P4P Program Eligibility Criteria

P4P Program Eligibility Criteria

• Must be a Contracted IEHP (via IEHP contracted PBM) Community Pharmacy Provider
• IEHP Pharmacy Provider in good standing (free of outstanding fraud, waste and abuse investigation)
• Store location within San Bernardino and Riverside Counties
• Annual IEHP Rx Volume over 1,000 (500/6 months)
• Pharmacy must be in business during the entire evaluation period
• Base criteria on number of members qualifying for majority of clinical measures (require at least 10 members qualifying for 4 out of 7 clinical measures) (NEW for 2015 - 2016)

Performance Level Evaluation

• Based on the final prescription volume, create a volume-based P4P dollar per claim. Pharmacies with higher volume will get proportional increase for P4P payments
• 50% for meeting the benchmark score and equally divided by measurements or composite score (P4P Benchmark Payment)
• 50% for meeting the target (target to be determined by the workgroup) and equally divided by measurements or composite score (P4P Bonus Payment)
• Payout Schedule - Bi-annually
• Top 10 Pharmacies based on the Composite Score will be named "IEHP Pharmacy Provider of the Year"
• In addition to posting the "Top IEHP Pharmacy Provider of the Year", IEHP will also display Top Pharmacies in each category monthly

Outcome-Based MTM Pharmacy Network

Tentative Start Date:  January 2016

Criteria:

• High Performing Pharmacy only- 4 and 5 Stars- # Pharmacies based on final 2014-2015 P4P Score (October 2015)
• MTM Pharmacy Network Status will be re-qualified every year
• Pharmacy moving to 4 or 5 Stars in mid-year may be allowed to join the network
• Recommended:  CPPA Center For Pharmacy Practice Accreditation
• More info to follow during 4Q2015

Contracting Requirements

Agreement with IEHP:

• Agreement for payment and program use only. All eligible pharmacies will receive a notification from IEHP. Pharmacy who wishes to participate must submit the Pharmacy credentialing information to IEHP. If you feel your pharmacy is eligible but has not received any notification from us, please email us at PharmacyP4P@iehp.org. If you are a new pharmacy in our area, please notify IEHP immediately.

Agreement with Pharmacy Quality Solutions (PQS):

• After receiving a confirmation from IEHP, you will be provided with login information for the EQuIPP website. Create an account and review the terms and conditions when using EQuIPP
• By acknowledging the terms and conditions in EQuIPP, your agreement with PQS is executed

Please visit here for Frequently Asked Questions (FAQ).