Retail: Reimbursement Solutions Announcements
Aug 31, 2010: Envision Rx Options Los Angeles Rx Prescription Savings Program
As a result of radio advertisements informing Los Angeles residents about the LARX Prescription Savings Program, your pharmacy may be receiving prescriptions from participants that just enrolled in the program. All participant information will be received via text message. The participant will present the text message which will include all member and group information. Download the provided document for more information.
Aug 31, 2010: Envision Rx Options Florida Discount Drug Program
As a result of radio advertisements informing Miami area residents about the Florida Discount Drug Card Program, your pharmacy may be receiving prescriptions from participants that just enrolled in the program. All participant information will be received via text message.
Aug 13, 2010: State of California Department of Corrections Parolee Program Update
As has been widely reported in the media, the state of California continues to experience budget constraints. This notice is to advise that HealthTrans has received communication from the State advising temporary suspension of payments to vendors and therefore will not be issuing pharmacy payments for services rendered to members of the Parolee Program until we have received payment for said services.
Aug 13, 2010: United Healthcare Newsletter
Attached is the first edition of the UnitedHealth Pharmaceutical Solutions (UHPS) periodic e-newsletter. We developed this communication to keep us better in touch with our network pharmacy providers and intend to communicate any programs or network updates through this newsletter. We hope that your pharmacy finds the information valuable and encourage feedback.
Aug 13, 2010: Health New England Update
Effective July 1, 2010, Health New England (HNE) will become a Managed Care Provider of Massachusetts Medicaid (“MassHealth”). HNE will send new identification cards (illustrated below) to members of our MassHealth plans in Hampden, Hampshire, Franklin and Berkshire counties. Please use the HNE ID# to process all pharmacy transactions.
May 19, 2010: Rx America Check Printing Error Information
CVS Caremark checks dated May 12, 2010, may have contained a printing error in the text portion of the check.
May 11, 2010: Molina Healthcare of California Plan Information
To prevent a patient's condition from worsening in an urgent situation, it may be necessary to dispense a medication before a Prior Authorization (PA) may be obtained from Molina Healthcare of California. Molina Healthcare of California will reimburse the pharmacy for medications at contracted rates provided the below policies are followed. These policies will ensure member(s) receive their medication promptly and pharmacies will be reimbursed.
May 11, 2010: Phasing Out of Asthma & COPD Inhalers with Ozone-Depleting CFCs
On April 13, 2010, the Food and Drug Administration (FDA) announced the phase out of seven metered-dose inhalers (MDI) used to treat asthma and chronic obstructive pulmonary disease (COPD). These inhalers contain ozone-depleting chlorofluorocarbons (CFCs), which are propellants that move medication out of the inhaler and into the lungs of patients.
Apr 29, 2010: Caremark Medicare Fraud Alert in California
Caremark and the California Department of Justice (DOJ) have identified a large-scale Medicare Part D prescription fraud scheme in California pharmacies.
Apr 29, 2010: Third Party Network Newsletter – Volume 1 Issue 2
As of May 1, 2010, the Max Pay Edit limit will change to $750 for most drugs. This change will impact all commercial and Medicare members with Aetna Pharmacy Management as their Pharmacy Benefit Manager.
Apr 20, 2010: New York Medicaid Updates
Effective May 1, 2010, New York Medicaid will provide incentives to encourage electronic prescribing (e-prescribing). As described in the New York State fiscal year 2009-2010 Health Budget, eligible Medicaid prescribers can receive an incentive payment of $0.80 per dispensed Medicaid e-prescription, and eligible retail pharmacies can receive $0.20 per dispensed Medicaid e-prescription. The long-term goals of the program are to reduce medication errors, encourage pharmaceutical practices that produce better patient outcomes, and yield savings. The following guidance is intended to assist prescribers and pharmacies to prepare for participation in the program. This program guidance will be updated as necessary to incorporate new Federal rules regarding electronic prescribing.
Mar 29, 2010: Express Scripts/Next Rx Transition Alert
If you are having an issue processing claims through the NextRx system, please be sure to submit the PCN as required by either the member ID card or by the custom payer sheet available at www.wellpointnextrx.com . (Click on Providers, then Pharmacist’s Payer Sheet.)
Mar 29, 2010: Express Scripts Repackaged NDCs Alert
Mar 29, 2010: Caremark Medicare Part D Formulary Updates Effective 6-1-10
CVS Caremark Medicare Part D Services may add or remove drugs from our formulary during the year. If we remove drugs from our formulary, or add prior authorization, quantity limits and/or step therapy restrictions on a drug and/or move a drug at a higher cost-sharing tier, we will notify you of the change before the change becomes effective. However, if the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, in which case we will immediately remove the drug from our formulary.
Mar 25, 2010: Caremark/Molina Healthcare of CA Plan Information
The status of some medications has changed in the 2010 Molina Healthcare of California Drug Formulary. Download the provided document for more information.
Mar 25, 2010: Express Scripts Pennsylvania UPMC Processing Alert
Express Scripts administers the prescription drug benefit for UPMC (University of Pittsburgh Medical Center). Effective April 1, 2010, certain UPMC for You members’ pharmacy coverage will be limited to six (6) prescriptions per calendar month. This benefit limit applies only to members in the General Assistance aid category, representing approximately five (5) percent of all UPMC for You members.
Mar 22, 2010: Navitus Pharmacy News
Mar 18, 2010: Caremark BCBS of Tennessee Update
Mar 15, 2010: Express Scripts Tricare System Downtime
Mar 9, 2010: Mirixa MTM Sign-up Document
Your Pharmacy is Contracted to Complete CCRx MTM 2010 Patient Cases
Mar 9, 2010: Hernandez Settlement Agreement
Please be advised that Express Scripts began administering the pharmacy benefits for certain Florida HMO Medicaid Prescription Plans on December 1, 2009
Mar 9, 2010: Prescription Solutions Pantoprazole Processing
Messaging, identifying the appropriate alternatives for Pantoprazole, will be provided at Point of Service (POS)
Mar 5, 2010: Medicare Part D Formulary Change
The product changes noted in the provided document will be implemented on the Medicare Part D Plan for the designated Express Scripts Medicare Part D clients.
Feb 24, 2010: CalOptima Claims Processing ALERT
Some CalOptima claims rejected with 04, Missing/Invalid Processor Control Number
Feb 12, 2010: Copayment Information for Commercial Members of Health Alliance
Copayment Information for Commercial Members of Health Alliance
Feb 10, 2010: Vaccine Network Informational Update
Specific Caremark and RxAmerica clients are reimbursing pharmacies for the dispensing and/or administration of vaccines
Feb 10, 2010: Medicare Part D Formulary Change
The product changes noted in this document will be implemented on the Medicare Part D Plan for the following Express Scripts Medicare Part D clients:
Jan 12, 2010: RxAmerica Pharmacy Cycle Payment Mailing Date Change
Since 2008, Caremark has consolidated and sent payment for three of its RXBINs (610415, 004336 and 610029) weekly every Wednesday. Effective Wednesday, January 13, 2010, the RxAmerica payment mailing date will also change to every Wednesday.
Jan 12, 2010: Argus INSIDERx January 2010
The January edition of Argus INSIDERx includes the following topics: Gateway Health Plan Vaccine Administration, CareFirst Employee Group Migration, New Priority Health Group, Database Proposed to Monitor Drug Safety, Tamiflu Shortage Update,
Jan 5, 2010: MHA Acquires Pharmacy Reimbursement Management Company
Managed Health Care Associates, Inc. (MHA), the largest Alternate Site Group Purchasing Organization (GPO) in the country, is pleased to announce the acquisition of Net-Rx
Dec 31, 2009: Argus Network Payment Cycles Changes - Reminder
Due to MIPPA - Medicare Improvements for Patients and Provider Act of 2008, Argus will be changing the frequency of payment cycles and the production of 835 files
Dec 30, 2009: Blue Cross Blue Shield of Massachusetts Update
Proton Pump Inhibitor (PPI) Prior Authorization Requirements, effective January 1, 2010
Dec 30, 2009: Golden State Medicare Health Plan and PartnersRx
All Golden State Medicare Health Plan members will have their prescription drug claims processed by Prescription Solutions and PartnersRx Management
Dec 29, 2009: Informed Rx MTM Program Announcement
informedRx invites you to become a participating provider in its new Medication Therapy Management (MTM) program
