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Exercise 4 – Pharmacy Pricing

In order to construct new plan setups, you must go into the ‘Pre-Production’ environment and create the new or updated elements.

Step 1. From CCT600, type on the command line ‘CMX000’ and press Enter.

01/13/2009 Rel 6.0 RxClaim Development: VB-05140 Sys: RXCDEV


4:12:51 Z106027 RxCLAIM Plan Administrator Menu Menu: CCT600

1. Eligibility/Claim Transaction
2. Product
3. Manual Claim
4. Plan
5. Price
6. Drug Utilization Review (DUR)
7. Provider
8. Profile
9. Batch Process
10. Miscellaneous Tables
11. Call Queue Menu
12. Client Specific Menu
13. RxMAX System

90. Signoff

Selection or Command
===> CMX000
F1=Help F3=Exit F4=Prompt F6=Wrk Msg F9=Retrieve
F12=Return F14=WRKSBMJOB F18=WRKSPLF F22=Calculator F23=Calendar

Step 2. Type 1 and press Enter to access the Pre-Production environment with existing production eligibility.

01/13/2009 Rel 6.0 RxClaim Development: VB-05140 Sys: RXCDEV


4:13:25 Z106027 User Change Control Menu Menu: CMX000

1. Pre-Production Env w/prod elig


2. Pre-Prodctn Env w/pre-prod elg
3. Production Environment
4. Administrator
5. Prod Envrnmnt w/Pre Prod Elig
6. PDCC Control
7. Work With Error Codes
8. Work With User Elec Details
9. W/W Application Areas
10. W/W Glossary Entries
11. W/W Glossary to Appl Area Xref

90. Signoff

Selection or Command
===> 1
F1=Help F3=Exit F4=Prompt F6=Wrk Msg F9=Retrieve
F12=Return F14=WRKSBMJOB F18=WRKSPLF F22=Calculator F23=Calendar

Step 3 – Type a 2 next to the BAR you created during Exercise 2 and press Enter to edit.

APBRU002 DISPLAY Caremark RxCLAIM - QAT 7/04/05


CBONNER BAR Selection Screen 13:04:51
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Type options, press Enter. 2=Edit 3=Close 4=Cancel 5=View BAR History
B=Process Batch Claims 9=View Users P=Promote X=Unschedule
C=Concurrency Rpt O=Out of Sync Rpt G=Bar Change Report
Active/New BARs Only

BAR Req Sched Sched Batch


? BAR ID Description Sts Type Err Env Date Time
Claims
2 10701250 01 RxClaim Training - CBo ACT PRE 0:00:00

F3=Exit F6=Add BAR F8=Display ALL or NEW/ACT or RQS F12=Previous

Step 4 – From the CCT600 menu, type 5 on the command line and press Enter.

01/13/2009 Rel 6.0 RxClaim Development: VB-05140 Sys: RXCDEV


4:17:27 Z106027 RxCLAIM Plan Administrator Menu Menu: CCT600

1. Eligibility/Claim Transaction
2. Product
3. Manual Claim
4. Plan
5. Price
6. Drug Utilization Review (DUR)
7. Provider
8. Profile
9. Batch Process
10. Miscellaneous Tables
11. Call Queue Menu
12. Client Specific Menu
13. RxMAX System

90. Signoff

Selection or Command
===> 5
F1=Help F3=Exit F4=Prompt F6=Wrk Msg F9=Retrieve
F12=Return F14=WRKSBMJOB F18=WRKSPLF F22=Calculator F23=Calendar

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Step 5 – From the Price Maintenance menu, type 1 and press Enter.

