The Union has received a Labor Notice regarding coding issues that impacted certain mail-order (Maintenance Choice\/mail service) prescription drug claims across multiple medical plan options, under NIC, Mobility Purple, West CWA and IBEW, and Southwest.<\/p>\n\n\n\n
These issues impacted mail-order prescriptions only; retail pharmacy copays were not affected. The notice outlines the identified issues and the corrective actions currently underway.<\/p>\n\n\n\n
<\/p>\n\n\n\n
Summary of Identified Issues<\/strong>:<\/p>\n\n\n\n Issue #1 \u2013 Missing Coinsurance at Mail<\/em><\/strong><\/p>\n\n\n\n Timeframe:<\/strong> January 1, 2025 \u2013 May 14, 2026<\/p>\n\n\n\n Description:<\/strong> Coinsurance was not applied to certain mail-order prescriptions.<\/p>\n\n\n\n Member Impact:<\/strong> Members paid $0 copays for generics and preferred brand drugs when coinsurance should have been applied.<\/p>\n\n\n\n <\/p>\n\n\n\n Issue #2 \u2013 Mail Coinsurance Overcharge (20% vs. 10%)<\/em><\/strong><\/p>\n\n\n\n Timeframe:<\/strong> January 1, 2025 \u2013 May 14, 2026<\/p>\n\n\n\n What happened:<\/strong> Mail coinsurance was set at 20% instead of 10% for generic & preferred brands.<\/p>\n\n\n\n Member impact:<\/strong> Members paid higher-than-expected coinsurance.<\/p>\n\n\n\n <\/p>\n\n\n\n Issue #3 \u2013 Specialty Coinsurance (10% vs. 20%)<\/em><\/strong><\/p>\n\n\n\n Timeframe:<\/strong> January 1, 2025 \u2013 December 31, 2025<\/p>\n\n\n\n What happened:<\/strong> Coinsurance was set at 10% vs 20%.<\/p>\n\n\n\n Member impact:<\/strong> Minimal, as most claims hit the $100 max, but some claims paid at a lower coinsurance<\/p>\n\n\n\n <\/p>\n\n\n\n Impacted Participant Counts<\/em><\/strong><\/p>\n\n\n\n NIC:<\/strong> 64 impacted members \/ 828 claims<\/p>\n\n\n\n Mobility Purple:<\/strong> 522 impacted members \/ 2,609 claims<\/p>\n\n\n\n West IBEW:<\/strong> Counts under 50 (not disclosed for confidentiality)<\/p>\n\n\n\n West CWA:<\/strong> 1,280 impacted members \/ 4,392 claims<\/p>\n\n\n\n Southwest:<\/strong> 3,087 impacted members \/ 10,694 claims<\/p>\n\n\n\n Counts fewer than 50 are not reported to maintain confidentiality and protect personal health information.<\/p>\n\n\n\n (*For clarification, a claim is each time a prescription is filled; for example, one person filling five prescriptions equals 5 claims, while 100 people filling two prescriptions each equals 200 claims.)<\/em><\/p>\n\n\n\n <\/p>\n\n\n\n Corrective Actions<\/em><\/strong><\/p>\n\n\n\n Caremark will reverse and reprocess all impacted claims. Members who were overcharged will receive refunds via mail. Members who were undercharged will not be billed, and those costs will be absorbed by Caremark. For additional questions, please advise your members to contact CVS Customer Care at 800-378-8851.<\/p>\n\n\n\n If you have any questions or need additional clarification to support member discussions, please let me know. President, CWA Local 6210<\/p>\n\n\n\n <\/p>\n","protected":false},"excerpt":{"rendered":" The Union has received a Labor Notice regarding coding issues that impacted certain mail-order (Maintenance Choice\/mail service) prescription drug claims across multiple medical plan options, under NIC, Mobility Purple, West CWA and IBEW, and Southwest. These issues impacted mail-order prescriptions only; retail pharmacy copays were not affected. The notice outlines the identified issues and the […]<\/p>\n","protected":false},"author":1,"featured_media":162,"comment_status":"closed","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"external_permalink":""},"categories":[8],"tags":[],"class_list":["post-160","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-local-updates"],"external_url":"","_links":{"self":[{"href":"https:\/\/cwa6210.org\/news\/wp-json\/wp\/v2\/posts\/160","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cwa6210.org\/news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cwa6210.org\/news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cwa6210.org\/news\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/cwa6210.org\/news\/wp-json\/wp\/v2\/comments?post=160"}],"version-history":[{"count":1,"href":"https:\/\/cwa6210.org\/news\/wp-json\/wp\/v2\/posts\/160\/revisions"}],"predecessor-version":[{"id":161,"href":"https:\/\/cwa6210.org\/news\/wp-json\/wp\/v2\/posts\/160\/revisions\/161"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cwa6210.org\/news\/wp-json\/wp\/v2\/media\/162"}],"wp:attachment":[{"href":"https:\/\/cwa6210.org\/news\/wp-json\/wp\/v2\/media?parent=160"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cwa6210.org\/news\/wp-json\/wp\/v2\/categories?post=160"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cwa6210.org\/news\/wp-json\/wp\/v2\/tags?post=160"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Jim Winsett<\/p>\n\n\n\n