Friday, December 24, 2021

OptumRX Letter 5 years later

Image result for quotes for trust but verify The quote, “trust, but verify,” is actually an old Russian proverb that President Ronald Reagan used during arms control negotiations with Russian President Mikhail Gorbachev in the 1980s. He learned the quote in the Russian language and used the phrase frequently as he and President Gorbachev worked to prevent the promise of mutually assured destruction if the two superpowers failed to get along during that era. 

Our message for today is not really a history lesson but more of wake up call for those of you in the pharmaceutical space , or looking to go into. 

FiveYears Ago OptumRx one the largest pharmacy care services, and the pharmacy that manages our health care plan as well, Sent a letter to all it's member/partner pharmacies.  Informing them that if they were not VAWD Certified then they might likely no longer be able to participate.  


IMPORTANT INFORMATION REGARDING Pharmacy – Wholesalers
Effective Date: 10/01/2016  OptumRx

Verified & Accredited Wholesalers

As a Network Pharmacy Provider and participant in OptumRx’s Networks, your pharmacy must comply with the terms and conditions of the Agreement and the Provider Manual (“Manual”). The OptumRx 2016 Provider Manual is available on-line at http://learn.optumrx.com/pharmacymanual. Information on accessing the OptumRx BINs and Payer Sheets are contained within this Manual.
Effective October 1, 2016, changes will be made to the provider manual stating that your pharmacy MUST purchase ALL medications dispensed for claims being dispensed to OptumRx participants from a Verified- Accredited- Wholesale Distributor (VAWD). This accreditation program is offered through the National Association of Boards of Pharmacy (NABP).


So what is this all about? 

I see it as a new way to trust but verify , as the business landscape changes and we need to push the liability buck (so to speak) , it is a new way to verify your business partners are real and are doing things in the correct manner. 
We saw a similar issue with the DSCSA and the requirements to check licenses on all your trading partners.  They want to trust you with the business but need to verify you are doing things right and know you can prove that fact, easily and quickly in the event of a question. 

The long and short of is that your business practices, SYSTEMS AND PROCESSES,  and people are now under more and more scrutiny.  It's not about cutting the little guy out,  as many may think, as we at TSH have both large and small clients who are VAWD Accredited. 

If you are still running your business  in spreadsheets and quick books , the time has come for you to look at the landscape and ask yourself how long will it be before you need a system with audit, security and business process management designed for the healthcare industry? 

That was the message of five years ago, many have made the jump and many have been left behind, but as more and more regulatory bodies come in the the market and offer solutions and addons , TSH continues as the only fully integrated solutions with a compliance guarantee. 

Are you ready to partner with a solution and team that knows healthcare and pharma?




For more information on TSH or MDS call The Systems House, Inc. at 1-800- MDS-5556.
 Or send a message to sales@tshinc.com

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