01/13/2009 Rel 6.0 RxClaim Development: VB-05140 Sys: RXCDEV


4:18:01 Z106027 RxCLAIM Price Maintenance Menu: CCT650

1. Price 16. Price Schedule Attachment Rpt


2. Fee Schedule 17. Medicare TA Benefit Schedule
3. Tax Schedule 18. Health Reimbursement Acct Schd
4. Copay Schedule 19. ICL/MedD BenMax Schedule
5. Deductible Schedule 20. CPP Schedule
6. OOP Within MedD Schedule
7. OOP/TrOOP Max Schedule
8. Benefit Max Schedule
9. Accumulation Codes
10. Adjustment Reason Codes
11. MAC List
12. State Fee Schedule
13. Minimum/Maximum Copay Calc Cds
14. Benefit Max Drug Status Sched
15. Health Spending Account Sched

Selection or Command
===> 1
F1=Help F3=Exit F4=Prompt F6=Wrk Msg F9=Retrieve
F12=Return F14=WRKSBMJOB F18=WRKSPLF F22=Calculator F23=Calendar

Step 6 – Type 1 and press Enter to create Pharmacy pricing ( This Pricing schedule is used to set
the price of the drug as specified by the Pharmacy .It is implemented while adding the Price
Schedule Override in setting up the Plan for specific pricing options).

01/13/2009 Rel 6.0 RxClaim Development: VB-05140 Sys: RXCDEV


4:18:39 Z106027 RxCLAIM Price Inquiry Menu: CCT653

1. Pharmacy Price
2. Client Price
3. Patient Pay
4. Benefit Pricing Profile
5. Original Pricing
6. Cross Reference Base
7. Claim Pricing Priority Table

Selection or Command
===> 1
F1=Help F3=Exit F4=Prompt F6=Wrk Msg F9=Retrieve
F12=Return F14=WRKSBMJOB F18=WRKSPLF F22=Calculator F23=Calendar

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Step 7 – This screen contains a list of all the existing Pharmacy Price schedules in alpha-numeric
order.

Press F6 key to add a new price schedule.

APSCR02B DISPLAY BAR 88728734-61 TESTING D02 (P-ELIG) 1/13/09


Z106027 Price Schedule 4:23:18
Pharmacy Price
Type 'PR'

Type options, press Enter. 0=Note 2=Edit 3=Copy 4=Delete 5=Display


7=Cross Reference Base

? Schedule Description
(219ELPR 219ELPR
$$KKSKS
$$MMTEST
$TESTMM
***TEST*** ** TEST
**TEST** *TEST
**TEST*** *TEST
*AJP001 *AMY'S TEST
*AWTEST *AWTEST PRICE
*CRSRX +

F3=Exit F6=Add F12=Previous

Step 8 – For the price schedule definition you can give any name, here type in your initials +
“RTL1”.

APSCR09B ADD BAR 88728734-61 TESTING D02 (P-ELIG) 1/13/09


Z106027 Price Schedule 4:24:03

Price Schedule

Schedule Type PR Pharmacy Price

Client Code

F3=Exit F4=Prompt

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Step 9 – Client code can be used to limit the price schedule to a specific carrier. This is
particularly needed when in order that only those members under that specific Carrier will be able
to use this Price Schedule. Place your cursor on the Client Code field and press F4. Your screen
will display a list of available client codes. Type TRAIN at the top of the screen and press Enter
to scroll to that selection. Type 1 next to Carrier TRAIN and press Enter.

APCCF05B DISPLAY BAR 88728734-61 TESTING D02 (P-ELIG) 1/13/09


Z106027 Carrier-Client Code 4:25:04

Type options, press Enter. 1=Select 5=Display

? Carrier Carrier Name Client


1 *AJPTEST *AMY'S TEST CARRIER TEST
*NONE *NONE *NONE
*5974047 STEP COPAY *5974047
AAA_001BB ABCD TEST
AAAAAAAAA TEST TEST
AAAAA1212 NEW CAARR ABH
AAACARRIE TEST CARRIER 123 TEST
AACARRIER TEST CARRIER TEST
AAR_0011 CAGM 36242 AAR_0011
AAR_0021 CAGM 36242 AAR_0021
AAR_0031 CAGM 36242 AAR_0031
AAR_0041 CAGM 36242 AAR_0041
AAR_0051 CAGM 36242 AAR_0051
ABC_001EF FOR TRNSFIL ABC_001EF +

F3=Exit F12=Previous F15=Search by Carrier Name

Step 10 – You are returned to the Add screen with a prompt to confirm that you want to create the
schedule. Type ‘Y’ and you will automatically go to the next screen.

