Every year around Open Enrollment, plans start making changes, adjustments, formulary alterations, etc. Most of them are obvious and the plans are transparent about them, while others are for us and you to discover.
After the Humana situation last year, Express Scripts announced they will be following suit with their own Quality Network. A new, opt-out, contract was sent to pharmacies last month. We addressed this controversial change in a webinar this month, which you can view here.
Looking more into the subject we’ve come to realize that pharmacies started seeing lower reimbursements on ESI plans as of July 1st, with dispensing fees decreasing from 0.25 cents to 0.10 cents. And also other “adjustments” have been made that need your attention.
This whole subject raises the doubt on the contracts that are signed on your behalf. So do pay attention and ask to read these contracts, as they influence your daily business.