Transition (Carve-Out) of Pharmacy Benefit from Managed Care to Fee-For-Service (FFS)
All Stakeholder: Implementation Update
- Presentation also available in Portable Document Format (PDF)
March 25, 2021
Overview
Key Deliverables and Timeline Update
Key Deliverables and Timeline Update
| Deliverable(s) | Target Date |
|---|---|
| Complete Work Plan and Establish State Transition Team and 340B Advisory Group | June 2020 ✔️ |
| Recurring Workgroup Calls with Health Plans and All Stakeholders begin | July 2020 ✔️ |
| Frequently Asked Questions Posted to the NYS DOH Website | August 2020 ✔️ |
| Finalize NYS DOH/Managed Care Plan Roles and Scope of Benefits | September 2020 ✔️ |
| Consensus between the state and plans on data sharing concept | October 2020 ✔️ |
| Deliver file formats, data dictionary, and process for daily claim file | November 2020 ✔️ |
| Transition Analysis Conducted (e.g., Formulary, DME, OTC Comparisons), Changes Made To Smooth Transition and Transition Strategy Finalized | November 2020 ✔️ |
| Identify Sections of the Model Contract that Require Changes | December 2020 ✔️ |
| Notice of 1115 Waiver Amendment | December 2020 ✔️ |
| Required System Changes Identified | December 2020 ✔️ |
| Initial Special Edition Medicaid Update Published | December 2020 ✔️ |
| Systems Stress Testing Performed to Verify Volume Handling | January 2021 ✔️ |
| Customer Service Staff Hired and Trained | February 2021 ✔️ |
| Second Special Edition Medicaid Update Published | March 2021 ✔️ |
| 1115 Waiver Renewal Application Accepted by CMS | March 2021 ✔️ |
| Member Notifice of Change and Non-Enrolled Provider Notifications Sent | March 2021 |
| Make Required Changes to Common Benefit Identification card (CBIC) Carrier or Notice | May 2021 |
| Required System Changes Implemented | By May 1, 2021 |
| Go Live | May 1, 2021 |
| 340B Related State Plan Amendment (SPA) Submitted | June 2021 |
Updates
- March 2021 Pharmacy Transition: Part Two Special Edition
- Member Search Tools:
- Member Fact Sheets
- Find a Pharmacy / Medical Equipment Supplier
- Search for Covered Prescription Drugs and Over the Counter (OTC) Products
- Search for Covered Medical Supplies
Communications and Resources
Website Updates
- The following content has been added to the website since the last meeting:
- All Stakeholder - February 26 Presentation
- FAQ Update - Updated 3/1/21
- Transition & Communication Activities - Updated 3/16/21
- Member Notice of Change - Updated 3/1/21
- Mailing Schedule - Updated 3/16/21
- Scope of Benefits - Updated 3/16/21
- March 2021 Pharmacy Transition: Part Two Special Edition - Published 3/18/21
Website updates will continue to be communicated via the MRT LISTSERV.
Resources
Website: www.health.ny.gov/health_care/Medicaid/redesign/mrt2/
Information regarding the transition of the pharmacy benefit from Managed Care to FFS will be posted at the above website.Email: PPNO@health.ny.gov – Please write Carve-Out in the subject line
DOH Medicaid Update: https://www.health.ny.gov/health_care/medicaid/program/update/main.htm
MRT LISTSERV: https://health.ny.gov/health_care/medicaid/redesign/listserv.htm
Q&A
Questions?
Please submit your question to All Panelists using the Q&A feature of the WebEx Event meeting.
Follow Us