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Weekly Update

Managed Care

Page 2

In the Know …

FDA Renews Safety Warning on Painkiller Patch

FENTANYL (Duragesic®, E-TRANS® Fentanyl) is prescribed to relieve moderate to severe chronic pain. The FDA is issuing another health alert to patients, healthcare providers, and caregivers regarding the proper use of the Fentanyl patch. This narcotic pain patch is to be applied directly to the patient’s skin for around-the-clock medication, however reports show that some patients are using these patches incorrectly, which could lead to life-threatening side effects. Fentanyl is a synthetic narcotic where a 100-µg dose of fentanyl is approximately equal to 10 mg of morphine. This CII drug is intended to increase the threshold of pain and reduce the perception of pain that the patient might experience. The FDA is directing drug makers to issue brochures that explain the dangers of the drug in plain language. The FDA has also posted the following safety information on the fentanyl skin patch:

  • Patients who are opioid-tolerant and have chronic pain that is not well controlled with other pain medicines should only use the fentanyl patch.

  • Healthcare professionals who prescribe and patients who use the fentanyl patch should be aware of the signs of fentanyl overdose.

  • Patients prescribed the fentanyl patch should tell their doctor about all the medicines that they take.

  • Heat may increase the amount of fentanyl that reaches the blood and can cause life-threatening breathing problems and death

FDA Renews Alert on Fentanyl Patch, Fentanyl Skin Patches, FDA PHA: Fentanyl, Medicinenet-Chronic Pain: Fentanyl

Compliance Training Available - Medicare Part D Fraud, Waste, and Abuse Compliance and Training Program Available

PRS Pharmacy Services will offer a Medicare Part D Fraud, Waste, and Abuse Compliance and Training Program, to MCC members at a discounted price of $147 (regularly $247. This offer is available for all Leader and Managed Care Connection pharmacies). CMS regulations require Medicare Part D Plan Sponsors to implement and comply with a comprehensive fraud and abuse program. Plan Sponsors and PBMs will soon begin to audit pharmacies to identify potential fraud, waste, abuse, and other compliance issues. Protect your pharmacy from criminal and civil fines, sanctions, penalties, and the possibility of losing the ability to fill Medicare/Medicaid prescriptions that may result from non-compliance. The PRS program includes policies, procedures, and forms necessary to meet the Medicare Part D regulation and PBM requirements.

PBM and Plan Updates (cont.) Nationwide Updates

Opus Health E f f e c t i v e 0 2 / 0 4 / 0 8 , O p u s H e a l t h w i l l b e g i n t o p r o c e s s c l a i m s f o r t h e S t a l e v o ® C o - P a y A s s i s t a n c e C a r d P l a n . BIN #: 601341, PCN #: OHCP, GRP #: OH7113011

Effective 02/04/08, Opus Health will begin to process claims for the Stalevo® Voucher Plan. BIN #: 601341, PCN #: OHS, GRP #: OH7113021


  • Effective immediately, WHI has begun to process claims for Art Van Furniture/Comfort Mattress. BIN#: 603286, PCN #: 01410000, GRP #: 51302

State Updates

MD Medco

  • Effective immediately, AmeriChoice of MD allows a Temporary Coverage Override (TCO) for non-preferred and prior authorization medications. Group #: PRODUR1


  • Effective 02/01/08, New Mexico Medicaid will require the NPI number for the Service Provider ID. BIN: 610084, PCN #: DRNMPROD. For a list of ACS payer sheets view ACS Payer Sheet

UT RxAmerica Effective immediately, Molina Utah has new customer service numbers for pharmacy providers. Please use the numbers below for all of your pharmacy concerns: Medication Exception Phone Number Medication Exception Fax Number Molina Advantage Member Services RxAmerica Customer Service Help Desk WA Medco Effective immediately, Medco is supporting the secondary Medicare Part D prescription drug benefit for WSHIP’s Medicare D eligible beneficiaries. When processing these claims, pharmacies should use: BIN #: 610031, PCN #: MEDDCOPAY, GRP#: WSHIPMD, and COPAY Only 866.771.0117 888.483.0760 888.483.0760 800.791.6856

For questions and additional information, please contact the Managed Care Connection Help Desk at 877.292.3196

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