHS Submits COVID-19 Vaccination Plan to the CDC
An update was published, November 17th, in the NC Medicaid Bulletin providing information on North Carolina’s transition to Medicaid Managed Care. On July 1, 2021, an estimated 1.6 to 1.8 million Medicaid and NC Health Choice beneficiaries will transition to Medicaid Managed Care. Beneficiaries will be able to choose from five Prepaid Health Plans (PHPs) or the Eastern Band of Cherokee Indians (EBCI) Tribal Option. Some beneficiaries will stay in fee-for-service known as NC Medicaid Direct. This provider update includes:
In October, North Carolina submitted its COVID-19 Vaccination plan to the Centers for Disease Control and Prevention. The goal of the plan is to immunize everyone who is eligible for and wants a COVID-19 immunization. The NC plan reflects five principles that will guide our state’s planning for and distribution of one or more COVID-19 vaccines. The five principles are:
• Links to sign up for one webinar series specifically for Medicaid Managed Care going live on July 1, 2021, and another that focuses on Quality and Performance on clinical criteria • How to ensure provider information displays correctly in NC’s Provider Directory Tool • Provider Ombudsman contact information
1. All North Carolinians have equitable access to vaccines. 2. Vaccine planning and distribution is inclusive; actively engages state and local government, public and private partners; and draws upon the experience and expertise of leaders from historically marginalized populations. 3. Transparent, accurate and frequent public communications is essential to building trust. 4. Data is used to promote equity, track progress and guide decision-making.
5. Appropriate stewardship of resources and continuous evaluation and improvement drive successful implementation.
The full plan as submitted to the CDC can be accessed here, and the table outlining the phases for immunizing prioritized populations can be found on pages 6467 of the plan.
NCAP Gathers NC Evidence of PBM Unfair Business Practices
NCAP is collecting evidence showcasing unfair PBM practices, such as, clawbacks (DIR fees), patient steering, unfair audits, forced mail order, and low or below cost reimbursement. You should be able to do this from your cell phone by taking a picture and uploading it or you can upload a PDF. PLEASE remove any patient identifiers before uploading and include the name of the PBM if able. We know that some PBMs have retaliated against pharmacies that have spoken out against what PBMs are doing; and others of you are hesitant because often network contracts forbid disclosing details. NCAP will keep your information confidential and share only the examples of the types of unfair practices occurring in
NCAP E-News November 20, 2020 Page 1