Current enrollment period:

• Monday, October 1st, 2007 - Thursday, November 15th, 2007 is the extended physician enrollment period for the CAP program
• Wednesday, Aug. 1st, 2007  - enrolled physician's can begin ordering medication from BioScrip

Previous enrollment periods:

• Saturday, June 3rd, 2006 - Friday, June 30th, 2006 - is the second physician election period
• Tuesday, August 1st, 2006 - physicians who enrolled in the  June 3rd to June 30th election period can begin ordering medication from BioScrip
  

November 15th, 2006

• Sunday, Oct. 1st, 2006 - Wednesday, Nov. 15th, 2006 - is the  physician election period for 2007
• Monday, Jan. 1st, 2007 - physicians who enrolled in the Oct 1st. election period can begin ordering medication from BioScrip
  

The (CAP) Competitive Acquisition Program was established as a result of the Medicare Modernization ACT to competitively acquire Medicare Part B drugs and biologics not paid on a cost or prospective payment system basis.

Those physicians who provide physician services that include the authority to prescribe and order Medicare Part B drugs will be given a choice between buying and billing a drug from the specified CAP drug category under the average sales price (ASP) system, or obtaining these drugs from BioScrip through the CAP program.

BioScrip was selected as a preferred CAP Vendor for the next three years based upon strict selection standards that included: Quality; Financial, Operational & Product integrity, and Price. A physician seeking to use BioScrip will enter a one-year agreement to use BioScrip exclusively as their CAP Vendor of choice.

1. Review the 2008 Physician Election Guide
   
2. Complete the Physician “Election Agreement”.  Medicare physicians will be given the opportunity to elect to participate in CAP, please see the enrollment dates outlined above.  Physicians wishing to participate must elect to do so prior to the end of the enrollment period. Complete the electronic form  provided by CMS "CAP Physician Election Agreement", then download and sign.
   
3. Return the Completed Agreement to the Physician’s Local Insurance Carrier. The participating CAP physician election agreement must be postmarked no later than 5 p.m. on the last day of the election period.  The physician’s Local Insurance Carrier will note the physician’s decision to participate in the CAP, and the approved CAP Vendor and drug category. Carrier contact information which includes toll-free numbers can be found on the CMS website.
   
4. Enrollment Verification. After the enrollment is submitted, the physician's Local Carrier will forward information from the CAP Election Agreement to the CAP Designated Carrier – Noridian Administrative Services. In addition, the Designated Carrier will notify BioScrip of the participating CAP physicians who have selected that approved CAP vendor. The Local Carrier will notify the physician that his/her enrollment has been accepted.
   
5. Claims Processing. After necessary claims processing files are prepared, the Local Carrier and the Designated Carrier will be ready to pay claims by the specified date.

BioScrip offers full pharmacy services and unsurpassed competency and experience in managing specialty pharmacy programs like CAP.

In addition to receiving outstanding drug distribution and administrative services for CAP drugs from BioScrip the physician’s patients benefit from:

• Customer service representatives that are available 24/7, 365 days a year. BioScrip's service representatives have completed structured training in CAP and are versed in operational processes, policies and procedures. In addition, they receive specialized training on all of the disease states we service.
• Pharmacists are available 24/7, 365 days a year for questions on side effects or other issues related to patient therapy.
• Spanish-speaking customer care representatives in addition to multilingual translation services for other languages. Through the AT&T language line, BioScrip uses a third party translator has available for over 140 languages.
• Disability friendly. BioScrip Supports Teletyper or Telecommunication device for Deaf (TTY/TDD), and our mail service facility can provide prescription label bottles in Braille.
• Comprehensive disease knowledge
• Refill reminders
• Free delivery to physician office
• Patient Information and Education

For more information on the “Physician Voluntary Agreement” please contact BioScrip’s CAP specialist toll-free at 1-888-899-7447 or e-mail cap@bioscrip.com.

The new CAP program applies to physician-injectable and infused drugs covered under Medicare’s Supplemental Insurance (Part B) program that are commonly provided incident to a physician’s service. This program does not apply to drugs included in the new Prescription Drug Benefit under Part D, which went into effect January 1, 2006.

See the enclosed list of approved CAP Drugs 2008 (Updated January 2008)

Effective January 1, 2008, Orthovisc (J7324), Tysabri (J2323), and Reclast (J3488) will be available through the CAP.

Effective April 1, 2008, Orencia® (abatacept): J0129, Boniva® (ibandronate): J1740, Ixempra® (ixabepilone): Q4082, Somatuline® (lanreotide): Q4082 will be available through the CAP

All changes to the CAP Vendor’s Drug List require physician approval from CMS or NAS. Consult a BioScrip CAP specialist regarding substitution methods requiring approval.