APSCR09B ADD BAR 10701250-01 RxClaim Tr QAT (PPELIG) 7/05/05


CBONNER Price Schedule 12:26:54

Price Schedule CBRTL1

Schedule Type PR Pharmacy Price

Client Code TRAIN

F3=Exit F4=Prompt
CONFIRM: N (Y/N)

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Step 11 – Type in a description to match the example below. This description contains abbreviations
that would be common in naming a production price schedule.

Type a ‘1’ in the Table Number field and press Enter.

APSCR04BI BAR 88728734-61 TESTING D02 (P-ELIG) 1/13/09


Z106027 Price Schedule Tables 4:26:45
Pharmacy Price
Price Schedule (219ELPR Type PR Description 219ELPR
Type Table number, press Enter. 1
--------- Paid --------- ------- Captured -------
Standard 1. Y 21. N

All/Formulary All/Formulary
Compound 2. Y 10. Y 22. N 30. N
Formulary Formulary
Generic (Y) 4. Y 11. N 24. N 31. N
Brand
Original (O) 5. Y 12. N 25. N 32. N
Single-Source (N) 6. Y 13. N 26. N 33. N
Multi-Source (M) 7. Y 14. N 27. N 34. N
Sales Tax C Yes; Allow Sbm % and Flat
Allow $0.00 Sbm Cost N

Added 8/10/07 Changed 8/10/07 User IBMMPALA N


F3=Exit F12=Previous F14=Notes

Step 12 – Fill in the pricing table to match the illustration below. Any drug that is not formulary
and not a compound will price with this table. Press Enter and then respond Y to confirm.

RCPTF005 ADD BAR 10701250-01 RxClaim Tr QAT (PPELIG) 7/05/05


CBONNER Price Table Detail Page 1 of 2 12:29:30
Price Schedule CBRTL1 Table Paid Standard
Schedule Type PR Pharmacy Price
-------------------------------- Drug Cost -----------------------------------
AWP Cost Source & Comparison M MEDISPAN (MS)
Cost Code 1 1 AWP at 86.00 %
Cost Code 2 at %
Cost Code 3 at %
Cost Comparison Code F L S | C1 Flat Amt Calc Cde

------------- Fee ------------ ----- Tax ------ --------- Price ----------


Fee 1 1.50 Amount Price
Comparison Code C
Fee 2 Sched Sched STD L CDF|
SM|U:GD UT=CT F1
Fee 3 Step# Minimum Cost + Fee

Percent Calc Cde Calc Code 9

Added Changed User


+
F3=Exit F12=Previous

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CONFIRM: Y (Y/N)

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Step 13 – You are automatically returned to the pharmacy price schedule screen. Change the
indicator to ‘Y’ for Formulary Compound (2), Generic (4), and Brand-Original (5) tables. Change the
indicator to ‘C’ for the Sales Tax field. The price schedule here is setup for products that are
compound, generic, original. Price for any other product will be picked up from standard price
schedule defined in option 1. Price Schedules can be setup for paid and captured claims based on the
products in the formulary list or not. Press Enter.

APSCR04B CHANGE BAR 10701250-01 RxClaim Tr QAT (PPELIG) 7/05/05


CBONNER Price Schedule Tables 12:31:50
Pharmacy Price
Price Schedule CBRTL1 Type PR Description RTL86%AWP+1.50/MAC01+1.50
Type Table number, press Enter.
--------- Paid --------- ------- Captured -------
Standard 1. Y 21. Y

All/Formulary Non-Formulary All/Formulary Non-


Formulary
Compound 2. Y 10. N 22. N
30. N
Formulary Non-Formulary Formulary Non-
Formulary
Generic (Y) 4. Y 11. N 24. N
31. N
Brand
Original (O) 5. Y 12. N 25. N
32. N
Single-Source (N) 6. N 13. N 26. N
33. N
Multi-Source (M) 7. N 14. N 27. N
34. N
Sales Tax C Yes; Allow Sbm % and Flat
Allow $0.00 Sbm Cost N

Added 7/05/05 Changed 7/05/05 User CBONNER

F3=Exit F10=Copy F12=Previous F14=Note F17=Client Price assoc

Step 14 – Type 5 in the Table number field at the top of the price schedule and press Enter.

