Greetings from the executive vice president
Celynda Tadlock, PharmD, MBA
Welcome to the first issue of Pharmastar News! One of my goals as the new leader of Pharmastar is to enhance the client experience. Pharmastar has always aimed to offer full-service pharmacy benefits with personalized, premium customer service, and we think we can do even more. In short, we want the Pharmastar experience to be the best in the industry. This new quarterly newsletter is just one step we are taking to provide more consistent communication and valuable insights. In future issues, we will cover a variety of topics, including:
- Centers for Medicare & Medicaid Services (CMS) updates
- Programs of All-Inclusive Care for the Elderly (PACE) trends
- Medicare Advantage Prescription Drug Plan trends
- CMS Audits: What to know and how to prepare
- Plan spotlight
- Ask the Pharmacist
- Pharmastar team member spotlight
- And more
Please feel free to contact me or your Client Support Specialist with suggestions for topics to include. In the meantime, enjoy this issue!
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Celynda Tadlock, PharmD, MBA, named chief client officer and executive vice president of Pharmacy Benefit Services
Celynda Tadlock, PharmD, MBA, was recently appointed executive vice president of Pharmacy Benefit Services for Pharmastar and chief client officer for Tabula Rasa HealthCare (TRHC), parent company of Pharmastar PBM. Dr. Tadlock will assist with growth, profitability, marketing, clinical and product strategies, and industry and trade relations. Additionally, she has identified enhancing the client experience as an area of focus.
Prior to joining TRHC, Dr. Tadlock launched Impera Healthcare Strategies, where she secured agreements in value-based innovations, market access solutions, and industry trends. She previously served as vice president, clinical strategy and pharmacy experience at Aetna, a CVS Health Company; president and chief operating officer, Pharmacy, at Coventry; and held executive roles at Express Scripts and Anthem. Dr. Tadlock is president of the Georgia Academy of Managed Care Pharmacy (AMCP) and serves on the National AMCP Public Policy Committee.
Dr. Tadlock received a Doctor of Pharmacy degree from Mercer University and a Master of Business Administration degree from Keller Graduate School of Management. Read the full press release announcing Dr. Tadlock's appointment on TRHC.com/news.
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Why Drug Pricing Matters in PACE
If Programs for All-Inclusive Care for the Elderly (PACE) plans bid on their Part D spend each year in order to receive reimbursement for participant medications, why should the organization care about drug pricing? This is a frequent question, even among PACE staff members, and there are multiple answers.
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Dr. Rich Mueller joins Pharmastar as vice president, Clinical Strategy
Pharmastar recently welcomed Richard J. Mueller, PharmD, MBA, MS, as vice president, Clinical Strategy. In this role, Dr. Mueller will work to ensure Pharmastar’s clinically related products and services meet current and future prospective client needs.
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- CMS Formulary Submission Deadline: June 7, 2021 (11:59 p.m. ET)
- 2020 PDE Submission Deadline: June 29, 2021 (11:59 p.m. ET)
- 2020 DIR Deadline: June 30, 2021 (11:59 p.m. PT)
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Audit Tips: Areas of focus on recent CMS One-Third Financial Audits
The One-Third Part D Financial Audits constantly change as Centers for Medicare & Medicaid Services (CMS) directs its auditors to focus on different areas of compliance risk for Programs of All-Inclusive Care for the Elderly (PACE) organizations. Here are some of the specific areas of interest we have observed auditors verifying in CY 2018 and 2019 audits.
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Ask the Pharmacist:
What is the best way to determine if a drug should be billed under Medicare Part B or Part D? Can Pharmastar assist with this process?
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Pharmastar can definitely help with this process! In general, Medicare Part D covers most self-administered drugs like tablets, suspensions, self-injections, insulins, etc. Medicare Part B covers most drugs that would typically be administered in a hospital or clinic by a healthcare provider in addition to a couple of specific drug classes. Making appropriate Medicare Part B vs Part D determinations is important, and Pharmastar understands the intricacies involved. To streamline the process for our clients, Pharmastar provides a Medicare Part B vs. Part D report. We have identified specific drugs that may require a Part B vs Part D determination, and we share a list of these drugs and the patients taking them with the plan sponsor. The plan sponsor views the list of drugs, answers a question that helps determine Part B vs Part D status, and then redacts PDEs for the drugs determined to be Part B. This is a retrospective way that Pharmastar assists plan sponsors with compliant billing practices.
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Overwhelmed by the number of update memos coming your way from Centers for Medicare & Medicaid Services (CMS)? The Pharmastar Bulletin summarizes memos relevant to Programs of All-Inclusive Care for the Elderly (PACE) and includes follow-up actions to take. Subscribe today to the bi-weekly bulletin and stay current. |
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Recent CMS Updates of Note |
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CMS Memo Title & Release Date |
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Access to COVID-19 Vaccine Data for Parts C & D Enrollees - Dated 01/07/2021 |
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The purpose of this memo is to explain how CMS will make certain COVID-19 vaccine (COVAX) data available to plans for their enrollee. This data will be offered via Acumen and RelayHealth. Refer to the memo for further detail regarding the process of obtaining COVAX data. |
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Applicable to PACE and MAPD. |
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CMS Memo Title & Release Date |
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2021 PACE and Medicare Parts C and D Program Audits - Dated 12/23/2020 |
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CMS has compiled a list of questions/answers about how routine audit activities for PACE and Medicare Parts C and D organizations in 2021 will proceed during the ongoing Public Health Emergency (PHE). |
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Applicable to PACE and MAPD. Refer to memo for complete details. |
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CMS Memo Title & Release Date |
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One-Third Financial Audits - Corrective Action Plan (CAP) Submission Instructions and Best Practices - Dated 12/08/2020 |
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The Division of Financial Audit and Resolution (DFAR) has the responsibility of evaluating the corrective actions and the overall close-out process for the One-Third Financial Audits (OFAs). After an Audit is completed, the audited organization will receive a notification email from the Health Plan Management System with instructions on retrieving the final audit report and responding to corrective actions. Instructions and best practices to aid organizations in completing successful Corrective Action Plans (CAPs) as a result of the OFAs are enclosed. |
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Applicable to PACE and MAPD. Refer to memo for details. |
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PACE plan spotlight
Would you like your plan to be featured in a future issue?
Contact your Client Support Specialist to learn more!
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