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VI Pharmacy Benefits Manager Finally Arrives

For years AARP Virgin Islands has advocated for the VI Government to institute a Pharmacy Benefits Manager or PBM to help bring down the cost of providing medications to VI patients. The newly negotiated arrangement with CIGNA and the Department of Health’s Medical Assistance Program (MAP) is anticipated to do just that.

The PBM, launched April 1 was the result of a Request for Proposals (RFP) advertisement program that the VI government embarked on years ago. The intent was to identify a private company that would enable electronic processing of prescriptions for the Medicaid program so it could improve its efficiency, accountability and services to program beneficiaries.

Until the program launched, MAP’s method of dealing with prescriptions for participants took a tremendous amount of employee time with all paperwork being done by hand. Some of the system’s limitations included the difficulty to oversee whether pharmacies were charging the program correctly. Going to an electronic method of doing things is expected to expedite services and ultimately bring down overall MAP program costs. Time formerly spent completing the paperwork will now free up MAP employees to focus their attention on other aspects of their jobs, like oversight and quality control.

CIGNA, the company selected to become the Medicaid PBM already handles the health insurance pharmacy benefit for government employees and will be using many of the same processes already in place although the Medicaid program will add a few new and different needs as well as medications to the pharmacy listing.

It is anticipated that the change to a PBM will also provide benefits to both physicians and pharmacists allowing prescriptions to now be telephoned into stores for filling. As far as beneficiaries are concerned, it is unlikely that Medicaid patients will even notice a difference, because they won’t be required to do anything differently.

According to a Government House press release, the change will benefit the territory because it will allow for better compliance with federal regulations and will put the territory in a better position to receive federal Medicaid funds.

Over the next year or so, the Medicaid program expects to be instituting several new processes that will further improve services to beneficiaries. One such process will be the institution of electronic billing and claims processing for medical providers.

It is anticipated that these important program changes will enable the income qualifications to be raised so that the program can be expanded and many of the territory’s thousands of low-income workers may be able to qualify for assistance. The new program changes and additions, like the institution of the new PBM are hoped to be steps in the right direction to streamline the Medicaid program and eventually enable more participants to benefit.

Let AARP hear what you think about the implementation of the new Pharmacy Benefits Manager program by sending your comments to viaarp@aarp.org.

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