MedImpact Healthcare Systems, Inc. (MedImpact) administers all CMSP prescription drug benefits provided through retail pharmacies. As approved by the CMSP Governing Board, there are two CMSP prescription drug benefits, the CMSP Primary Care Benefit and the CMSP Standard Benefit. Both of these benefits emphasize the use of generic medications, where available and appropriate, and require prior authorization and other utilization controls for selected medications based upon clinical efficacy, medical necessity and cost.
For prescriptions provided under the CMSP Standard Benefit, there are no cost-sharing requirements beyond the CMSP member’s monthly Share of Cost (SOC). For members that have a SOC, the pharmacy will handle these payments at the time the prescription is provided to the member, in the same way SOC payments have been handled in the past. If members do not have a SOC for their CMSP Standard Benefit, they will not be charged a SOC for their prescriptions.
For prescriptions provided under the CMSP Primary Care Benefit, there is a $5.00 copay for each prescription provided to the member. There is no additional SOC beyond the copay. Members with a SOC under the CMSP Standard Benefit and aid code 50 (undocumented) members may seek prescriptions under the CMSP Primary Care Benefit first.
Other Health Coverage
If a CMSP member has Other Health Coverage that provides coverage for prescription drugs, this coverage will be billed first, before coverage under the CMSP Primary Care Benefit or the CMSP Standard Benefit is billed. CMSP prescription drug coverage is intended to serve as secondary coverage to a CMSP member’s Other Health Coverage.
Additional information about the CMSP Prescription Drug Benefits is provided through the following links: