19.1.48 NRx Enhancements

Modified the RxFill message to suppress Rx Notes from being sent with the dispense, as they are used for internal purposes in some cases. Alternatively, a note can be manually added to the Reason for ProfileRx? field on the RxFill Message window.

Added a Control File Option, Send Rx Notes, in the HL7 Orders in outbound for PointClickCare. Default = Checked. If option remains checked, Rx Notes are sent in both RXE-21 and RXO-7.

Added DAW code, A - Multi-payer Brand/Reference Product Formulary Conflict, to the DAW drop-down field on the Rx Summary.

On occasion, an order may not yet have been inactivated, but is no longer administered or has exceeded life, and therefore does not need to be sent to the eMAR during facility onboarding when performing an HL7 Orders push. Updated the following to accommodate.

Updated the system to skip prescriptions with a stop date, an expiration date that equals order push date or older, or prescriptions with an inactive status.

Added the NP/PA to the CSMP report per requirement that the provider who prescribed the prescription be reported. Previously, only the Supervising Physician was reported even when there was an NP/PA on the prescription.

For ease-of-use, increased the number of characters of the Drug Name from 25 to 27 on the QS/1 Fax coverpage.

Note: This enhancement will be completed in two phases. None of the features will be ready for use until phase two completion in Service Pack 49. Please do not turn on Two-Factor or configure any other options until that time.

Many pharmacies have the need for employees to use a secondary form of identification when completing workflow or other pharmacy tasks. A secondary form of identification is required in certain states. Added the following changes to incorporate a Random Daily Access Code (RDAC) barcode to be printed daily for each employee. When completing tasks, the employee can scan the barcode to authenticate their ID.

Added the following options to Store Control >  Security Access > Security Options:

• Two-Factor: Default = Unchecked. Option is store specific.
• Barcode Expiration (hours): Default = 12 hours. This option is not available if the Two-Factor option is set to Biometric.
• Print Barcode at Login: Default = NO. This option is not available if the Two-Factor option is set to Biometric.

 

Security Journals

Updated Security Journals to log the user, along with date and time when the Two-Factor option is enabled or disabled. All Security Journals Control Options including Log File, Updates, Log New, and All Fields default to checked.

Employee Record

Added a drop-down option, Two-Factor, to the Print ID barcode option on the Employee Detail screen.

Print a Barcode Two Ways

1. If Print Barcode at Login is selected in Security Options, a unique barcode prints for the employee once they enter their Username, Password, and Store Password at login.
   
   
2. Select Print ID > Two-Factor from the Employee Detail screen. The time limit for how long the barcode can be used is based on your setting in the Barcode Expiration (hours) field in Security Options. The default is 12 hours. The time limit is reset each time a barcode is printed.

 

Note: If a user's barcode has expired, a new one should automatically print at login. A message, "Printed New Two-Factor Barcode for User Name", displays after the barcode prints.

Added a report, Security Options to Store Control > Security Access > Reports Security Options with the following options:

• Employee ID
• Date of Change
• Time of Change
• Field Changed
• Before
• After

 

Effective January 1, 2025, Part D sponsors are required to offer enrollees the option to make monthly payments for their out-of-pocket prescription costs during the plan year as a part of M3P.

The Way the Plan Works:

1. The member opts into the M3P program with their sponsor.
2. The pharmacy enters and adjudicates the prescription.
3. The member receives their prescription and pays $0 for the Part D covered drug at the time of fill.
4. The Part D sponsor pays the pharmacy what the member would have paid if they had not opted into the M3P program.
5. The Part D sponsor bills the member monthly.

 

The following are Medicare Part D claim responses that assist your pharmacy in determining when and where to submit the Other Payor Patient Responsibility Amount.

• Approval Codes:
• 056 - Beneficiary likely to benefit from Medicare Prescription Payment Plan - Details

  Approval Code 056 is returned when:

  • The prescription is a Part D covered drug with Benefit Stage Qualifier (393-MV) 01 (Deductible)/02 (Initial Benefit).
  • The single Part D covered prescription calculates member cost sharing that meets the CMS definition of an enrollee who would benefit from Medicare Prescription Payment Plan (member whose cost share is equal to or greater than the CMS-defined threshold (e.g., $600 for 2025).
  • The Part D prescription is not incurred in the last month of the applicable plan year.
  • The Medicare Prescription Payment Plan Program status for the Part D member is:
  • Not a current participant in the Medicare Prescription Payment Plan for the date of service.
  • Not precluded - according to CMS definition - from Medicare Prescription Payment Plan by the plan sponsor for the date of service.
• 057 - Beneficiary participating in Medicare Prescription Payment Plan - Details

  Approval Code 057 is returned when:

  • The prescription is a Part D covered drug with Benefit Stage Qualifier (393-MV) 01 (Deductible)/02 (Initial Benefit).