APSCR04B CHANGE BAR 10701250-01 RxClaim Tr QAT (PPELIG) 7/05/05


CBONNER Price Schedule Tables 12:31:50
Pharmacy Price
Price Schedule CBRTL1 Type PR Description RTL86%AWP+1.50/MAC01+1.50
Type Table number, press Enter. 5
--------- Paid --------- ------- Captured -------
Standard 1. Y 21. Y

All/Formulary Non-Formulary All/Formulary Non-


Formulary
Compound 2. Y 10. N 22. N
30. N
Formulary Non-Formulary Formulary Non-
Formulary
Generic (Y) 4. Y 11. N 24. N
31. N
Brand
Original (O) 5. Y 12. N 25. N
32. N
Single-Source (N) 6. N 13. N 26. N
33. N
Multi-Source (M) 7. N 14. N 27. N
34. N
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Sales Tax C Yes; Allow Sbm % and Flat
Allow $0.00 Sbm Cost N

Added 7/05/05 Changed 7/05/05 User CBONNER

F3=Exit F10=Copy F12=Previous F14=Note F17=Client Price assoc

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Step 15 - You are creating the price table for formulary “O” drugs. “O” is the generic indicator.
It means that the drug is the original “brand-name” drug, but that generics are available.

Fill in the information as detailed below. Press Enter.

RCPTF005 ADD BAR 10701250-01 RxClaim Tr QAT (PPELIG) 7/05/05


CBONNER Price Table Detail Page 1 of 2 12:34:41
Price Schedule CBRTL1 Table Paid Formulary Original Brand (O)
Schedule Type PR Pharmacy Price
-------------------------------- Drug Cost -----------------------------------
AWP Cost Source & Comparison M
Cost Code 1 1 at 86 %
Cost Code 2 Z at 100 %
Cost Code 3 at %
Cost Comparison Code G Flat Amt Calc Cde

------------- Fee ------------ ----- Tax ------ --------- Price ----------


Fee 1 1.50 Amount Price
Comparison Code C
Fee 2 Sched Sched STD
Fee 3 Step# Minimum Cost + Fee
Percent Calc Cde Calc Code 9

Added Changed User


+
F3=Exit F12=Previous

Step 16 - You will be prompted for the name of the MAC List. Put your cursor on the MAC List 2
field and press F4. MAC is the maximum allowable cost. MAC list is the list of all products for
which the price schedule check for the price. In this case, the price for that product should not go
above 100%.

RCPTF005 ADD BAR 10701250-01 RxClaim Tr QAT (PPELIG) 7/05/05


CBONNER Price Table Detail Page 1 of 2 12:37:37
Price Schedule CBRTL1 Table Paid Formulary Original Brand (O)
Schedule Type PR Pharmacy Price
-------------------------------- Drug Cost -----------------------------------
AWP Cost Source & Comparison M MEDISPAN (MS)
Cost Code 1 1 AWP at 86.00 %
Cost Code 2 Z MAC List MAC List 2 at 100.00 %
Cost Code 3 at %
Cost Comparison Code G 1278 L S|C1;L S|C1|C2|C3 Flat Amt Calc Cde

------------- Fee ------------ ----- Tax ------ --------- Price ----------


Fee 1 1.50 Amount Price
Comparison Code C
Fee 2 Sched Sched STD L CDF|
SM|U:GD UT=CT F1
Fee 3 Step# Minimum Cost + Fee

Percent Calc Cde Calc Code 9

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Added Changed User
+
F3=Exit F12=Previous
MAC List must be entered.

