Oxford now enforcing drug card rules

As you may be aware, in 2014 Oxford small group NY and Conn went to a mandatory generic Rx card, which they called the “Ancillary charge program”.  If you wanted a name brand drug and there was a generic available you were supposed to pay the difference (the ancillary charge) in cost between the name brand and the generic, even if the doctor write DAW (dispense as written).  This was never properly adjudicated by Optum Rx, so members in some instances have been getting name brand drugs for the 3rd Tier copay instead of paying the difference in price between the name brand and the generic.

They have caught the error and are correcting it  now as of Jan 1st, 2016 to adjudicate scripts as they had set it up originally to do.  So now it’s more important than ever to make sure members discuss Rx options with their provider  so they are best prepared for this.  Oxford reports that “Impacted members received {a} letter in December of 2015 – outlining the drug(s) they are currently taking, that will be enforced as part of the program.