Visit OmedaRx™ for information about our pharmacy program and procedures, such as viewing the formulary and available generics, prior authorization instructions and medication limits on doses or refills.
You will find a list of covered medications (called a formulary) on the OmedaRX website. The formulary is a list of generic, brand name and specialty medications that are approved by an independent committee of doctors and pharmacists.
Some medications require pre-authorization (also called prior authorization) in order to be covered by the member's insurance plan. Visit the OmedaRx website to find out if your prescribed medication needs prior authorization.
Other information available on the OmedaRx website includes:
- Formulary updates and communications
- Instructions to request an exception
- Explanation of limits or quotas for commercial and Medicare Advantage
- Process for generic substitution, therapeutic interchange and step-therapy protocols
- Instructions for ordering specialty medications
- Medication policies - Note: All medications with associated medication policies are subject to prior authorization requirements.
New pharmacy benefits manager in 2018
We have chosen Prime Therapeutics (Prime) to be our pharmacy benefits manager (PBM) beginning January 1, 2018. Prime will administer our pharmacy benefits, provide customer service and manage an extensive retail network. Home delivery and specialty pharmacy services will be delivered through AllianceRx Walgreens Prime, a joint venture between Prime and Walgreens.
In addition, we are introducing new web-based tools to help you submit pharmacy pre-authorization requests and submit claims for medications administered in your office.
Join us and learn how to submit electronic pre-authorization requests and submit claims for medications in 2018 at our upcoming webinars. All webinars will last an hour and times listed are Pacific Time. Click on one of the links below to register. You will receive an email with a link that will allow you to join the webinar at the designated time.
CoverMyMeds works with electronic medical record systems (EMRs), health plans, pharmacy systems and providers to streamline the process of requesting pre-authorization for medications. This web-based tool allows you to submit and track requests online for your Regence patients, eliminating phone calls and faxes. You can be assured that the information sent will be complete, allowing a faster determination and response.
Attend one of these webinars with CoverMyMeds staff so you can learn more about this valuable tool and how you can integrate it into your clinical workflows:
You can also access a variety of provider support tools including a user guide and training videos from CoverMyMeds.
TransactRx is an online billing solution that allows you to submit claims online for outpatient medications and vaccines that are covered under your patient's pharmacy benefits, but provided in your office. This will help to streamline and automate claims processing for medications administered or dispensed in your office.
Beginning January 1, 2018, when you provide medications and vaccines in your office that are covered under our member's pharmacy benefits, we will require the claim to be submitted through TransactRx. If a claim for a medication that is covered under the pharmacy benefit is submitted through the medical plan, it will be denied and you will be instructed to resubmit the medication claim through TransactRx.
Attend one of these webinars with TransactRx staff so you can learn more about this valuable tool and how you can integrate it into your office workflows:
- November 28, 2017 at 9 am or noon
- November 29, 2017 at 9 am or noon
- December 5, 2017 at 9 am or noon
- December 6, 2017 at 9 am or noon
- January 9, 2018 at noon
- January 10, 2018 at 9 am
- January 23, 2018 at 9 am
- January 23, 2018 at noon
Please sign up to use TransactRx and review other provider support materials on their website.