OptumRX Demands Survey From Network Pharmacies, Creating Big Questions
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OptumRX Demands Survey From Network Pharmacies, Creating Big Questions

Last week OptumRX released a mandatory survey to a portion of their Network Pharmacy Providers “as part of their ongoing credentialing requirements.” The survey requires Network Pharmacy Providers to provide all sources of the medication and products they dispense, including both prescription drug and diabetic testing supplies (VAWD and VDIP).

The survey is fairly straightforward:

 1. Asks for identifying information (pharmacy name, NPI number, NCPDP number, etc.)
2. Asks how many wholesalers the pharmacy is purchasing from
3. Asks you to select each wholesaler the pharmacy is from using a drop-down list
4. Asks you to write-in each wholesaler that was not on the drop-down list
5. Attestation that the list provided is complete and accurate, in that it contains all wholesalers from whom the pharmacy purchases medication inventory

If pharmacies are complying with the policies implemented on October 1, 2016 (specifically that pharmacies may only source from VAWD Accredited wholesalers or wholesalers that are pending VAWD Accreditation), there is little to worry about at this time. However, with this information readily available to OptumRX, there are quite a few big questions about the possible implications of this survey.

Darned if you do, darned if you don’t:

1. If a Pharmacy includes a wholesaler not on the list (and, consequently, one that does not have an Extension under OptumRX), will they be set up for audits, having claims denied, or worse, be dropped from the Network?

2. If a Pharmacy does not include a wholesaler and they are audited, will they have claims denied, or worse, be dropped from their Network?

3. Does this have anything to do with the Extension expiring on June 30? In essence, will it create a hit-list of pharmacies that will see more audits, denials of claims or simply, be dropped from their Network if there are wholesalers on the list that are denied an extension under Optum?

4. Is this data being shared with a pharmacy’s primary vendors (e.g. Cardinal, Smith Drug), pharmacy competitors (e.g. OptumRX mail-order pharmacy, CVS or Walgreens), distributor competitors (e.g. Parmed, Bellco), manufacturers, insurance companies, or anyone else?

If you or a trading partner need assistance with VAWD/VDIP Accreditation, a recent Application Cancellation, or an OptumRX extension – Pharma Solutions has the experience, market stance, and network to guide you through any issue.
More information as it breaks!

About Pharma Solutions

Pharma Solutions is a leading pharmaceutical compliance services firm that uses experience, relationships and knowledge to develop custom solutions for their clients. The company provides numerous services including VAWD Accreditation, state Board licensing and federal registration. Five Rivers helps third-party logistic firms, distributors and manufacturers in the pharmaceutical industry focus on their supply chain while reducing costs, enhancing efficiency and improving quality. Five Rivers is committed to helping their clients thrive and to providing peace of mind.


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