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Department of Veterans Affairs VA Pharmacy Benefit Program for Job Injured Employees (First Script) By: Office of Administration/Office of Occupational Safety and Health July 15, 2010
VA Pharmacy Benefit Program(First Script ) • First Script is a pharmacy benefit management (PBM) system designed exclusively for the workers’ compensation program. • First Script is a voluntary program which represents a new benefit for the injured worker that provides a more efficient way to obtain prescriptions for their work related injuries. • First Script provides a nationwide network of pharmacies as well as a mail order program.
Current Prescription Process • Employee experiences traumatic injury – obtains prescription from doctor • Employee takes prescription to retail pharmacy • First fill - employee pays out-of-pocket • Claim accepted – employee submits claim for reimbursement • Claim denied – employee absorbs cost • Recurring Prescriptions – requires OWCP authorization – filled only at a retail pharmacy • Exceptions require pharmacy phone call to OWCP
First Script Prescription Card Process • Employee experiences traumatic injury – obtains prescription from doctor – • Takes prescription and temporary prescription drug card or First Script Help Line telephone number to choice of pharmacy • First Fill – no out of pocket costs for the injured employee, First Script pays pharmacy directly • Claim accepted – First Script bills OWCP electronically • Claim denied – First Script absorbs the cost • Recurring Prescriptions – • Fill at First Script’s Retail Pharmacy Network or by Mail Order Program
First Script Enrollment Process • Identify eligible claims based on our VA/OWCP data • Eligible claimants will receive by mail: • Postcard announcing the program • Injured worker communication kit • Personalized prescription benefit card • First Script invoices electronically • Already an enrolled provider • Online eligibility check via ACS
First Script’s Enrollment Process(Continued) • For employees who suffer traumatic injuries temporary prescription drug cards will be available at the facility where the accident occurred and provided to the employee • If an employee suffers an occupational illness, a personalized prescription card will be mailed to the employee once the claim has been accepted by OWCP. • Periodic Roll Claimants will have the option to receive their prescriptions by mail order.
Instructions: Prescription Drug Card CA-1 • VA injured workers who file a CA-1 for traumatic injury will take the First Script initial prescription drug card to their pharmacy with their prescription. • Or VA injured workers may take their prescription and the dedicated First Script number 1-877-203-8966, to their pharmacy. • A list of network pharmacies is included on the initial prescription drug card or pharmacies can be located by zip code at www.firstscript.com. • Personalized prescription cards will be mailed to the injured worker when the claim has been accepted by OWCP.
Program Safeguards • Pharmacy card only valid for medications prescribed for a work-related injury • Controlled enrollment based on VA/OWCP data • Only injured worker with an approved claim receives personalized card by mail • Enrollments are terminated if a valid claim number is not identified within 60 days (First Script absorbs cost of prescriptions filled during this time frame) • Pharmacy requires photo ID to pick up prescriptions • Card expires if claim is closed or there is no prescription activity for 3 months
Program Benefits • Reduction in number of claims for reimbursement – reduces VA administrative workload • First Script pays pharmacy direct – no provider pay issues • First Script absorbs cost of denied claims • Electronic billing – more cost efficient, more accurate • First Script Help Desk resolves processing issues reducing calls from pharmacies to VA staff
Program Benefits (continued) • Easy access to obtain medication during acute phase – 62,000 pharmacies nationwide • No out of pocket cost for injured employee, including first prescription fills: • No cash flow issue for injured worker • Promotes compliance with physician orders • Mail order option available
Program Benefits(continued) • Reduction in medical costs on VA Chargeback • Prescription Drug costs to VA totaled $12 million in FY 2008 • First Script savings average 10-15% nationwide • Increased savings with increased participation • First Script implemented at no cost to the VA • Increased Employee Satisfaction 12
First Script Implementation • First Script initial enrollment begins– 8/16 • VA injured workers take the First Script temporary prescription card sheet to their pharmacy with their work related prescription • Or VA injured workers may take their prescriptions and the dedicated First Script number 1-877-203-8966 to their pharmacy • Announcement Post Card mailed to eligible VA injured workers on 8/25
First Script Implementation • 8/26 & 8/27 First Script personalized prescription card mailed to all eligible VA injured workers • VA injured workers will call First Script to activate their card • First Script will capture the employee’s choice of pharmacy • First Script will ensure the pharmacy has billing information • Upon receipt of the First Script Pharmacy Card the VA injured workers my receive their work related prescriptions through First Script with no out of pocket expense.
First Script Contact List: 24/7 Toll Free Number 1-877-203-8966 • VA Call Center Manager Jeanne Johnson 520-434-5355 email@example.com • Account Manager Cara Williams 520-202-1259 firstname.lastname@example.org • Director of Account Management Susan Keating 520-202-1226 email@example.com
Contact Information Danna Corbell Program Manager firstname.lastname@example.org