NPDP Presentation June 2010
Organization of Presentation
Statement of Problem
The Action Program
Other Drug Plans Reviewed
COVERAGE - Phase 1
COVERAGE - Phase 2
DEFINED LIST OF DISEASES
COVERED CONDITIONS
COVERED CONDITIONS
COVERED CONDITIONS
COVERED CONDITIONS
COVERED CONDITIONS
COVERED CONDITIONS
COVERED CONDITIONS
COVERED CONDITIONS
COVERED CONDITIONS
COVERED CONDITIONS
COVERED CONDITIONS
COVERED CONDITIONS FOR PHASE ONE
DEFINED MEMBERSHIP
REGISTRATION PROCESS
NPDP MEMBERSHIP CARD FRONT OF CARD BACK OF CARD NOTE: CARDS AVAILABLE FOR COLLECTION FROM MID-JULY
REGISTRATION PROGRESS
ADMINISTRATION
BUSINESS MANAGEMENT
BUSINESS MANAGEMENT
PHARMACIES
PARTICIPATING PHARMACIES
DRUG BENEFITS
SPECIAL ARRANGEMENTS
SUPPLY AND PURCHASE OF DRUGS
CLAIMS PROCESSING/IT SYSTEMS
PAYMENTS – FORMULA & TIMING
PAYMENT SCHEDULE & FORMULA Band Cost of Drug % Mark-up Fixed Fee 1 0 - $5.00 45% $3.00 2 $5.01 - $25.00 35% $3.00 3 > $25.00 25% $3.00
COPAYMENTS & COORDINATION OF BENEFITS
AUDITS
When will I get my medication?
HEALTHY PEOPLE PROGRAM
HEALTHY PEOPLE PROGRAM
SUMMARY OF KEY POINTS
SUMMARY OF KEY POINTS
Q & A
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