A. Patient Name (First and Last) Required by Law

VITAS Q&A

1. What information needs to be provided to the pharmacy when the VITAS nurse orders the prescription? The VITAS nurse will need to provide the following information when the prescription is ordered:

a. Patient name (first and last) – required by law

b. Patient’s VITAS ID Number

c. Patient’s date of birth (day, month, year)

d. Patient’s gender (when needed – usually the name is self explanatory)

e. Necessary prescription information as required by state law

f. Authorized individual’s name that is ordering the prescription(s).

g. Delivery or pick up instructions

h. The NDC number that the pharmacy will need to submit on a separate prescription to be reimbursed for delivery charges.

2. How will the pharmacy be reimbursed for delivery charges? If the pharmacy has an arrangement with VITAS to be reimbursed for delivery charges, then the pharmacy will need to submit a separate prescription for the delivery charge. The pharmacy should use NDC number 88888-7777-01 and enter a usual and customary drug cost equal to the agreed upon delivery fee.

3. What information does the pharmacy need to submit the claim to PBM Plus? The pharmacy should only need to know the BIN number and Processor Control number for PBM Plus in order to have the pharmacies “switch” to direct the online claim to PBM Plus. PBM Plus’s BIN number is 610106 and the Process Control Number is “VITAS”

4. What is PBM Plus’s BIN Number? 610106

5. What is PBM Plus’s Processor Control Number for VITAS claims? VITAS

6. How can a pharmacy get a non-formulary medication covered? Non-formulary medications are limited to a 3 day supply. All prescriptions filled for non-formulary drugs will be reviewed by VITAS. If the VITAS manager approves the non-formulary medication to be continued, a prior approval will be placed into the PBM Plus claims processing system that will allow the non-formulary prescription to be filled for up to a 15 day supply.

7. What does the pharmacy do if the claim rejects for “member eligibility not on file”? The pharmacy should first verify that they have entered the information correctly as provided by the VITAS representative. Next the pharmacy should contact the VITAS representative that ordered the medication and verify that the information they have is correct. If this does not work, either the pharmacist or VITAS representative should contact PBM Plus at 888-726-7979 and verify that the member information is valid in the claims processing system. Lastly, the VITAS representative will provide a group number (equal to the VITAS program number) to enter on the claim that should allow the claim to process.

8. What is the maximum day supply for new orders of formulary medications? New medication orders are limited to a maximum of a 7 day supply for formulary medications. Please note that there is a limit of a 3 day supply for non-formulary medications.

9. What is the maximum day supply for new admitted hospice patients? New orders for new patients admitted to the hospice are limited to a 7 day supply for formulary medications and a 3 day supply for non-formulary medications.

10. Can a pharmacy dispense more than a 7 day supply of a new medication? No. The plan design only allows for a 7 day supply to be dispensed for an initial prescription.

11. Can a pharmacy dispense more than a 15 day supply of a refill medication? No. The plan design only allows for a 15 day supply to be dispensed for a refill prescription. If a situation requires more than a 15 day supply to be dispensed, the VITAS nurse will have to authorize an override.

VITAS patients residing in certain nursing homes and certain other facilities may be eligible to receive up to a 30 days supply of medication. When this is the case, the pharmacy must submit an appropriate location code with the claim to allow the 30 days supply to process. Pharmacies will be provided with separate instructions regarding this situation.

12. Can a prescription be refilled early? All prescriptions can be refilled once 50% of the original day supply has been exceeded (example: a 7 day supply can be refilled on day 4 after the original dispensing). To refill a prescription earlier than that will require a VITAS to authorize the early refill.

13. How can PBM Plus be reached?

Phone: 888-726-7979

Fax: 513-248-3079

Email:

Website: www.pbmplus.com