  • The Part D member is a current participant in the Medicare Prescription Payment Plan for the date of service.

  • The member cost share is greater than zero.

  Plan Sponsor/Processor returns the following information in addition to the 057 Approved Message Code:

  • Other Payor ID Qualifier

  • Other Payer ID

  • Other Payer Processor Control Number

  • Other Payor Group ID

  • Other Payor Cardholder ID

• 058 - Beneficiary no longer participating/has opted not to participate in Medicare Prescription - Details

  Approval Code 058 is returned when:

  • The prescription is a Part D covered drug with Benefit Stage Qualifier (393-MV) 01 (Deductible)/02 (Initial Benefit).

  • The Part D member formerly participated in the Medicare Prescription Payment Plan of the benefit year (calendar or non-calendar), but no longer participates due to voluntary or involuntary termination.

  • The prescription date of service falls within the terminated benefit year.

• Rejection Codes:
• D01 - Beneficiary is not a participant in this Medicare Prescription Payment Plan
• D02 - Matching Medicare Part D claim not found to allow processing for Medicare Prescription Payment Plan
• D03 - This claim is not eligible for Medicare Prescription Payment Plan

 

MTM Type Table

Added an MTM Type, M3P1 - Medicare Prescription Payment Plan, to the MTM Type table. The corresponding Auto-Create MTM Opportunity and Prompt MTM Alert at Checkout options default as checked.

Patient Record

Added an MTM Alert, Medicare Prescription Payment Plan, to the Patient MTM Alerts window.

An MTM Record is created if the Auto-Create MTM Opportunity option is selected for the new M3P1 Type and the following is true:

• A prescription for the patient is filled/refilled

• A paid response is received with an Approval Code 056

• Patient does not already have an outstanding Medicare Prescription Payment Plan MTM Record

• Patient does not have a completed Medicare Prescription Payment Plan MTM Record that was entered/created on the same day as the prescription being filled/refilled that would have already triggered a record to be created.

MTM Opportunity Details Window

When accessing the MTM Opportunity Details window via Print > MTM Opportunity and the MTM Record type is Medicare Prescription Payment Plan, these fields display.

Create MTM Opportunity Alert Window

The Create MTM Opportunity Alert window displays the same fields as the screen mentioned above with the following additions:

• Mark Complete button - Grayed until all fields populated.

 

Signature Capture

If the M3P1 - Medicare Prescription Payment Plan option on the MTM Type table is selected, the system checks if the patient has an outstanding or uncompleted MTM Opportunity Record for the M3P Type when capturing signatures either from the Transaction Status or the Rx Transaction Record. If so, and the Opt in MTM Alerts option on the Patient Record is selected for the Medicare Prescription Payment Plan MTM Type, the MTM Opportunity Alert displays for the patient when capturing signatures from the Prescription Status or the Rx Transaction Record. If there are any controlled prescriptions and the prompt to capture a signature is triggered, the MTM Opportunity Alert is prompted after the ID for Controlled Substance Rx prompt.

Electronic Signature Options - Store Level Options

Added an option, MPPP Likely to Benefit Notice, to Store Level Options > System > Electronic Signature Options. Default = Checked.

Claim Payment Detail

Added an option, MPPP Likely to Benefit Notice, to the Print icon dropdown on the Claim Payment Detail. Option becomes available in the dropdown for paid claims that receive an approval code, 056 - Likely to Benefit.

Transaction Signature Screen

Added the following to the Transaction Signature screen:

• MPPP Likely to Benefit Notice checkbox - Default = Unchecked. Field updated by the signature capture.

• Last Updated by field - Updates with the user's initials whom last updated the field via signature capture, manual update, or printing the MPPP Likely to Benefit Notice from Payment Detail.

• Date - Date the field was updated.

• Time - Time the field was updated.

M59

Added Delegating Nurse to the bottom of the M59 form.

M117

Changed the barcode at the top of the M117 form to print the alias from the Patient Record instead of the patient's name.

Removed the Facility Code from the top box on the form.

Bolded the "TAKE THIS RECORD WITH YOU WHEN YOU VISIT YOUR DOCTOR OR HOSPITAL" statement.

Added Rx # and Refills Remaining for each medication.

Moved the questions or changes to your medication question/phone at the bottom of the form lower.

Moved pharmacy name/DEA # to the left at the bottom of the form.

Moved pharmacy address at the bottom of the form lower.

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