A physician can begin ordering CAP drugs through BioScrip once they have been notified of acceptance by the physician’s local carrier

To order CAP medications from BioScrip, the physician will go through the following steps:

1. Order submission. The physician will need to complete a BioScrip “Medication Patient Order Form”; these order forms are available at the end of this section.
2. Order verification. Upon receipt of a complete order form, BioScrip will verify the Rx is an approved CAP medication and verify the physician's participant CAP eligibility along with the beneficiary's Medicare eligibility.
3. Processing notification. The physician will be notified via fax, email, secure web or by phone that the order has been received, it is complete, the information has been verified and the Rx is now being processed for fulfillment.
4. Delivery. Once the order is filled and shipped, the Physician will be notified of the tracking number used for shipping. Normal delivery turnaround is two days or, in case of emergencies one day, in all areas of the United States and its territories, with the exception of the Pacific Territories. The physician will also be sent a “How to Bill” document from BioScrip.
5. Receipt and storage.  The physician will need to appropriately store all medications until the time they are administered. In addition, they must keep a separate electronic inventory for each CAP drug obtained.
6. Drug administration. Upon administration of the CAP drug, the physician must provide the patient the CMS developed CAP fact sheet. The physician will also notify BioScrip when drug is not administered or a smaller amount was administered than was originally ordered.

BioScrip Medication Patient Order Forms:
The forms have been updated as of 12/06 to reflect the drug updates that were published on the approved "CAP Drug List".

Allergy / Immunology
Cardiology
Endocrinology
Gastroenterology
General Medicine
Infectious Disease
Neurology
OB-GYN
Oncology
Ophthalmology
Orthopedics
Osteoporosis
Psychiatry
Pulmonology
Rheumatology
Thyrogen
Urology

One of BioScrip’s core services is our knowledge of specialty billing and coordination of benefits. BioScrip tries to ease the often complex billing process on behalf of the physicians and patients we serve. We save office staff and patients’ time and money by providing complete insurance billing services, including verification of Benefits, claims processing, and coordination of benefits.

BioScrip has dedicated teams of Insurance Verification and Billing Specialists able to coordinate benefits from Medicare, Medicaid, commercial insurance plans, and other assistance programs. We participate with all major insurance and drug card programs. BioScrip has more than 250 specialty pharmacy contracts and participates in approximately 1,200 networks. We are a Medicaid provider in 41 states and a Medicare provider in all four DMERC regions.

• BioScrip, upon shipment of the drug(s) to the physician, will bill Noridian the Designated Carrier.
• The physician is required by CMS to submit a claim to their Local Carrier with required documentation for drug administration services within 14-days of administration. Each dose’s unique Rx must be provided to their Local Carrier using the CMS claims forms. The Rx order number will be provided in the shipment from BioScrip.
• The physician will next need to notify BioScrip of claim submission along with actual dosage (not vial information) since only administered drugs, not vials, are billable.
• BioScrip’s Designated Carrier will seek to match the BioScrip claim and the physician claim for administration within the Medicare system. Once the claim has been matched, CMS will proceed with payment.
• BioScrip will notify beneficiaries of any out-of-pocket expenses.
• Payment is received from CMS.

NEW - CAP Physician Billing Tips Published by CMS

For billing assistance and questions please contact BioScrip’s CAP specialist
toll-free at 1-888-899-7447 or e-mail cap@bioscrip.com.

Emergencies
Physicians, based on an unforeseen event and their clinical judgment of the situation, may require use of his/her own drug stock in emergency situations. CAP allows for the use of emergency supplies based on the following criteria:

• The drugs are required immediately
• The physician could not have anticipated the need for the drugs
• BioScrip, the CAP Vendor, could not deliver the drugs in a timely manner
• The drugs needed to be administered in an emergency situation
  

For the most up-to-date information, please visit the CMS website.

The following links resources are also available:

• NEW - Download PDF - 2007 Cap Physician Election Guide
• Download  PDF – Competitive Acquisition Program Cap for Part B Drugs,  MM4064published by the Center for Medicare and Medicaid 
• Download PDF – Additional Requirements for the Competitive Acquisition Program, MM4309 published by the Center for Medicare and Medicaid
• Information for Physicians found on the CMS website will provide up-to-date information regarding the CAP program.
• You may also contact your carrier at their toll free numbers. Carrier contact information can be found on the CMS website. 
• Tips on billing CAP drugs
  

To learn more about BioScrip or for additional information on the CAP program call, as toll-free at 888-899-7447 or e-mail cap@bioscrip.com.