Dec 29, 2009: Prescription Solutions 2010 Medicare Part D BIN Info
As a reminder, all Medicare Part D claims must be submitted using the BIN/PCN/Group that appears on the member issued ID card
Dec 29, 2009: Prescription Solutions Fidelis Processing
All Fidelis SecureCare members will have their prescription drug claims processed by Prescription Solutions and PartnersRx Management
Dec 29, 2009: Procare Bulletin-Medicare Transition Process
CY2010 Medicare Part D Transition Process General Transition Process Requirement
Dec 29, 2009: Express Scripts Acquires NextRx
The acquisition of WellPoint’s NextRx pharmacy benefit management (PBM) subsidiary by Express Scripts closed on December 1, 2009
Dec 29, 2009: Prescription Solutions Local 29 New York
Effective January 1, 2010 Prescription Solutions will assume responsibility for claims processing for members of Blasters, Drillrunners & Miners Union Local 29
Dec 29, 2009: Navitus Credentialing for 2010
Navitus will start the credentialing process earlier in 2010
Dec 28, 2009: Caremark Amerigroup Updates
Effective January 1, 2010, AMERIGROUP Amerivantage pharmacy services will continue being administered by Caremark
Dec 28, 2009: Caremark Citizens Choice Updates
Effective January 1, 2010, Citizens Choice Healthplan HMO will begin utilizing the claim processing system that is assigned Bank Identification Number
Dec 28, 2009: Caremark Molina Notice Florida
Molina is implementing a Medicare prescription drug option in Florida on January 1, 2010
Dec 28, 2009: Health Net Part D Updates
This update contains important information for Retail, I/T/U and Home Infusion pharmacies about Health Net’s Medicare Part D plans and the Temporary Supply Override Code effective January 1, 2010
Dec 24, 2009: Express Scripts Phoenix Health Plan Vaccine Update
Phoenix Health Plan has opted not to have their members receive influenza vaccines
Dec 23, 2009: Bristol-Myers Squibb Co-Pay Benefit Program
Bristol Myers Squibb is extending the Co-Pay Benefit Program through December 31, 2010
Dec 23, 2009: 2010 LTC Medicare Part D Transition Policy &Temporary Supply Override Codes
This update contains important information for Long Term Care (LTC) pharmacies about Health Net’s Medicare Part D plans and the Temporary Supply Override Codes effective January 1, 2010
Dec 23, 2009: BCBSRI Medicare Part D Plan
Effective January 1, 2010, Caremark will begin administering the Medicare Part D drug benefit programs for Blue Cross & Blue Shield of Rhode Island (BCBSRI)
Dec 23, 2009: BCBSRI New Implementation and Electronic Coordination of Benefits (COB)
Effective January 1, 2010, Caremark will begin administering the commercial drug benefit program for Blue Cross & Blue Shield of Rhode Island (BCBSRI)
Dec 23, 2009: BCBSM Processing Alert
Effective January 1, 2010, Blue Cross Blue Shield of Massachusetts (BCBSMA) will add a significant number of new lives to their existing prescription drug program, administered by Express Scripts
Dec 23, 2009: Caremark Pharmacy Notice Florida Molina
Molina is implementing a Medicare prescription drug option in Florida on January 1, 2010
Dec 23, 2009: Horizon Blue Cross Blue Shield of New Jersey Formulary Changes
Beginning January 1, 2010, Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) will introduce new edits
Dec 23, 2009: Express Scripts Update on UCare Plan
Effective January 1, 2010, Express Scripts will administer the prescription benefit for UCare
Dec 23, 2009: Harvard Pilgrim Health Care
On July 31, 2009, MedImpact Healthcare Systems, Inc. released a communication for the purpose of soliciting a new “90-Day at Retail” network product
Dec 22, 2009: H. D. Smith Comments on the Non-Matched NDC List
H. D. Smith addresses impact of the Non-Matched NDC list on pharmacists
Dec 16, 2009: Non-Match NDC Rejections
Non-Match NDC Rejections
Dec 1, 2009: Express Scripts Acquisition of NextRx
Express Scripts Acquisition of NextRx is complete
Nov 24, 2009: Molina CA Plan Information
Nov 20, 2009: Express Scripts Acquiring NextRx
Nov 13, 2009: Medicare Part D NDC Code Update
Oct 26, 2009: Caremark Total Choice of Florida Plan Information
Oct 23, 2009: American Health Care Provider Notice
Oct 23, 2009: Caremark National League of Cities New Implementations
Oct 20, 2009: Argus: Health Partners of Philadelphia