The program known as the WellPoint Point-of-Sale Facilitated Enrollment (POS FE) process has been changed by CMS. Effective Jan. 1, it will be known as the Limited Income Newly Eligible Transition program, or Limited Income NET, and will be administered by Humana.

WellPoint will continue to accept claims through midnight (EST), Dec. 31, 2009. Pharmacy providers with questions about claims submitted to the POS FE process prior to Jan. 1, 2010 will need to call the NextRx Pharmacy Benefits line at 800-957-5147.

The "Four Steps" instructions continue to apply to the 2009 POS FE process. After the fist of the year, pharmacy providers will need to use the following BIN/PCN to submit claims for the 2010 Limited Income NET program: BIN = 610649, PCN = 05440000.

More information on the Limited Income NET program is available online at the following location:

Pharmacist Forum
The CMS Dallas Regional Office is conducting a series of "Pharmacist Forum" conference calls about the 2010 Annual Enrollment. This is one of a series of interactive teleconferences for pharmacists.

The first one is today, Tuesday, Dec, 8 from 2 - 3 p.m. (CST) The agenda includes limited net income (LI Net), which is the 2010 replacement for Wellpoint Point-of-Sale, Facilitated Enrollment, as well and Q&A time.
Call in: 1-877-267-1577 (toll free) (CST)
Code: 181935
Only 100 phone lines available

If you have questions, comments, or suggestions, e-mail the CMS Dallas Regional Office with "PF" in the subject line.
 
Other Forum dates and tentative topics:

• Jan. 5, 2010         CMS Complaint Tracking Module
• Jan. 19, 2010       To Be Determined...Open to Suggestions
  

Oral electrolyte solutions, including Oralyte, are back in the formulary, thanks to an effective workaround developed by the Texas Vendor Drog Pogram.

"Coverage will be retroactive to Nov. 17, 2009, so there should be no gap in the coverage of these products," according to Don Valdes RPh, manager of the Texas Health and Human Services Vendor Drug Program Drug Use Review/Formulary program.

The issue stems from a directive from CMS instructing THHS to remove Oralyte solution from the Vendor Drug Program formulary. CMS made a determination it does not meet the definition of a covered, out-patient drug. There was a concern that the few alternatives would be banned, too, so this is very good news for our patients.

North Texas

972.523.2064