RxBenefits and PBM Partners’ Response to COVID-19
Friday, August 21, 2020
Member reimbursements, appeal filing edit deadlines extended 180 days
On May 4, the U.S. Department of Labor (DOL) and the Internal Revenue Service (IRS) published new guidance that requires extensions on certain claim and appeal filing deadlines to allow additional time to make critical health coverage and other decisions affecting benefits during the COVID-19 pandemic. These extensions allow members additional time to file manual/paper claims and exercise their rights to appeal benefit and utilization review determinations.
- The DOL rule “Extension of Certain Timeframes for Employee Benefit Plans, Participants, and Beneficiaries Affected by the COVID-19 Outbreak” requires all benefit plans subject to ERISA or the Internal Revenue Code to disregard claimant claim and appeal filing deadlines under existing ERISA and Internal Revenue regulation for the duration of the “Outbreak Period.”
- The Outbreak Period began on March 1, 2020. It ends 60 days after the end of the COVID-19 national emergency, a date which has not yet been determined but will be announced later. This timeframe may end on different dates in different parts of the country, in which case additional guidance will be provided.
- The timeframe in which members may file a benefit claim under the plan’s claims procedure must be waived during the COVID-19 outbreak period.
- The timeframe in which members may file an appeal of an adverse benefit determination/denial must be waived during the COVID-19 outbreak period.
- The timeframe in which members may file a request for an external review after receipt of an adverse benefit determination or final internal adverse benefit determination is waived.
RxBenefits and the PBMs will be in compliance with the rule.
Wednesday, March 18, 2020
The world is grappling with an issue of enormous scale and human impact, and our hearts go out to all who have been or will be affected by the outbreak of coronavirus (COVID-19).
As your partner in health, we believe our role and responsibility is to prioritize three things:
- The health and well-being of our associates, partners, and clients,
- The provision of essential pharmacy benefit services, and
- Finally, playing a constructive role in supporting government officials and local communities as they endeavor to contain the virus and minimize the impact to the healthcare system.
We are committed to keeping you, our consulting partners, clients, and members, aware of all news related to the coronavirus (COVID-19). This is a rapidly evolving situation which we continue to monitor closely. As new information unfolds, we will keep you informed on any new details that impact your pharmacy benefits plan.
We are actively engaged with all of our PBM partners, and will continue to update you as new information is made available. If we have any news that is deemed urgent, we will email all clients with the information specific to their PBM choice. We will be making real-time updates as they come in throughout the day.
Together, we can help flatten the curve and slow the spread of the coronavirus (COVID-19).