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Step 17 – Type ‘1’ next to the entry for *DEFAULT - MAC01 and press Enter

RCMCL005 SELECT BAR 10701250-01 RxClaim Tr QAT (PPELIG)


7/05/05
CBONNER Select MAC List 12:38:31

Type options, press Enter. 1=Select 7=List

? Carrier Name MAC List Name


1 *DEFAULT Default Carrier Name MAC01 *MAC01
*DEFAULT Default Carrier Name MAC02 *MAC02
*DEFAULT Default Carrier Name MAC03 *MAC03
*DEFAULT Default Carrier Name MAC04 *MAC04
*DEFAULT Default Carrier Name MAC05 *MAC05
*DEFAULT Default Carrier Name MAC06 *MAC06
*DEFAULT Default Carrier Name MAC07 *MAC07
*DEFAULT Default Carrier Name MAC08 *MAC08
*DEFAULT Default Carrier Name MAC09 *DEFAULT MAC09
*DEFAULT Default Carrier Name MAC10 *MAC10
*DEFAULT Default Carrier Name MAC11 *MAC11
*DEFAULT Default Carrier Name MAC12 *MAC12
*DEFAULT Default Carrier Name MAC13 *DEFAULT MAC13 +

F3=Exit F12=Previous

Step 18 – You are returned to the Price Detail screen where the MAC list field for Cost Code 2 now
contains MAC01. Press Enter and confirm with Y at the prompt

RCPTF005 ADD BAR 10701250-01 RxClaim Tr QAT (PPELIG) 7/05/05


CBONNER Price Table Detail Page 1 of 2 12:40:23
Price Schedule CBRTL1 Table Paid Formulary Original Brand (O)
Schedule Type PR Pharmacy Price
-------------------------------- Drug Cost -----------------------------------
AWP Cost Source & Comparison M MEDISPAN (MS)
Cost Code 1 1 AWP at 86.00 %
Cost Code 2 Z MAC List MAC List 2 MAC01 at 100.00 %
Cost Code 3 at %
Cost Comparison Code G 1278 L S|C1;L S|C1|C2|C3 Flat Amt Calc Cde

------------- Fee ------------ ----- Tax ------ --------- Price ----------


Fee 1 1.50 Amount Price
Comparison Code C
Fee 2 Sched Sched STD L CDF|
SM|U:GD UT=CT F1
Fee 3 Step# Minimum Cost + Fee

Percent Calc Cde Calc Code 9

Added Changed User


+
F3=Exit F12=Previous
CONFIRM: Y (Y/N)

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Step 19 – Type 4 and press Enter. This table is for formulary “Y” drugs. “Y” is the multi-source
indicator. It means that the drug is a generic drug.

Fill in the pricing table to match the illustration below. Press Enter. Type MAC01 in field for MAC
List 2 and press Enter. Confirm with Y at the prompt.

RCPTF005 ADD BAR 10701250-01 RxClaim Tr QAT (PPELIG) 7/05/05


CBONNER Price Table Detail Page 1 of 2 12:43:41
Price Schedule CBRTL1 Table Paid Formulary Generic (Y)
Schedule Type PR Pharmacy Price
-------------------------------- Drug Cost -----------------------------------
AWP Cost Source & Comparison M MEDISPAN (MS)
Cost Code 1 1 AWP at 86.00 %
Cost Code 2 Z MAC List MAC List 2 MAC01 at 100.00 %
Cost Code 3 at %
Cost Comparison Code D L S | C1 | C2 | C3 Flat Amt Calc Cde

------------- Fee ------------ ----- Tax ------ --------- Price ----------


Fee 1 1.50 Amount Price
Comparison Code C
Fee 2 Sched Sched STD L CDF|
SM|U:GD UT=CT F1
Fee 3 Step# Minimum Cost + Fee

Percent Calc Cde Calc Code 9

Added Changed User


+
F3=Exit F12=Previous
CONFIRM: Y (Y/N)

Step 20 – Type 2 and press Enter. This table is used to price compounds.

Fill in the pricing table to match the illustration below. Compounds will be set up in the plan to
be priced using the most expensive ingredient. Note that the drug cost is calculated at 300% of AWP.
This is done to compensate the pharmacy for additional ingredients and labor in preparing the
compound.

Press Enter and confirm with a Y at the prompt.

