Cvs overriding DURs

[luckyrx]

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Hello, I'm an intern at CVS in CA. I was wondering how do I resolve DUR 88 rejections particularly from MediCal? I don't know which field to enter under "Additional information"

Also, can you provide info on how to initiate a tar e.g. Abilify

Thank you for your help and much appreciated

 

[sosoo]

please make full use of cvs helpdesk for all rxconnect issues. otherwise they will make full use of their time creating updates after endless updates.

 

[farmadiazepine]

Why would MediCal pay for brand Abilify when a bottle of generic any strength costs ~$15 to $20 now?

 

[zelman]

Why would MediCal pay for brand Abilify when a bottle of generic any strength costs ~$15 to $20 now?

Rebates!

 

[owlegrad]

Rebates!

For the PBMs!

 

[owlegrad]

explain. how is pBM involved with Medicaid?

http://lab.express-scripts.com/lab/...grams/value-of-a-pbm-in-medicaid-managed-care

Obviously PBMs save Medicaid money. Duh

 

[owlegrad]

that's managed care medicaid. it's different from straight Medicaid.

Are you saying Medicaid plans don't use PBMs? I won't claim to be an expert, but I thought they did. Or perhaps it depends on the state?

 

[Sine Cura]

I assume all managed care plans outsource the management of their pharmacy benefit. Here are some PBMs for various managed Medicaid plans (aside from Kaiser) that I have encountered (I have seen all of these at least twice and Sacramento County, the home of FOUR managed care plans, and adjacent counties plenty of times)

Medimpact: CalOptima, Partnership, CC Alliance for Health
Envolve: California Health & Wellness
CVS Caremark: Molina and Health Net
Express Scripts: Anthem Blue Cross
PerformRx: San Francisco Health Plan, Contra Costa Health Plan, Alameda Alliance for Health
Argus: Health Plan of San Mateo
ProCare RX: San Joaquin Health Plan

Fee-for-service Medi-Cal does not utilize a PBM, so none of the above receive any rebates for Abilify brand as antipsychs are carved out of managed care

 

[CetiAlphaFive]

Why would MediCal pay for brand Abilify when a bottle of generic any strength costs ~$15 to $20 now?

Add a 0

 

[Sparda29]

Add a 0

Nope, I can get them for under $30 a bottle.

 

[CetiAlphaFive]

Nope, I can get them for under $30 a bottle.

Yeah, Teva is still cheap through ANDA, but all of the others are fluctuating wildly through McKesson and ABC

 

[farmadiazepine]

Next time I go to work I'll take a picture of the $16.99 price for 30 count 20mg.

 

[ldiot]

Isn't the brand Abilify like 1k for 30?