- Beginning January 1, 2013 ACOs are responsible for prescription benefits.
- ACOs should be billed for pharmacy benefits for all drugs except for the following that have been carved out:
- Hemophillia treatment drugs
- Immunosuppresant drugs used for organ transplants
- Pshycotherapeutic drugs as defined as:
- Anticonvulsant/mood stabilizers
- Anti-Anxiety Benzodiazepines
- Attention deficit hyperactivity disorder Stimulants
- Specific Addiction Therapy Drugs that include: Suboxone, naltrexone (Vivitrol), Revia, Methadone clinic therapy methadone, Campral, disulfiram (Antabuse).
- Carved out drugs remain the responsibility of Medicaid.
- Members who continue to receive pharmacy benefits directly from Medicaid Fee-For-Service include new enrollees for up to 3 months, Primary Care Network (PCN) members, and members who go into nursing homes for greater than 30 days.
ACO Websites:Health Choice | Healthy U | Molina | SelectHealth
Any project documentation, FAQs, or general information that contains PHI or proprietary information will be shared with individual ACO using secure protocols.
The project documents believe are provided in Adobe format. If you cannot view a file, please download the free plug-in from the link below.