• ePrescribing

  • Affinity Health Plan supports e-prescribing as an important element in improving the quality of patient care. In July 2006, the Institute of Medicine reported e-prescribing is reducing medication errors and enhancing patient safety. Developing standards to facilitate e-prescribing is also one of the government’s key action items to expedite the adoption of electronic medical records and build a national electronic health information infrastructure.

    On this page, we provide information to help our providers electronically send accurate, error-free and understandable prescriptions directly to a pharmacy. For Medicaid, please refer to the current guidance from NYSDOH. For Medicare, eligible providers may receive incentives for e-prescribing as detailed below.

    2009 E-Prescribing Medicare Incentive Program Provisions

    Reporting Periods and Incentive Amounts
    The 2009 reporting period is the entire calendar year. The e-prescribing incentive amount is based on a percent of the Secretary of Health and Human Services’ estimate (based on claims submitted not later than two months after the end of the reporting period) of the allowed charges for all covered professional services furnished by the eligible professional during the reporting period. The e-prescribing incentive percent amount for reporting years 2009 and 2010 is 2.0 percent; for reporting years 2011 and 2012 it is 1.0 percent; and for reporting year 2013 the incentive percent amount is 0.5 percent.

    Adjustment to E-Prescribing Incentive (Reduction in Medicare Payments)
    Starting in 2012, Medicare eligible professionals will be subject to a payment differential if they do not adopt e-prescribing. The MIPPA law states that if an eligible professional is not determined by CMS to be a “successful electronic prescriber,” the professional’s fee schedule payments will be reduced by 1.0 percent in 2012, by 1.5 percent for 2013, and by 2.0 percent for 2014 and each subsequent year.

    Additional Requirements

    In order to earn an incentive payment under the 2009 E-Prescribing Incentive Program, the e-prescribing measure’s denominator codes for professional offices and outpatient services must represent at least 10 percent of the total of allowed charges for all such covered services furnished by the eligible professional.

    Qualifying as a “Successful Electronic Prescriber”
    In order to qualify for an incentive payment under the 2009 E-Prescribing Incentive Program, a “successful electronic prescriber” is defined as an eligible professional who reports the e-prescribing measure in at least 50 percent of the applicable cases. Information on which cases are considered “applicable cases” for the incentive program may be found on CMS’ e-prescribing site at www.cms.hhs.gov/pqri.

    Determining a “Qualified” E-Prescribing System
    For 2009, the e-prescribing measure requires that an eligible professional must use a “qualified system” in order to be considered an adopter of e-prescribing technology. A “qualified system” must be able to:

    • Generate a medication list; Allow eligible professionals to select medications, print prescriptions, transmit prescriptions electronically and conduct safety checks (including automated prompts that offer information on the drug being prescribed, potential inappropriate dose or problems in how the drug comes in contact with the patient’s body (the “route of administration”), drug-to-drug interactions, allergy concerns, and warnings/cautions.); Provide information on lower cost alternatives; and Provide information on formulary or tiered formulary medications, patient eligibility, and authorization requirements that are received electronically from the patient’s drug plan.
    • CMS has updated their website with all of the new e-Prescribing measure specifications; you may log in at www.cms.hhs.gov/eprescribing.
  • Pharmacy Grievances

  • A grievance is a complaint about any problem you had with Affinity or one of our network pharmacies. Grievances do not relate to payment for or approval of a prescription drug, which are known as coverage determinations.

    Contact Us Immediately

    If you (your appointed representative) have a grievance, please:

    • Call Customer Service:
      TTY: 711
    • Fax: 866.633.7673
    • Mail:
      CVS Caremark Inc
      Part D Services
      P.O. Box 52000
      Phoenix, AZ 85072-2000

    Expedited Grievances

    If you are grieving the decision by Affinity not to expedite an initial determination or an appeal, you can request an expedited grievance. In these situations, Affinity will respond to you within 24 hours.