In recent months, the reversals on policy regarding awarding extensions to the highly controversial PBM requirement has caused a lot of confusion.
August 2016 through March 2018: Unrestricted Extensions
POLICY 1: With a previous application to VAWD, a company will receive an Extension.
The established policy since the announcement of the VAWD® requirement in August 2016 was simple: if a company could provide proof of an active VAWD® application (paid NABP invoice), OptumRx would provide an extension letter. There was no continuing due diligence performed by OptumRx – if a company went out of business or was cancelled by the NABP, they were still awarded an extension.
June 28, 2018: Revocation of Extension
POLICY 1: With an active application verified by OptumRx, a company will receive an Extension.
POLICY 2: If the active application was submitted after July 1, 2017, but before June 28, 2018, an extension is awarded through December 31, 2018.
Per OptumRx, companies without an active application had their application revoked. However, in many instances, companies with an active VAWD® application also had their extensions revoked. This prompted a mad scramble of those companies with an active application providing NABP permission to communicate on the status of their VAWD® application with OptumRx in hopes of being awarded an extension. Companies applying before June 1, 2018 but after July 1, 2017 were, in most cases, awarded an extension through December 31, 2018.
“OptumRx has been offering an extension to this (VAWD®) requirement to allow non-accredited wholesalers the time to obtain the necessary accreditation. With the granting of previous extensions, the wholesaler previously agreed that OptumRx may inquire to the status of the VAWD® accreditation with NABP for the sole purpose of gauging the status of completion for the VAWD® accreditation. After contacting NABP regarding the status of your application, we have made the decision to revoke this interim extension and request that you no longer continue to provide the products to OptumRx network providers. No further extensions will be granted through these circumstances.”
July 6, 2018: Temporary Extension
POLICY 1: Temporary Extensions are only offered if the company has an active application verified by OptumRx.
POLICY 2: Companies applying after July 1, 2018 will not be offered an extension.
POLICY 3: This will be the last extension offered.
Most likely under threat of a class-action Temporary Restraining Order (TRO), OptumRx provided an extension through August 31, 2018. The language clearly stated that it would be the last extension offered. Additionally, in private correspondence, OptumRx additionally stated that they would not award extensions to companies that were not previously awarded an extension.
“OptumRx is providing a response to your request for extension to our requirements related to sourcing of medications from accredited wholesale distributors. The information you provided satisfies our expectations to grant a TEMPORARY EXTENSION to the requirement through August 31, 2018.
You may utilize this notice to assure our contracted Network Pharmacy Providers that you are able to continue to act as a distributor to provide covered products through the date of the TEMPORARY EXTENSION noted above.
This is an interim extension that is only valid through the period of time indicated above. This will be the last extension offered.
We will require an update from each wholesaler regarding your application status with NABP. Please send this to email@example.com. OptumRx maintains that our contracted Network Pharmacy Providers must source medications from an accredited source. This interim extension may be revoked at any time at the sole discretion of OptumRx.”
August 29, 2018: Extension through December 31, 2018
POLICY 1: This is the last extension offered, regardless of having an active VAWD application.
Once again Extensions are offered but only to a select few companies. There are many rumors surrounding a legal agreement between those companies that were provided an extension and OptumRx.
“OptumRx is providing a response to your request for extension to our requirements related to sourcing of medications from accredited wholesale distributors. The information you provided satisfies our expectations to grant an EXTENSION to the requirement through 12‐31‐2018. You may utilize this notice to assure our contracted Network Pharmacy Providers that you are able to continue to act as a distributor to provide covered products through the date of the EXTENSION noted above. This is a final extension that is only valid through the period of time indicated above. This will be the last extension offered. OptumRx maintains that our contracted Network Pharmacy Providers must source medications from an accredited source.”
2019 and Moving Forward
Although OptumRx has claimed that they would not be providing any further extensions twice, it is very possible that extensions will not be offered past December 31. If your company is in the VAWD process or has difficulty obtaining an extension, please reach out. More as it breaks!
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