CVS Caremark announces settlement of retail pharmacy reimbursements
WOONSOCKET, R.I. — CVS Caremark announced on Friday that it has agreed to pay $17.5 million, to be allocated among the federal government and 10 participating states, to resolve a civil complaint concerning how its CVS/pharmacy retail pharmacies submitted reimbursement claims in certain states for prescriptions filled for "dual eligible" patients who have coverage under both Medicaid and a third-party insurance plan.
The settlement agreement is with the U.S. Department of Justice, the Office of Inspector General of the Department of Health and Human Services, and state attorneys general from 10 states — Alabama, California, Florida, Indiana, Massachusetts, Michigan, Minnesota, New Hampshire, Nevada and Rhode Island. This payment amount has been fully accrued for in prior fiscal periods and is not material.
Pursuant to the agreement, the company denied engaging in any wrongful conduct, and indicated that it has settled the matter to avoid the expense and uncertainty of protracted litigation.
CVS/pharmacy stated that it did not intentionally overcharge any state Medicaid program. The company regularly receives reimbursement from Medicaid and believes it is in compliance with each state’s billing requirements for dual eligible patients. Dual eligible patients with third-party insurance coverage comprise a small percentage of the Medicaid patient population, and this matter involves only certain state Medicaid programs. The settlement involves the CVS/pharmacy retail business only and does not involve CVS Caremark’s pharmacy benefit manager or Medicare Part D businesses, the company noted. CVS Caremark stressed its commitment to ensuring its business operations are in compliance with the law and that they adhere to the highest ethical standards.
The company stated that it continues to work with the government to reconcile the billing processes for dual eligible patients, which vary based on each state’s Medicaid program, to ensure compliance with all reimbursement regulations.
Scorpiniti’s vision for pharmacy will benefit new role
WHAT IT MEANS AND WHY IT’S IMPORTANT — In recent years, Duane Reade has gone from simply being Manhattan’s homegrown pharmacy chain to a truly innovative retailer with unique product offerings and marketing concepts that even the biggest retailers can learn from. And visionary merchant Joe Magnacca has received a lot of credit for the chain’s transformation — as he should. However, on the pharmacy side of the equation, Frank Scorpiniti was busy leading some important health-and-wellness initiatives at Duane Reade, including helping to develop a growing clinic program in one of the most difficult clinic markets in the country.
(THE NEWS: Katz Group names new COO. For the full story, click here.)
With more than 20 years of retail pharmacy experience, Scorpiniti served as SVP pharmacy operations at Duane Reade, a post he held since December 2008. At Duane Reade, the efforts on the back end in pharmacy, spearheaded by Scorpiniti and his team, resulted in a cost reduction for the company, better in-stocks for stores and less wait time for pharmacy customers.
Now, Scorpiniti inherits one of the most exciting new pharmacy prototypes in the new Rexall stores and will oversee operations for the Canadian retailer as it looks to add the fresh new concept to more of its stores. Called Rexall Healthy Living Pharmacy, the concept is aimed at making its stores innovative health destinations that will provide customers with preventive-health products and solutions, information to lead healthier lives and an integrated approach that weds such clinical capabilities as disease state management with wellness counseling.
Redding Rancheria Tribal Health Clinic implements Innovation’s PharmAssist Symphony system
JOHNSON CITY, N.Y. — A Native American tribal clinic in Redding, Calif., that fills some 300 prescriptions per day has adopted a pharmacy automation system made by Innovation, the company said Friday.
Innovation said the Redding Rancheria Tribal Health Clinic, affiliated with the Indian Health Service, had implemented the PharmAssist Symphony workflow management system to automate prescription fulfillment, saying the goal was to enhance patient safety, remodel internal processes and staff member roles, implement quality reporting, reduce patient wait times and improve pharmaceutical care overall.
“Due to our prescription mix, it’s critical that Symphony handles prescription grouping so efficiently, and it’s particularly important at patient pickup when staff has to gather all the prescriptions for a specific patient,” clinic pharmacy director Terry Lerma said. “The combination of Innovation’s Patient Notification Display and Symphony’s Will Call and e-Signature Capture modules has really streamlined the pickup process, helping us cut our wait times and improve the customer experience.”
The system integrates with the clinic’s QS/1 pharmacy management system for real-time prescription order flow and Ateb’s Pharmacy Line Interactive Voice Response system for refill management. The clinic also plans to install the PharmAssist ROBOTx system later this year.