RCPTF005 ADD BAR 10701250-01 RxClaim Tr QAT (PPELIG) 7/05/05


CBONNER Price Table Detail Page 1 of 2 12:45:10
Price Schedule CBRTL1 Table Paid Cmpnd All/Formulary
Schedule Type PR Pharmacy Price
-------------------------------- Drug Cost -----------------------------------
AWP Cost Source & Comparison M MEDISPAN (MS)
Cost Code 1 1 AWP at 300.00 %
Cost Code 2 at %
Cost Code 3 at %
Cost Comparison Code F L S | C1 Flat Amt Calc Cde

------------- Fee ------------ ----- Tax ------ --------- Price ----------


Fee 1 1.50 Amount Price
Comparison Code C
Fee 2 Sched Sched STD L CDF|
SM|U:GD UT=CT F1

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Caremark Confidential
Fee 3 Step# Minimum Cost + Fee

Percent Calc Cde Calc Code 9

Added Changed User


+
F3=Exit F12=Previous
CONFIRM: Y (Y/N)

Step 21 – Press F12 to return to the Price Schedule list. Copy the price schedule you just created.
Type 3 next to the price schedule on the list and press Enter.

APSCR02B DISPLAY BAR 10701250-01 RxClaim Tr QAT (PPELIG) 7/05/05


CBONNER Price Schedule 12:50:22
Pharmacy Price
Type 'PR'
CBRTL1

Type options, press Enter. 0=Note 2=Edit 3=Copy 4=Delete 5=Display

? Schedule Description
3 CBRTL1 RTL86%AWP+1.50/MAC01+1.50
CDHP_PR FOR CDHP QA TESTING
CLACWH0630
CLADD%NEG
CLCCPR002 CAL CD PR 002
CLPS0628 TEST
CLPS0630AA TEST 0630AA
CLTAMT0630
CLTEST0001 TEST
CLTOTAMT 1EST TOTAL AMOUNT
CLTOTAMT00 TEST +

F3=Exit F6=Add F12=Previous

Step 22 – Type in a price schedule definition, changing the last digit to ‘2’. Type in a similar
description with 1.50 replaced by 2.00 which will be the dispensing fee for the new schedule. Type
TRAIN for the Client Code. Press Enter and confirm with Y.

APSCR06B ENTER BAR 10701250-01 RxClaim Tr QAT (PPELIG) 7/05/05


CBONNER Copy Price Schedule 12:52:03

Description

From: Price Schedule CBRTL1 RTL86%AWP+1.50/MAC01+1.50


Type PR Pharmacy Price

To: Price Schedule CBRTL2 RTL86%AWP+2.00/MAC01+2.00


Type PR Pharmacy Price
Client Code TRAIN

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F3=Exit F12=Previous
CONFIRM: Y (Y/N)

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Step 23 – Type a 2 next to the new price schedule and press Enter.

APSCR02B DISPLAY BAR 10701250-01 RxClaim Tr QAT (PPELIG) 7/05/05


CBONNER Price Schedule 13:00:08
Pharmacy Price
Type 'PR'
CBRTL1

Type options, press Enter. 0=Note 2=Edit 3=Copy 4=Delete 5=Display

? Schedule Description
CBRTL1 RTL86%AWP+1.50/MAC01+1.50
2 CBRTL2 RTL86%AWP+2.00/MAC01+2.00
CDHP_PR FOR CDHP QA TESTING
CLACWH0630
CLADD%NEG
CLCCPR002 CAL CD PR 002
CLPS0628 TEST
CLPS0630AA TEST 0630AA
CLTAMT0630
CLTEST0001 TEST
CLTOTAMT 1EST TOTAL AMOUNT +

F3=Exit F6=Add F12=Previous

Step 24 – Type 1 and press Enter to change the Standard pricing table.

APSCR04B CHANGE Caremark RxCLAIM - Jan Q01 12/28/04


CBONNER Price Schedule Tables 13:38:43
Pharmacy Price
Price Schedule CBRTL2 Type PR Description RTL86%AWP+2.00/MAC01+2.00
Type Table number, press Enter. 1
--------- Paid --------- ------- Captured -------
Standard 1. Y 21. Y

All/Formulary All/Formulary
Compound 2. Y 22. N

Formulary Formulary
Generic (Y) 4. Y 24. N

Brand
Original (O) 5. Y 25. N

Single-Source (N) 6. N 26. N

Multi-Source (M) 7. N 27. N

Sales Tax Y Yes; R if Sbm % and Flat


Allow $0.00 Sbm Cost N

Added 12/28/04 Changed 12/28/04 User CBONNER

F3=Exit F10=Copy F12=Previous F14=Note F17=Client Price assoc

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Step 25 – Update the standard pricing table, making the fee $2.00.

