As of January 1, 2016, claims for Multi-Ingredient Compounds (MICs) will process according to the Cigna-
HealthSpring Medicare Part D Formularies.
This means that each ingredient within a compound will pay or reject based on the specific ingredient‟s
Formulary status. Part D products with Prior Authorization (PA), including B vs. D and Step Therapy (ST) will
be subject to Formulary rules. Non-Formulary (NF) ingredients will reject as such.
-The pharmacy will have the option to:
- Submit a coverage determination for the rejected ingredients (PA, ST or NF); or
- Resubmit a MIC claim with the rejected ingredients (PA, ST or NF) by submitting a submission
clarification code (SCC) value of „08‟. This means that the non-covered drugs will process at $0
and by submitting the „08‟ that you are accepting payment for this amount as the entire
payment. CMS does not allow pharmacies to charge the beneficiaries any more than their
adjudicated co-payment.
Please download attached PDF file for more information.