by Jared Staheli
July 8th, 2015
The FIs get drug prices from the carrier for drugs not listed on the SDP.
Carriers prepare a list of the drug payment allowance limits updates (or new file depending upon local requirements) to the claims system.
Carriers distribute, free of charge, the updated limits in an agreed upon format directly to the FIs in their jurisdiction.
Carriers should contact each FI to determine the preferred method of transmission. Carriers are to send this information to all FIs they routinely deal with. If this method of obtaining payment allowance updates does not work for any FI, the carrier must contact the appropriate RO office.