Press Enter to update and confirm with a Y. Press F12 to return to the previous screen.

RCPTF005 CHANGE Caremark RxCLAIM - Jan Q01 12/28/04


CBONNER Price Table Detail Page 1 of 2 13:39:17
Price Schedule CBRTL2 Table Paid Standard
Schedule Type PR Pharmacy Price
-------------------------------- Drug Cost -----------------------------------
AWP Cost Source & Comparison M MEDISPAN (MS)
Cost Code 1 1 AWP at 86.00 %
Cost Code 2 at %
Cost Code 3 at %
Cost Comparison Code F L S | C1 Flat Amt Calc Cde

------------- Fee ------------ ----- Tax ------ --------- Price ----------


Fee 1 2.00 Amount Price
Comparison Code C
Fee 2 Sched Sched STD L CDF|
SM|U:GD UT=CT F1
Fee 3 Step# Minimum Cost + Fee

Percent Calc Cde Calc Code 9

Added 12/28/04 Changed 12/28/04 User CBONNER


+
F3=Exit F11=Delete F12=Previous
CONFIRM: Y (Y/N)

Step 26 – Change the fee to $2.00 for the Formulary O, Formulary Y and Compound tables. Then, press
F12 to return to the Price Schedule list screen.

Step 27 - Copy the price schedule you just created. Type 3 next to the price schedule on the list
and press Enter.

APSCR02B DISPLAY BAR 10701250-01 RxClaim Tr QAT (PPELIG) 7/05/05


CBONNER Price Schedule 13:05:16
Pharmacy Price
Type 'PR'
CBRTL2

Type options, press Enter. 0=Note 2=Edit 3=Copy 4=Delete 5=Display

? Schedule Description
3 CBRTL2 RTL86%AWP+2.00/MAC01+2.00
CDHP_PR FOR CDHP QA TESTING
CLACWH0630
CLADD%NEG
CLCCPR002 CAL CD PR 002
CLPS0628 TEST
CLPS0630AA TEST 0630AA
CLTAMT0630
CLTEST0001 TEST
CLTOTAMT 1EST TOTAL AMOUNT
CLTOTAMT00 TEST +

17
Caremark Confidential
F3=Exit F6=Add F12=Previous

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Step 28 – Type in a price schedule definition= your initials + “MAIL”. Type in a description
identifying this as a Mail Pharmacy price schedule. Type TRAIN for the Client Code. Press Enter
and confirm with Y.

APSCR06B ENTER BAR 10701250-01 RxClaim Tr QAT (PPELIG) 7/05/05


CBONNER Copy Price Schedule 13:06:38

Description

From: Price Schedule CBRTL2 RTL86%AWP+2.00/MAC01+2.00


Type PR Pharmacy Price

To: Price Schedule CBMAIL CB MAIL PHARMACY NET


Type PR Pharmacy Price
Client Code TRAIN

F3=Exit F12=Previous
CONFIRM: Y (Y/N)

Step 29 - Type an 2 next to the new price schedule and press Enter.

APSCR02B DISPLAY BAR 10701250-01 RxClaim Tr QAT (PPELIG) 7/05/05


CBONNER Price Schedule 13:08:26
Pharmacy Price
Type 'PR'
CBMAIL

Type options, press Enter. 0=Note 2=Edit 3=Copy 4=Delete 5=Display

? Schedule Description
2 CBMAIL CB MAIL PHARMACY NET
CBRTL1 RTL86%AWP+1.50/MAC01+1.50
CBRTL2 RTL86%AWP+2.00/MAC01+2.00
CDHP_PR FOR CDHP QA TESTING
CLACWH0630
CLADD%NEG
CLCCPR002 CAL CD PR 002
CLPS0628 TEST
CLPS0630AA TEST 0630AA
CLTAMT0630
CLTEST0001 TEST +

F3=Exit F6=Add F12=Previous

19
Caremark Confidential
Step 30 – Type 1 and press Enter to edit the standard pricing table.

APSCR04B CHANGE BAR 10701250-01 RxClaim Tr QAT (PPELIG) 7/05/05


CBONNER Price Schedule Tables 13:09:49
Pharmacy Price
Price Schedule CBMAIL Type PR Description CB MAIL PHARMACY NET
Type Table number, press Enter. 1
--------- Paid --------- ------- Captured -------
Standard 1. Y 21. Y

All/Formulary Non-Formulary All/Formulary Non-


Formulary
Compound 2. Y 10. N 22. N
30. N
Formulary Non-Formulary Formulary Non-
Formulary
Generic (Y) 4. Y 11. N 24. N
31. N
Brand
Original (O) 5. Y 12. N 25. N
32. N
Single-Source (N) 6. N 13. N 26. N
33. N
Multi-Source (M) 7. N 14. N 27. N
34. N
Sales Tax C Yes; Allow Sbm % and Flat
Allow $0.00 Sbm Cost N

Added 7/05/05 Changed 7/05/05 User CBONNER

F3=Exit F10=Copy F12=Previous F14=Note F17=Client Price assoc

Step 31 - Update the standard pricing table to change Cost Code 1 to 84%. 84% means that the
pharmacy will charge 84% of the AWP of the product.

Press Enter to update and type Y to confirm. Press F12 to return to the previous screen.

RCPTF005 CHANGE BAR 10701250-01 RxClaim Tr QAT (PPELIG) 7/05/05


CBONNER Price Table Detail Page 1 of 2 13:10:52
Price Schedule CBMAIL Table Paid Standard
Schedule Type PR Pharmacy Price
-------------------------------- Drug Cost -----------------------------------
AWP Cost Source & Comparison M MEDISPAN (MS)
Cost Code 1 1 AWP at 84.00 %
Cost Code 2 at %
Cost Code 3 at %
Cost Comparison Code F L S | C1 Flat Amt Calc Cde

------------- Fee ------------ ----- Tax ------ --------- Price ----------


Fee 1 2.00 Amount Price
Comparison Code C
Fee 2 Sched Sched STD L CDF|
SM|U:GD UT=CT F1
Fee 3 Step# Minimum Cost + Fee

Percent Calc Cde Calc Code 9

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Added 7/05/05 Changed 7/05/05 User CBONNER
+
F3=Exit F11=Delete F12=Previous
CONFIRM: Y (Y/N)

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Step 32 - Change the Cost Code 1 percentage to 84% for both the Formulary O and Formulary Y tables.

Step 33 - The CBMAIL price schedule does not have a Compound price table. Set the flag for compound
to ‘N’.

APSCR04B CHANGE BAR 10701250-01 RxClaim Tr QAT (PPELIG) 7/05/05


CBONNER Price Schedule Tables 13:13:02
Pharmacy Price
Price Schedule CBMAIL Type PR Description CB MAIL PHARMACY NET
Type Table number, press Enter.
--------- Paid --------- ------- Captured -------
Standard 1. Y 21. Y

All/Formulary Non-Formulary All/Formulary Non-


Formulary
Compound 2. N 10. N 22. N
30. N
Formulary Non-Formulary Formulary Non-
Formulary
Generic (Y) 4. Y 11. N 24. N
31. N
Brand
Original (O) 5. Y 12. N 25. N
32. N
Single-Source (N) 6. N 13. N 26. N
33. N
Multi-Source (M) 7. N 14. N 27. N
34. N
Sales Tax C Yes; Allow Sbm % and Flat
Allow $0.00 Sbm Cost N

Added 7/05/05 Changed 7/05/05 User CBONNER

F3=Exit F10=Copy F12=Previous F14=Note F17=Client Price assoc

Step 34 – Press F3 5 times to return to th BAR selection screen. Your BAR should still display ACT status. F3 2 more times to exit Plan Database.
Always be sure to totally exit from Plan Database so that your changes are correctly stored for the BAR.

Exercise 4 is complete.

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Caremark Confidential

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